Download Patient Care: Oral, Nail, Hair, and Skin

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Patient Care: Oral, Nail,
Hair, and Skin
Jamie Roney, MSN, BSHCM, RN-BC, CCRN
Sepsis Coordinator
Covenant Health System
Lubbock, Texas
Nurse Aide/Nurse Assistant I 41615
Oral Hygiene
Purpose of Oral Hygiene
 Cleanliness of mouth and teeth
 Prevent mouth odor and infection
 Prevent dental disease and tooth loss
 Comfort
 Pleasant taste
 Improve taste of food
When to Perform Oral Hygiene
 Upon awakening
 After each meal
 Bedtime
 If not eating, perform oral care at least every
2-4 hours
 Brush the teeth at least twice a day
 Be sure and provide moisturizer to inside
and outside of the mouth
Special Circumstances
 Unconscious – side-lying to prevent choking
and aspiration
 Mouth breather
 Oxygen
 Nasogastric tube/intubated
 Unable to perform own oral care
Standard Precautions with Oral
Hygiene
 Contact with mucous membranes
 Gums may bleed
 Pathogens exist in mouth on gums and teeth
 Use appropriate oral care products
Examine Oral Cavity
 Dry, cracked, swollen, blistered lips
 Redness, swelling, sores, white patches in
mouth or on tongue
 Redness, swelling, or bleeding of gums
 Observed damage to dentures
 Loose, broken, or chipped teeth
 Patient complaints
Dentures
 Use standard precautions for same
reasons as
oral hygiene
 To break suction from dentures, push down gently
over upper rim of denture
 Put towel or washcloth in sink and fill with 2-3
inches of water to protect dentures from breaking
 Dentures should be stored in denture cup, clearly
labeled with name, with cool water covering them
Nail Care
 Done to prevent infection, injury, and odors
 Easier to clean after soaking in warm, soapy water
 Cut nails with clippers, not scissors, and prevent
tissue damage; only with a doctor’s order
 Don’t trim diabetic patient’s nails
 NEVER trim toenails
 Report any redness or tenderness of fingertips,
cuticles, or toes to licensed nurse
Hair Care
 Important for identity and self-esteem
 Should be in style chosen by patient
 Medicinal shampoo
– verify order and review procedure for
application
– standard precautions
Hair Care
 Observations
– scalp sores and flaking
– lice
– patches of hair loss
– very dry or oily hair
– how procedure was tolerated
Shaving
 Important for comfort and self-esteem
 Never share blades between patients
 Electric versus safety razors
 Only trim or clip hair with electric clippers
prior to surgery
Shaving
 Safety razors can cause nicks or cuts
– apply shaving cream to soften beard
– pull skin taut, shave gently, using short and even
strokes in direction of hair growth
– rinse razor frequently
– lather neck and shave upward
– use with caution on a patient who is on
anticoagulants or has bleeding problems
– dispose of in sharps container
Shaving
 Electric razors
– check equipment
– shave in direction of hair growth for underarms
– shave upward from ankle with legs
– wash shaved area and dry gently
– apply aftershave lotion
Maintain Healthy Skin
 Encourage well-balanced diet and fluids
 Skin care
– bathe, rinse off soap thoroughly
– apply lotion as necessary and massage skin
– keep skin clean and dry
 Observe high-risk patients for potential
problems
Maintain Healthy Skin
 Pay close attention to bony prominences
– turn and position correctly
– keep pressure off of red or irritated areas
 Keep bed free from objects and WRINKLES
 Prevent friction
and shearing
Risk Factors for Skin Breakdown
 Mobility/sensory problems
– paraplegic or quadriplegic
– CVA (cerebrovascular accident)
– peripheral vascular disease
– bed rest or decreased mobility
– COPD (chronic obstructive pulmonary disease)
– decreased sensation
Risk Factors for Skin Breakdown
 Elimination
– incontinence
– diarrhea
– diaphoresis
– dehydration
– leaking tubes or drainage
Risk Factors for Skin Breakdown
 Fluid status
– edema
– dehydration
 Nutritional
status/body build
– obese or thin
– poor appetite
– nutritional lab values low
– poor fluid balance
Risk Factors for Skin Breakdown
 Predisposing factors
– circulatory problems
– COPD
• low oxygen level
• Fowler’s position
• medications
Risk Factors for Skin Breakdown
 Predisposing factors
– diabetes
• arterial disease and neuropathy
• poor circulation and healing
– medications (prednisone)
– cancer, anemia
– splints, casts, prosthetic devices
– age
Conditions Leading to Decubitus
 Pressure leads to decreased blood flow and
nutrition resulting in tissue loss
 Excessively wet or dry skin
 Moving patient, causing shearing
Patient Care: Oral, Nail, Hair, and Skin
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Nurse Aide/Nurse Assistant I 41615
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