COMFORT NEEDS
By: Jeremiah B. Eco, RN
HYGIENE
Science of health and its maintenance
Factors: Culture Religion Environment Developmental Level Health and Energy Personal Preference
SKIN
Largest organ in the body FUNCTIONS: First line of defense Maintains body temperature Secretory organ – sebum Sensory organ – nerve receptors Produces and absorbs Vit. D
Two Types of Sweat Glands
APOCRINE Primarily located in the axilla and anogenital areas Functions begin in puberty Secretion is odorless but may become musky/unpleasant ECCRINE Found in palms of the hand, soles of feet and forehead Produces sweat (water, sodium, potassium, chloride, glucose, urea and lactate)
COMMON PROBLEMS OF THE SKIN (and nursing interventions)
ABRASION Scraped/rubbed away superficial layer of skin EXCESSIVE DRYNESS Scaly and rough skin ACNE Inflammatory condition of the skin which occurs in and around sebaceous glands Characterized by papules pustules and comedones
Folliculitis
COMMON PROBLEMS OF THE SKIN (and nursing interventions)
ERYTHEMA Redness of the skin may be associated with rashes, exposure to sun, elevated body temp.
COMMON PROBLEMS OF THE SKIN (and nursing interventions)
HIRSUTISM Excessive growth of the hair among women
COMMON PROBLEMS OF THE SKIN (and nursing interventions)
HYPERHIDROSIS BROMHIDROSIS VITILIGO Patches of hypopigmented skin caused by destruction of melanocytes in the area
Appearance of Lesion
Macule: flat; nonpalpable; circumscribed; less than 1 cm in diameter; brown, red, purple, white, or tan
Example: flat moles, rubella, rubeola, freckles
Papule: elevated; palpable; firm; circumscribed; less than 1 cm in diameter; brown, red, pink, tan or bluish red
Example: warts, drug-related eruptions, pigmented nevi, eczema
Pustule: elevated; superficial; filled with purulent fluid
Example: impetigo, acne, variola, herpes zoster
Vesicle: elevated ; circumscribed; superficial; filled with serous fluid; less than 1 cm in diameter Example: blister, varicella
Wheal: elevated; irregular-shaped area of cutaneous edema; solid, transient, changing; variable diameter; pale pink
Example: urticaria, insect bites
Plaque: elevated; flat topped; firm; rough; superficial papule greater than 1 cm in diameter Example: seborrheic and actinic keratoses, psoriasis, eczema
Nodule: elevated; firm; circumscribed; palpable; deeper in dermis than papule; 1 to 2 cm in diameter Example: erythema nodosum, lipomas
TYPES OF SKIN LESION
SECONDARY SKIN LESIONS SCALE Thickened epidermal cells that take off CRUST Dried serum or pus on the skin FISSURE A deep linear crack EROSION Loss of all or part of the epidermis, appears moist demarcated depressed area EXCORIATION Superficial linear or hollowed out crushed area exposing dermis
Scale: flaky exfoliation; irregular; thick or thin; dry or oily; varied size
Example: psoriasis, exfoliative dermatitis
crust: dried serum, blood, or purulent exudates; slightly elevated; size varies
Example: scab on abrasion, eczema, impetigo
Secondary Skin Lesions
ATROPHY Decrease in volume of epidermis SCAR Formation of connective tissue ULCER Excavation extending into the dermis or below
Secondary Skin Lesions
LICHENIFICATION Epidermal thickening resulting in elevated plaque with accentuated skin markings
General Guidelines for Skin Care
An intact, healthy skin is the body’s first line of defense. The degree to which the skin protects the underlying tissues from injury depends o the amount of subcutaneous tissue and dryness of the skin. Moisture in contact with the skin can result in increased bacterial growth and irritation.
General Guidelines for Skin Care
Body odors are caused by resident skin bacteria acting on the body secretions. Cleanliness is best deodorant. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health Agents used for skin have selective actions and purposes.
Methods of Bathing
Tub bath Stand-up shower Sit-down shower Bed bath
BED BATH
PURPOSES To remove microorganisms, body secretions and excretion and dead skin cells To improve circulation To promote relaxation and comfort To prevent and eliminate body odors and promote self-esteem To promote sense of well-being To assess the client’s skin and body parts To provide activity and exercise
BED BATH
SALIENT POINTS Privacy Temperature Warm water Sequence in bed bath
BED BATH
Special Nursing Considerations Cleansing of eyes Soap in cleaning the face? Stroke in washing body parts
BACK RUB
Effleurage Tapotement Petrissage/kneading
PERINEAL-GENITAL CARE
PURPOSES To remove normal perineal secretions and odor To prevent infection To promote comfort
PERINEAL-GENITAL CARE
SALIENT POINTS Privacy, informing of client Positioning Procedure FEMALE MALE
FOOT CARE
Wash feet daily, paying attention to interdigital spaces Use warm water for soaking
FOOT CARE
Wash feet daily, paying attention to interdigital spaces Use warm water for soaking (except for DM patients) Use of lotion/cream Use of deodorant sprays/foot powder File toenails straight across
Change socks/stockings daily Use of well-fitted pair of shoes Do not do barefoot Exercise of feet Avoid crossing the legs Avoid self-treatment for corns and calluses
Common Foot Problems
CALLUS Painless, flat, thickened epidermis CORN Keratosis caused by friction and pressure from the shoe. Circular and raised
Common Foot Problems
UNPLEASANT ODORS PLANTAR WARTS Papova-virus hominis
Common Foot Problems
TINEA PEDIS Scaling and cracking of the skin, between the toes INGROWN TOENAIL (unguis incarnatu) FISSURES Dryness and cracking of the skin
NAIL CARE
Trim nails straight across File nails Do not trim at the lateral corners DM nail care
NAIL CARE
Onycholysis – separation of nail from nailbed Paronychia – inflammation of the skin fold at the nail margin
MOUTH CARE
MEASURES TO PREVENT TOOTH DECAY Brush q pc and hs Floss Intake of Ca, F, Vit. A,C,D Avoid sweet foods and drinks between meals Eat coarse and fibrous foods Dental check-up q 6 months Topical fluoride applications
ORAL CARE
SALIENT POINTS Positioning Towel under chin Soft bristle Strokes for upper and lower front teeth, biting surfaces, gingival margins Rinse and floss
Common Problems of the Mouth
TARTAR Visible, hard deposit of plaque and bacteria HALITOSIS GLOSSITIS GINGIVITIS STOMATITIS PAROTITIS
Common Problems of the Mouth
SORDES Accumulation of foul matter on the gums and teeth CHEILOSIS DENTAL CARIES
HAIR CARE/SHAMPOO
PURPOSES Stimulate circulation Clean the hair and improve well-being SALIENT POINTS Position Remove pins, etc. Comb thoroughly first Materials and set-up Patient care Application of shampoo Rinse thoroughly!
Common Hair Problems
DANDRUFF ALOPECIA PEDICULOSIS Capitis Corporis Pubis SCABIES HIRSUTISM
Peduculosis
Gray blue macules- reaction of the insect’s saliva with bilirubin
SCABIES
EYE CARE
SALIENT POINTS Inner to outer canthus For comatose patients – cover with sterile moist compresses Care of eyeglasses, contact lenses, artificial eyes Health teaching Avoid regular use of eyedrops Emergency treatment
EAR CARE
SALIENT POINTS Cerumen Ear irrigation
NOSE CARE
SALIENT POINTS Blowing of nose Proper cleaning
Care of Environment: BED MAKING
TYPES OF BED Closed bed Open bed Post-op bed Occupied bed
BED MAKING
SALIENT POINTS Body mechanics Strip one linen at a time Finish on one side at a time Avoid fanning of soiled linen Discard of linen Keep soiled linen away from uniform Application of bed sheets Mitering
HEAT AND COLD THERAPY
HEAT Vasodilation Increases capillary permeability Increases cellular metabolism Relaxes muscles COLD Vasoconstriction Decreases capillary permeability Decreases cellular metabolism Relaxes muscle by decreasing muscle contractility Slows bacterial growth, decreases inflammation
Increases inflammation; increases blood flow to an area, bringing phagocytes
HEAT AND COLD THERAPY
HEAT Decreases pain by relaxing muscles COLD Decreases pain by numbing the area, slowing the flow of pain impulses, and by increasing the pain threshold Local anesthetic effect Decreases bleeding
Sedative effect Reduces joint stiffness by decreasing viscosity of synovial fluids
GENERAL GUIDELINES
Determine if the agency requires the client to sign a consent form Determine client’s ability to tolerate the therapy Identify conditions that might contraindicate treatment Explain the procedure to client Assess skin area Ask client to report any discomfort
GENERAL GUIDELINES
Return to the client 15 minutes after starting the heat/cold and observe the skin Apply therapy for the time required. To prevent REBOUND PHENOMENON Remove the equipment at the designated time Examine the area and record client’s response
Application of Heat and Cold Therapy
DRY HEAT/COLD Hot water bag Aquathermia pad Hot and Cold packs Electric pads Heat cradle Heat lamp Ice bag/glove/collar HYPERTHERMIA AND HYPOTHERMIA BLANKETS MOIST HEAT/COLD Compresses Packs Soak Sitz bath Cooling sponge bath
Principles
Cold application is generally safer than heat application. Heat application usually requires a doctor’s order Cold application is done within 72 hours after an injury, while heat application is done after 72 hours.