Nursing Interventions

Hygiene:
Skin largest organ in the body
Trends in healthcare:
Bath ingredients packaged to decrease dry skin, to use instead of tub baths, to use instead of basins
Oral care to decrease colonization of bacteria in oropharynx associated with pneumonia, cardiovascular disease

Culturally:
Maintain privacy especially women
Uncovering arms and lower torso taboo
Allow family to participate
Gender congruent care for Hindus, Orthodox Jewish, Muslim, Amish
Asians believe top part of body cleaner than lower parts
Among Hindu do not show aversion when washing an elders feet
Hindus and Muslims left hand cleans, right eats and prays

Bath is therapeutic
Removes sweat, dirt, oil, microorganisms
Stimulates circulation
Promotes relaxation

Caution:
Maintain privacy
Avoid hot water and friction (diabetic neuropathy)
Minimize exposure to low humidity and cold
Opportunity to assess skin integrity
ROM
Cleansing versus therapeutic (sitz, medicated, Aveeno)


Bathing a patient



Nutritional Considerations:
Many factors can affect nutrition:
Age, decreased taste, smell, dentition, lack of resources, ability, strength
Disease, nausea, vomiting,
Increased nutritional needs due to surgery
Eating poorly, decreased appetite
Tooth loss
Economic hardship
Reduced social contact
Multiple medicines
Involuntary weight loss/gain
Needs assistance with self-care
Elder years above age 80
Inappropriate use of dietary supplements
Bowel changes and inappropriate use of bowel cleansers

Complications of malnutrition:
Increased hospital stay
Compromised immune system
Delayed healing
Increased complications
Increased mortality
Dysphagia

Reasons for assistance needs:
Hemiplegia
Fractured arm
Weakness
IV catheter, tubes, dressings
Vision loss (plate / clock)

Tools and labs to use to assess nutritional status
Weight, BMI (edema, ascites)
Serum albumin, prealbumin, serum protein indicate liver or kidney dysfunction

Dysphagia
Signs & Symptoms
– wet voice, prolonged swallow, coughing or choking on food, frequent clearing of the throat, drooling, pocketing

Causes –
Neurogenic - stroke, cerebral palsy, ms, Parkinson’s ,
Myogenic – fatigue, Myasthenia gravis, aging, muscular dystrophy, polymyositis
Nurses and RD initial screen then screening conducted by a speech pathologist

Dysphagia diet classification:
Regular – all foods
Dysphagia advanced - regular foods except hard crunchy, sticky foods
Dysphagia mechanically altered
Dysphagia puree
Positioning important!
4 levels of liquid consistency:
Thin liquids – low viscosity
Nectar like – medium
Honey like –
Spoon thick – pudding consistency

Cultural:
Hot / Cold
Kosher


Feeding the hospitalized patient



Vital signs














References:
Potter, P. A., & Perry, A. G. (2009). Fundamentals of Nursing (7th ed.). St. Louis, Missouri: Mosby Elsevier.

Giving a bedbath
http://youtu.be/hYXYcOHT6aE

Feeding a patient
http://youtu.be/TFhbmeS3FZc

Vital signs
http://youtu.be/mmSOum2gxxg