Nursing Fundamentals: Hygiene and Nutrition

Skin Integrity and Care

The skin serves as a vital protective barrier against heat, injury, and infection, while also assisting in secretion, excretion, and temperature regulation. Because the skin is so central to health, nurses must be vigilant in assessing for common problems such as dryness, acne, rashes, psoriasis, and abrasions.

Risk Factors for Impairment

Skin integrity can be compromised by several factors:

• Immobilization: Lack of movement increases pressure on skin surfaces.
• Reduced Sensation: Patients may not feel injury or irritation.
• Vascular Insufficiency: Poor blood flow hinders skin health.
• Nutrition and Hydration: Alterations in these areas weaken the skin's resilience.
• External Factors: The use of medical devices and the presence of secretions/excretions on the skin.

Oral, Hair, and Denture Care

Oral Hygiene

Daily oral care is essential to prevent plaque-associated diseases and promote nutrition and verbal communication.

• Conscious Patients: Should be encouraged to brush at a 45-degree angle to the gum line, including the inner and outer surfaces and the biting surfaces.
• Unconscious or Debilitated Patients: These patients face a high risk of aspiration (the misdirection of fluids/secretions into the respiratory tract).

Safety Alert: Unconscious Oral Care For unconscious patients, it is safest to have two nurses perform care: one to provide the oral care and one to provide continuous suctioning of secretions.

Denture and Hair Care

When cleaning dentures, use tepid water. Avoid hot water, which can cause warping, and avoid cold water, which can cause cracking. Hair care frequency is largely dictated by the patient's personal routine and hair condition; nurses may use traditional soap and water or disposable dry shampoo caps.

Nutrition and Feeding

Nutrition provides the energy necessary for healing, though it can be heavily impacted by illness, medications, or treatments.

Aspiration Precautions

To prevent aspiration during feeding, follow these positioning rules:

1. Place the patient in High Fowler’s position with the chin in a down position.
2. After the meal, keep the head of the bed (HOB) elevated at $45^{\circ}$ for 30–60 minutes.

International Dysphagia Diet Levels

Patients with swallowing difficulties (dysphagia) require specific food consistencies:

Monitoring Intake and Output (I&O)

Monitoring I&O is a critical component of assessing a patient's fluid and electrolyte balance. This is especially vital for patients with fever, edema, those receiving IV fluids, or those on diuretic therapy.

Accuracy is paramount. When recording measurements, use the following conversions and rules:

• 1 ounce = 30 mL
• Ice Chips: Record as 50% of their total volume.
• Critical Threshold: In adults, report any output that is less than 30 mL/hr to the healthcare provider immediately.

Exam Tip: Calculating Ice Volume If a patient consumes a cup containing 200 mL of ice chips, the recorded intake is: $200 \text{ mL} \times 0.50 = 100 \text{ mL}$ Always remember to account for the volume reduction when ice melts.