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Mrs Moohan is frail, malnourished and pyrexial. The writer will describe the nursing care that should be carried out to meet Mrs Moohan’s hygiene needs.
The nurse should initially discuss with Mrs Moohan her usual hygiene routine to assess her ability to meet her own hygiene needs. The nurse may at this time endeavour to ascertain Mrs Moohan’s preference to a bath or shower or if she has any religious beliefs which may affect her choice. The nurse may recommend a therapeutic bath of 37ºC as this would not only clean the patient but also could reduce her temperature.
Before commencing the bath Mrs Moohan would be offered the opportunity have a cool drink as she is at risk of becoming dehydrated due sweating. Mrs Moohan may wish to use the toilet before having her bath, as she is likely to have a larger fluid intake due to thirst caused by hyperthermia, making her micturate more frequently.
The nurse would ensure Mrs Moohan’s privacy is maintained by keeping the door closed when undressing and bathing. The environmental temperature should be warm, because shivering will cause a chill, which raises the patient’s temperature higher. When wet the skin can loose more heat through convection (Potter and Perry 2001). The bath should be cleaned before use to prevent cross infection.
As Mrs Moohan is frail she will require nursing assistance throughout (Chandler 1991). If the nurse has to leave her momentarily a call bell should be placed within easy reach.
She may need the aid of a hoist or bath chair if she has difficulty getting into the bath. Mrs Moohan would be encouraged to do as much for herself as she is able as this promotes her self-esteem (Roper et al 1996). The Nurse should talk to her patient to find out whether she uses soap, bubble bath and if she would like her hair washed. When bathing Mrs Moohan the nurse has good opportunity to assess her skin condition, as she may be more at risk from developing pressure sores due to poor nutrition (Brunner and Suddarth 1991).
The nurse should ensure that all the equipment required is close at hand before starting.
Certain areas may need special attention. The nurse should take great care when washing Mrs Moohan’s hair, as it may be very thin and brittle due to her poor nutritional status (Potter and Perry 2001). Her eyes should be cleaned with plain water and a clean cloth, if any discharge is present each eye should be cleansed using disposable swabs. Her ears should not be cleaned with cotton buds as they can damage the inner ear. Ensure glasses are clean and hearing aids switched on if worn. Nails should be washed thoroughly to ensure all dirt is removed to prevent growth of microorganisms that cause infection. If the toenails need to be clipped this should be done by a chiropodist and not the nurse (Burton 2001).
Mrs Moohan will need to have her perineal area washed carefully as she is at greater risk from pressure sores due to malnutrition and reduced mobility caused by her frailty. Because she is febrile she is sweating and passing urine more than usual, this can cause a greater risk of infection or become odorous.
When getting dried Mrs Moohan should sit down, as she may be exhausted after her bath but should still be encouraged to participate as much as she is able. Deodorant and talc should be available if used and assistance offered applying them. The nurse encourages Mrs Moohan to dress in her own choice of clothing, recommending loose, cotton clothing to help reduce her temperature. Mrs Moohan’s hair should be brushed or combed and dried in a style that she likes.
The nurse should assist Mrs Moohan to clean dentures or brush her teeth if she is unable to herself. Her mouth could be very dry as she has a potential problem of dehydration so mouthwash should be offered. Ensure that Mrs Moohan’s dentures are well fitting if she wears them, as this could be a cause of malnutrition (Mallik 1998) this could also be true if she has dental caries or periodontal disease.
The nurse should educate Mrs Moohan about the need to eat a light diet to fight the fever and also to improve her nutritional status and give her more strength, as poor nutrition increases the risk of infection (Watson and Royle 1987).
The nurse should record the procedure and any changes in Mrs Moohan’s care plan (Heath and Taylor 2002).