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| Science of health; care of the skin, hair, hands, feet, eyes, ears, nose |
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| Disease producing microorganisms |
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| Clean the skin, promote comfort, stimulate cirulation, remove waste |
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| Use warm water, mild soap |
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| Prevention of gingivitis and peridontitis |
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| Improve morale and self-image |
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| Shaving is contraindicated with |
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| Diabetes, peripheral vascular disease, chemotherapy, high doses of ASA, immuno compromised, electric razor for depressed or disoriented |
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| Help prevent spread of infection, clippers, emery board (Diabetics-nails will not be trimmed with clippers |
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| Soak feet for comfort, assess circulation |
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| Use different portion of washcloth, clean from inner to outer |
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| No object, including cottong tipped applicators, assess hearing aid if worn |
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| Personal Preference of Bathing |
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| Soaps, shampoos, deodorant |
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| Bed or chair confinment, inability to move, incontinence, poor nutrition |
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| Factors of Pressure Ulcers |
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| Low LOC, dehydration, obesity, sweating, age, edema |
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| Non blancheable redness, heralding lesion of skin ulceration occurs |
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| Partial thickness skin loss (epidermis, dermis) Looks like abrasion, blister, area around skin may feel warmer |
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| Full thickness skin loss, deep crater, extend to fascia, subcutaneous tissue is damaged, damage to surrounding tissue |
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| Full tissue skin loss, extensive destruction, necrosis, damage to muscle, bone, or supporting structures |
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| Surgical asepsis, appropriate dressing, debridement, allergies, proper irrigation, wet-to-damp dressing |
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| Nursing Interventions for Prevention |
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| Skin observation, change position, heels off bed, avoid position on trochanter, pressure reduce devices, move in chair, avoid burns, good techniques, adequate nutrition and fluid |
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| Early mornin, A.M or morning care, afternoon care, hour-of-sleep care, linens |
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| Provide help to the bathroom, bedside commode, wash face and hands, clean and clear the over bed table |
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| Offer bedpan or urinal, oral care, partial bed bath, care of the nails, dress |
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| Care after testing, oral care |
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| Bedpan, wash hands and face, oral care, nightclothes |
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