SKIN CARE AND

GENERAL HYGIENE

PREPARED BY :CADANG,HANNA B
 MAINTAINING HEALTHY SKIN
Maintaining an IV line, removing a dressing, positioning a child in bed, changing a
diaper, using electrodes, and using restraints all have the potential to contribute to skin
injury.
APPLYING EVIDENCE TO PRACTICE
Skin Care
• Keep skin free of excess moisture (e.g., urine or fecal incontinence, wound drainage,
excessive perspiration).
• Cleanse skin with mild nonalkaline soap or soap-free cleaning agents for routine bathing.
• Provide daily cleansing of eyes, oral and diaper or perineal areas, and any areas of skin
breakdown.
• Apply non-alcohol-based moisturizing agents after cleansing to retain moisture and
rehydrate skin.
• Use minimum amount of tape and adhesives. On very sensitive skin, use a protective,
pectin-based or hydrocolloid skin barrier between skin and tape or adhesives.
• Place pectin-based or hydrocolloid skin barriers directly over excoriated skin. Leave
barrier undisturbed until it begins to peel off or for 5 to 7 days.
• Alternate electrode and probe placement sites and thoroughly assess underlying skin
typically every 8 to 24 hours.
• Eliminate pressure secondary to medical devices such as tracheostomy tubes,
wheelchairs, braces, and gastrostomy tubes.
• Be certain fingers or toes are visible whenever extremity is used for intra- venous (IV) or
arterial line.
Reactive hyperemia, or flush-is the earliest sign of tissue compromise and pressure-
related ischemia.
Pressure ulcers are staged to classify the amount of tissue damage that has occurred.*
Necrotic tissue must be removed so the tissue depth can accur

Interventions found to prevent pressure ulcers in critically ill children include the
following:

• Turning children every two hours

• Using pillows, blanket rolls, and positioning devices
• Using draw sheets to minimize shear
• Using pressure reduction surfaces (e.g., foam overlays, gel
pads, specialty beds)
• Allowing moisture reduction through the use of dry-weave
diapers and disposable underpads
• Using skin moisturizers
• Conducting nutrition consults

Friction occurs when the surface of the skin rubs against another surface, such as bed
sheets. The skin may have the appearance of an abrasion.The skin damage is usually
limited to the epidermal and upper layers. It most often occurs over the elbows, heels, or
occiput. Prevention of friction injury includes the use of cus- tomized splinting over infants’
heels; gel pillows under the heads of infants and toddlers; moisturizing agents;
transparent dressings over susceptible areas; and soft, smooth bed linens and clothing
Shear is the result of the force of gravity pushing down on the body and friction of the body
against a surface, such as the bed or chair.
Epidermal stripping results when the epidermis is uninten- tionally removed when tape
is pulled off the skin. These lesions are usually shallow and irregularly shaped. Babies
are at increased risk for epidermal injury. Prevention includes using no tape when
possible or securing dressings with laced binders (Montgomery straps) or stretchy
netting

BATHING
Most infants and children can be bathed at the bedside or in a standard bathtub or
shower. For infants and young children confined to bed, use commercially available
bath cloths or the towel method. Immerse two towels in a dilute soap solution and wring
them damp. With the child lying supine on a dry towel, place one damp towel on top of
the child and use it to gently clean the body.

ORAL HYGIENE
Mouth care is an integral part of daily hygiene and should be continued in the hospital.
For some young children, this is their first introduction to the use of a toothbrush.

HAIR CARE
Children should have their hair brushed and combed at least once daily. The hair is
styled for comfort and in a manner pleas- ing to the child and parents. The hair should
not be cut without parental permission, although clipping hair to provide access to a
scalp vein for IV insertion may be necessary.
FEEDING THE SICK CHILD

Loss of appetite is a symptom common to most childhood ill- nesses. Because an acute illness
is usually short, the nutritional state is seldom compromised. Urging food on the sick child may
precipitate nausea and vomiting.

APPLYING EVIDENCE TO PRACTICE

Feeding a Sick Child

➡️Encourage parents or other family members to feed child or to be present at mealtimes.

Make mealtimes pleasant; avoid any procedures immediately before or after eating; make
certain child is rested and pain free.

➡️Serve small, frequent meals rather than three large meals or serve three meals and nutritious
between-meal snacks.

➡️Provide finger foods for young children.

➡️Involve children in food selection and preparation whenever possible.

➡️Serve small portions and serve each course separately, such as soup first,
followed by meat, potatoes, and vegetables and ending with dessert. With young children,
camouflage size of food by cutting meat thicker so less appears on plate or by folding a cheese
slice in half. Offer second helpings.

➡️Ensure a variety of foods, textures, and colors.

CONTROLLING ELEVATED TEMPERATURES

➡️An elevated temperature, most frequently from fever but occa- sionally caused by
hyperthermia, is one of the most common symptoms of illness in children. This manifestation
is a great concern to parents. To facilitate an understanding of fever, the following terms are
defined:

Set point—The temperature around which body temperature is regulated by a thermostat-like

mechanism in the hypothalamus
Fever (hyperpyrexia)—An elevation in set point such that body temperature is regulated at a
higher level; may be arbi- trarily defined as rectal temperature above 38° C (100.4° F)
Hyperthermia—Body temperature exceeding the set point, which usually results from the
body or external conditions creating more heat than the body can eliminate, such as in
heatstroke, aspirin toxicity, seizures, or hyperthyroidism Body temperature is regulated by a
thermostat-like mechanism in the hypothalamus.

Therapeutic Management

➡️Treatment of elevated temperature depends on whether it is attributable to a fever or

hyperthermia. Because the set point is normal in hyperthermia but increased in fever,
different approaches must be used to lower body temperature
Fever

The principal reason for treating fever is the relief of discom- fort. Relief measures include
pharmacologic and environmental intervention. The most effective intervention is the use of anti-
pyretics to lower the set point.
Antipyretics include acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs
(NSAIDs). Acetaminophen is the preferred drug.
➡️Aspirin should not be given to children because of its association in children with influenza
virus or chickenpox and Reye syndrome. One nonprescription NSAID, ibuprofen, is
approved for fever reduction in children as young as 6 months of age.

➡️Shivering is the body’s way of maintaining the ele- vated set point by producing heat.
Compensatory shivering greatly increases metabolic requirements above those already
caused by the fever.

➡️Seizures associated with a fever occur in 3% to 4% of all children, usually in those

between 6 months and 6 years of age.
Hyperthermia
Unlike in fever, antipyretics are of no value in hyperthermia because the set point is already
normal. Consequently, cooling measures are used. Cool applications to the skin help reduce
the core temperature.
FAMILY TEACHING AND HOME CARE
Fever is one of the most common problems for which parents
seek health care. High levels of parental anxiety (fever phobia)
surrounding potential complications of fever such as seizures and
dehydration are prevalent and can result in overusing anti-
pyretics

SAFETY
Safety is an essential component of any patient’s care, but chil-
dren have special characteristics that require an even greater
concern for safety. Because small children in the hospital are
separated from their usual environment and do not possess the
capacity for abstract thinking and reasoning, it is the responsi-
bility of everyone who comes in contact with them to maintain
protective measures throughout their hospital stay. Nurses need
to understand the age level at which each child is operating and
plan for safety accordingly.
ENVIRONMENTAL FACTORS
All of the environmental safety measures for the protection of adults apply to children,
including good illumination, floors that are clear of fluid and objects that might contribute
to falls, and nonskid surfaces in showers and tubs. All staff members should be familiar
with the area-specific fire plan. Elevators and stairways should be made safe.

Toys play a vital role in the everyday lives of children, and they are no less important in
the hospital setting. Nurses are respon- sible for assessing the safety of toys brought to
the hospital by well-meaning parents and friends.

Falls prevention begins with identification of children most at risk for falls. Pediatric
hospitals use various methods to identify a child’s risk of falls

Risk factors for hospitalized children include:

• Medication effects—Postanesthesia or sedation; analgesics
or narcotics, especially in those who have never had narcotics
in the past and in whom effects are unknown
• Altered mental status—Secondary to seizures, brain tumors,
or medications
• Altered or limited mobility—Reduced skill at ambulation
secondary to developmental age, disease process, tubes, drains, casts, splints, or other
appliances; new to ambulation with assistive devices such as walkers or crutches
• Postoperative children—Risk of hypotension or syncope secondary to large blood loss,
a heart condition, or extended bed rest
• History of falls
Prevention of falls requires alterations in the environment, including:

• Keep the bed in the lowest position with the breaks locked and the side rails up.
• Place the call bell within reach.
• Ensure that all necessary and desired items are within reach
(e.g., water, glasses, tissues, snacks).
• Offer toileting on a regular basis, especially if the patient is
taking diuretics or laxatives.
• Keep lights on at all times, including dim lights while
sleeping.
• Lock wheelchairs before transferring patients.
• Ensure that the patient has an appropriate-size gown and
nonskid footwear. Do not allow gowns or ties to drag on the
floor during ambulation.
• Keep the floor clean and free of clutter. Post a “wet floor ”
sign if the floor is wet.
• Ensure that the patient has glasses on if he or she normally
wears them.
INFECTION CONTROL

According to the Centers for Disease Control and Prevention, approximately 2 million
patients each year develop nosocomial (hospital-acquired) infections. These infections occur
when there is interaction among patients, health care personnel, equipment, and bacteria.

Standard Precautions synthesize the major features of Universal (blood and body fluid)
Precautions (designed to reduce the risk of transmission of blood-borne pathogens) and body
substance isolation (designed to reduce the risk of transmission of pathogens from moist body
substances)

Standard Precautions involve the use of barrier protection, such as gloves, goggles,
gown, or mask, to prevent contamination from
1) blood
2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain
visible blood
3) non- intact skin
4) mucous membranes

Transmission-Based Precautions are designed for patients with documented or suspected

infection or colonization (i.e., presence of microorganisms in or on patient but without clinical
signs and symptoms of infection) with highly transmissible or epidemiologically important
pathogens for which addi- tional precautions beyond Standard Precautions are needed to
interrupt transmission in hospitals.
Airborne Precautions reduce the risk of airborne transmis- sion of infectious agents.
Airborne transmission occurs by dis- semination of either airborne droplet nuclei (small-
particle residue [<5 mm] of evaporated droplets that may remain sus- pended in the air for
long periods) or dust particles containing the infectious agent.

Droplet Precautions reduce the risk of droplet transmission of infectious agents. Droplet
transmission involves contact of the conjunctivae or the mucous membranes of the nose
or mouth of a susceptible person.

Contact Precautions reduce the risk of transmission of microorganisms by direct or

indirect contact. Direct-contact transmission involves skin-to-skin contact and physical
transfer of microorganisms to a susceptible host from an infected or colonized person,
such as occurs when turning or bathing patients. Direct-contact transmission also can
occur between two patients (e.g., by hand contact). Indirect contact transmis- sion
involves contact of a susceptible host with a contaminated intermediate object, usually
inanimate, in the patient’s environment.

TRANSPORTING INFANTS AND CHILDREN

Infants and children need to be transported within the unit and to areas outside the
pediatric unit. Infants and small children can be carried for short distances within the unit,
but for more extended trips, the child should be securely transported in a suitable
conveyance.
RESTRAINING METHOD

Mummy Restraint or Swaddle

When an infant or small child requires short-term restraint for examination or treatment that
involves the head and neck (e.g., venipuncture, throat examination, gavage feeding), a
papoose board with straps or a mummy wrap effectively con- trols the child’s movements.

Jacket Restraint
A jacket restraint is sometimes used to keep the child safe in various chairs. The jacket is put
on the child with the ties in back so the child is unable to manipulate them.

Arm and Leg Restraints

Occasionally, the nurse needs to restrain one or more extremi- ties or limit their motion. Several
commercial restraining devices are available, including disposable wrist and ankle restraints

Elbow Restraint
Sometimes it is important to prevent the child from reaching the head or face (e.g., after cleft lip
or palate surgery, when a scalp vein infusion is in place, or to prevent scratching in skin
disorders).
CADANG,HANNA B