CHAPTER 33-HYGI ENE

● Hygiene is the science of health and its maintenance.

● Personal hygiene is the self-care by which people attend to such functions as bathing, toileting,
general body hygiene, and grooming.

● Hygiene is a highly personal matter determined by individual values and practices. It involves
care of the skin, feet, nails, oral and nasal cavities, teeth, hair, eyes, ears, and perineal-genital
areas.

HYGIENIC CARE

● Early morning care is provided to clients as they awaken in the morning. This care consists of
providing a urinal or bedpan to the client confined to bed, washing the face and hands, and giving
oral care.

● Morning care is often provided after clients have breakfast, although it may be provided before
breakfast. It usually includes providing for elimination needs, a bath or shower, perineal care,
back massages, and oral, nail, and hair care. Making the client’s bed is a part.

● Hour of sleep or PM care is provided to clients before they retire for the night. It usually involves
providing for elimination needs, washing face and hands, giving oral care, and giving a back
massage.

● As-needed (prn) care is provided as required by the client. For example, a client who is
diaphoretic (sweating profusely) may need more frequent bathing and a change of clothes and
linen.

Factors Influencing Individual Hygienic Practices

1. Culture

2. Religion

3. Environment

4. Developmental level

5. Health & energy

6. Personal preferences

SKIN - largest organ of the body. It serves five major functions:

 1. It protects underlying tissues from injury by preventing the passage of microorganisms. The
skin and mucous membranes are considered the body’s first line of defense
2. It regulates the body temperature. Cooling of the body occurs through the heat loss processes
of evaporation of perspiration, and by radiation and conduction of heat from the body when the
blood vessels of the skin are vasodilated. Body heat is conserved through lack of perspiration
and vasoconstriction of the blood vessels.
3. It secretes sebum, an oily substance that (a) softens and lubricates the hair and skin, (b)
prevents the hair from becoming brittle, and (c) decreases water loss from the skin when the
external humidity is low. Because fat is a poor conductor of heat, sebum (d) lessens the
amount of heat lost from the skin. Sebum (e) also has a bactericidal (bacteria-killing) action.
4. It transmits sensations through nerve receptors, which are sensitive to pain, temperature,
touch, and pressure.
5. It produces and absorbs vitamin D in conjunction with ultra- violet rays from the sun, which
activate a vitamin D precursor present in the skin.

Sudoriferous (sweat) glands are on all body surfaces except the lips and parts of the genitals.

The apocrine glands, located largely in the axillae and anogenital areas, begin to function at puberty
under the influence of androgens.

The eccrine glands are important physiologically. They are more numerous than the apocrine glands
and are found chiefly on the palms of the hands, soles of the feet, and forehead. The sweat they produce
cools the body through evaporation.

Sweat is made up of water, sodium, potassium, chloride, glucose, urea, and lactate.

Nursing Management:

Assessment: Assessment of the client’s skin and hygienic practices includes (a) a nursing health history
to determine the client’s skin care practices, self-care abilities, and past or current skin problems; and (b)
physical assessment of the skin

Common skin problems:

ABRASION -- Superficial layers of the skin are scraped or rubbed away. Area is reddened and may have
localized bleeding or serous weeping.

Nursing Implications:

1. Prone to infection; therefore, wound should be kept clean and dry.

 2. Do not wear rings or jewelry when providing care to avoid causing abrasions to clients.

3. Lift, do not pull, a client across a bed.

4. Use two or more people for assistance.

EXCESSIVE DRYNESS -- Skin can appear flaky and rough.

N/I: 1. Prone to infection if the skin cracks; therefore, provide alcohol-free lotions to moisturize the
skin and prevent cracking.

2. Bathe client less frequently; use no soap, or use nonirritating soap and limit its use. Rinse skin
thoroughly because soap can be irritating and drying.

3. Encourage increased fluid intake if health permits to prevent dehydration.

AMMONIA DERMATITIS (DIAPER RASH) -- Caused by skin bacteria reacting with urea in the urine. The
skin becomes reddened and is sore.

N/I: 1. Keep skin dry and clean by applying protective ointments containing zinc oxide to areas at
risk (e.g., buttocks and perineum).

2. Boil an infant’s diapers or wash them with an antibacterial detergent to prevent infection. Rinse
diapers well because detergent is irritating to an infant’s skin.

ACNE -- Inflammatory condition with papules and pustules.

N/I: 1. Keep the skin clean to prevent secondary infection.

2. Treatment varies widely.

ERYTHEMA -- Redness associated with a variety of conditions, such as rashes, exposure to sun,
elevated body temperature.

N/I: 1. Wash area carefully to remove excess microorganisms.

2. Apply antiseptic spray or lotion to prevent itching, promote healing, and prevent skin
breakdown.

HIRSUTISM -- Excessive hair on a person’s body and face, particularly in women.

N/I: 1. Remove unwanted hair by using depilatories, shaving, electrolysis, or tweezing.

2. Enhance client’s self-concept.

Self-Care Deficit diagnoses are used for clients who have problems performing hygiene care.
• Deficient Knowledge related to:

a. Lack of experience with skin condition (acne) and need to prevent secondary infection

b. New therapeutic regimen to manage skin problems.

c. Lack of experience in providing hygiene care to dependent person

d. Unfamiliarity with devices available to facilitate sitting on or rising from toilet.

• Situational Low Self-Esteem related to:

a. Visible skin problem (e.g., acne or alopecia) b. Bodyodor.

***

Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.

Agents Commonly Used on the Skin

Soap -- Lowers surface tension and thus helps in cleaning. Some soaps contain antibacterial agents,
which can change the natural flora of the skin.

Chlorhexidine gluconate (CHG) -- A disposable cloth saturated with 2% CHG and skin-moisturizing
substances. An advantage is continued antimicrobial activity after application. These cloths are often
used in critical-care settings.

Bath oil -- Used in bathwater; provides an oily film on the skin that softens and prevents chapping. Oils
can make the tub surface slippery, and clients should be instructed about safety measures (e.g., using
nonskid tub surface or mat).

Skin cream, lotion Powder -- Provides a film on the skin that prevents evaporation and therefore
chapping.

Deodorant -- Can be used to absorb water and prevent friction. For example, powder under the breasts
can prevent skin irritation. Some powders are antibacterial.

Antiperspirant -- Masks or diminishes body odors. Reduces the amount of perspiration.

Two categories of baths: cleansing and therapeutic

Cleansing baths are given chiefly for hygiene purposes and include these types:

● Complete bed bath. The nurse washes the entire body of a dependent client in bed

● Self-help bed bath. Clients confined to bed are able to bathe them- selves with help from the
nurse for washing the back and perhaps the feet.
 ● Partial bath (abbreviated bath). Only the parts of the client’s body that might cause discomfort
or odor, if neglected, are washed: the face, hands, axillae, perineal area, and back. Omitted are
the arms, chest, abdomen, legs, and feet. The nurse provides this care for de- pendent clients
and assists self-sufficient clients confined to bed by washing their backs. Some ambulatory
clients prefer to take a partial bath at the sink. The nurse can assist them by washing their backs

● Bag bath. This bath is a commercially prepared product that contains 10 to 12 presoaked
disposable washcloths that contain no- rinse cleanser solution. The package is warmed in a
microwave. The warming time is about 1 minute, but the nurse needs to deter- mine how long it
takes to attain a desirable temperature. Each area of the body is cleaned with a different cloth
and then air dried. Because the body is not rubbed dry, the emollient in the solution remains on
the skin.
● Towel bath. This bath is similar to a bag bath but uses regular towels. It is useful for clients who
are bedridden and clients with dementia. The client is covered and kept warm throughout the
bathing process by a bath blanket. The nurse gradually replaces the bath blanket with a large
towel that has been soaked with warm water and no-rinse soap. The client is then gently
massaged with the warm, wet, soapy towel. The wet towel is replaced with a large dry towel for
drying the client’s skin.
● Tub bath. Tub baths are often preferred to bed baths because it is easier to wash and rinse in a
tub. Tubs are also used for therapeutic baths. The amount of assistance the nurse offers depends
on the abilities of the client. There are specially designed tubs for dependent clients. These tubs
greatly reduce the work of the nurse in lifting clients in and out of the tub and offer greater
benefits than a sponge bath in bed.
● Sponge baths are suggested for the newborn because daily tub baths are not considered
necessary. After the bath, the infant should be immediately dried and wrapped to prevent heat
loss. Parents need to be advised that the infant’s ability to regulate body temperature has not yet
fully developed. Infants perspire minimally, and shivering starts at a lower temperature than it
does in adults; therefore, infants lose more heat before shivering begins. In addition, because the
infant’s body surface area is very large in relation to body mass, the body loses heat readily.
● Shower. Many ambulatory clients are able to use shower facilities and require only minimal
assistance from the nurse.

Therapeutic baths are given for physical effects, such as to soothe irritated skin or to treat an area (e.g.,
the perineum). Medica- tions may be placed in the water. A therapeutic bath is generally taken in a tub
one third or one half full. The client remains in the bath for a designated time, often 20 to 30 minutes.

● Perineal-genital care is also referred to as perineal care or pericare. Perineal care as part of the
bed bath is embarrassing for many clients.

FEET

The feet are essential for ambulation and merit attention even when people are confined to bed.
Each foot contains 26 bones, 107 ligaments, and 19 muscles. These structures function together
for both standing and walking.

A callus is a thickened portion of epidermis, a mass of keratotic material. Calluses are usually caused by
pressure from shoes. They can be softened by soaking the foot in warm water with Epsom salts, and
abraded with pumice stones or similar abrasives. Creams with lanolin help to keep the skin soft and
prevent the formation of calluses.

A corn is a keratosis caused by friction and pressure from a shoe. It commonly occurs on the fourth or
fifth toe, usually on a bony prominence such as a joint. Corns are usually conical (circular and raised).
The base is the surface of the corn and the apex is in deeper tissues, sometimes even attached to bone.
Corns are generally removed surgically.

Unpleasant odors occur as a result of perspiration and its interaction with microorganisms. Regular and
frequent washing of the feet and wearing clean hosiery help to minimize odor.

Plantar warts appear on the sole of the foot. These warts are caused by the papovavirus hominis virus.
They are moderately contagious.

Fissures, or deep grooves, frequently occur between the toes as a result of dryness and cracking of the
skin. The treatment of choice is good foot hygiene and application of an antiseptic to prevent infection.

Athlete’s foot, or tinea pedis (ringworm of the foot), is caused by a fungus. The symptoms are scaling
and cracking of the skin, particularly between the toes. Sometimes small blisters form, containing a thin
fluid.

An ingrown toenail, the growing inward of the nail into the soft tissues around it, most often results from
improper nail trimming. Pressure applied to the area causes localized pain.

NAILS

Physical assessment involves inspection of the nails (e.g. nail shape and texture, nail bed color,
and tissues surrounding the nails)

Nursing diagnoses related to nail care and nail problems include self-care deficit and risk for
infection

Bathing Self-Care Deficit related to:

A. Impaired vision

B. Cognitive impairment

Risk for infection around the nail bed related to:

A. Impaired skin integrity of cuticles

B. Altered peripheral circulation

MOUTH
Each tooth has three parts: the crown, the root, and the pulp cavity.

The crown is the exposed part of the tooth, which is outside the gum. It is covered with a hard substance
called enamel.

The ivory-colored internal part of the crown below the enamel is the dentin. The root of a tooth is
embedded in the jaw and covered by a bony tissue called cementum.

The pulp cavity in the center of the tooth contains the blood vessels and nerves.

Teeth usually appear 5 to 8 months after birth.

Baby-bottle syndrome may result in dental caries (Edelman & Mandle, 2010). This syndrome occurs
when an infant is put to bed with a bottle of formula, milk, or fruit juice.

The carbohydrates in the solution cause demineralization of the tooth enamel, which leads to tooth decay.
If the child wants a bottle at bedtime, it should contain only water.

Children are 2 years old, they usually have all 20 of their temporary teeth. At about age 6 or 7, children
start losing their deciduous teeth, and these are gradually replaced by the 33 permanent teeth. By
age 25, most people have all of their permanent teeth.

Plaque is an invisible soft film that adheres to the enamel surface of teeth; it consists of bacteria,
molecules of saliva, and remnants of epithelial cells and leukocytes.

When plaque is unchecked, tartar (dental calculus) is formed. Tartar is a visible, hard deposit of plaque
and dead bacteria that forms at the gum lines. Tartar buildup can alter the fibers that attach the teeth to
the gum and eventually disrupt bone tissue.

Periodontal disease is characterized by gingivitis (red, swollen gingiva), bleeding, receding gum lines,
and the formation of pockets between the teeth and gums.

In advanced periodontal disease (pyorrhea), the teeth are loose and pus is evident when the gums are
pressed. An oral assessment guide (OAG) is a useful tool for detecting early signs of oral problems.

Oral dryness and mucositis (inflammation of mucous membranes). A common side effect of the
anticonvulsant drug phenytoin (Dilantin) is gingival hyperplasia. Optimal oral hygiene (e.g., brushing with
a soft toothbrush and flossing) is needed.

Clients who are receiving or have received radiation treatments to the head and neck may have
permanent damage to salivary glands. This results in a very dry mouth and can often be treated by
providing a thick liquid called artificial saliva. Some clients prefer to just sip on liquids to moisten their
mouth. Radiation can also cause damage to teeth and the jaw structure, with actual damage occurring
years after the radiation.

Impaired Oral Mucous Membrane refers to injury of the lips, soft tissue, buccal cavity, and/or oropharynx
Manifestations can include a coated tongue; dry mouth (xerostomia); halitosis; gingival hyperplasia,
difficulty eating, oral pain or discomfort; oral lesions or ulcers. =

Providing oral hygiene is an independent nursing function; yet, re- search has shown that oral hygiene is
one of the most overlooked aspects of basic nursing care.

Moreover, the oral care provided by nurses is often inadequate.

Barriers to providing effective oral care include the low priority placed on oral care, dislike of work- ing
inside another person’s mouth, and insufficient time 


Most dentists recommend that dental hygiene should begin when the first tooth erupts and be practiced
after each feeding.

Beginning at about 18 months of age, brush the child’s teeth with a soft toothbrush.

Fluoride remains important at this stage to prevent dental car- ies.

The rate of edentulism (lack of teeth) among older adults continues to decline.

One of the techniques recommended for brushing teeth is called the sulcular technique, which removes
plaque and cleans under the gingival margins,

Those who do not wear their prostheses are prone to shrinkage of the gums, which results in further tooth
loss.

Foam swabs are often used in health care agencies to clean the mouths of dependent clients. These
swabs are con- venient and effective in removing excess debris from the teeth and mouth, but are not
effective for plaque removal.

HAIR

The appearance of the hair often reflects a person’s feelings of self- concept and sociocultural well-being.

Oil prevents the hair from breaking and the scalp from drying.

Newborns may have lanugo (the fine hair on the body of the fetus, also referred to as down or woolly hair)
over their shoulders, back, and sacrum.

Chemotherapeutic agents and radia- tion of the head may cause alopecia (hair loss). Hypothyroidism
may cause the hair to be thin, dry, and/or brittle.

dandruff appears as a diffuse scaling of the scalp.

Baldness, common in men, is thought to be a hereditary problem for which there is no known remedy
other than the wearing of a hairpiece

mall gray-brown parasites that bite into tissue and suck blood, ticks transmit several diseases to people,
in particular Rocky Mountain spot- ted fever, Lyme disease, and tularemia.
Lice are parasitic insects that infest mammals. Infestation with lice is called pediculosis. Hundreds of
varieties of lice infest humans. Three common kinds are Pediculus capitis (the head louse), Pediculus
corporis (the body louse), and Pediculus pubis (the crab louse).

Pediculus capitis is found on the scalp and tends to stay hidden in the hairs; similarly, Pediculus pubis
stays in pubic hair. Pediculus cor- poris tends to cling to clothing, so that when a client undresses, the lice
may not be in evidence on the body; these lice suck blood from the person and lay their eggs on the
clothing.

Lice are very small, grayish white, and difficult to see. The crab louse in the pubic area has red legs. Lice
may be contracted from in- fested clothes and direct contact with an infested person.

The treatment often includes topical pediculicides.

Scabies is a contagious skin infestation by the itch mite. The char- acteristic lesion is the burrow
produced by the female mite as it pene- trates into the upper layers of the skin. Burrows are short, wavy,
brown or black, threadlike lesions most commonly observed between the fingers, creases of the wrists
and elbows, beneath breast tissue, and in the groin area

The growth of excessive body hair is called hirsutism.

In North America, the well-groomed woman, as depicted in magazines, has no hair on her legs or under
her axillae. In many European cultures, it is not customary for well-groomed women to remove this hair.

Brushing has three major functions: It stimulates the circulation of blood in the scalp, it distributes the oil
along the hair shaft, and it helps to arrange the hair. 


Water used for the shampoo should be 40.5°C (105°F) for an adult or child to be comfortable and not
injure the scalp.

INFANTS

• Shampoo an infant’s hair daily to prevent seborrhea.

CHILDREN

• Monitor school-age children for nits (pediculosis).

OLDER ADULTS

• Ensure adequate warmth for older adults when shampooing their hair, because they are susceptible to
chilling.

EYES

lacrimal fluid continually washes the eyes, and the eyelids and lashes prevent the en- trance of foreign
particles. 

Cleaning eye- glasses to prevent breaking or scratching the lenses. Glass lenses can be cleaned with
warm water and dried with a soft tissue that will not scratch the lenses. Plastic lenses are easily scratched
and may require special cleaning solutions and drying tissues.

Contact lenses, thin curved disks of hard or soft plastic, fit on the cor- nea of the eye directly over the
pupil. They float on the tear layer of the eye.

Hard contact lenses are made of a rigid, unwettable, airtight plastic that does not absorb water or saline
solutions. They usually cannot be worn for more than 12 to 14 hours and are rarely recommended for
first-time wearers.

Soft contact lenses cover the entire cornea. Being more pliable and soft than hard lenses, they mold to
the eye for a firmer fit. The duration of extended wear varies by brand from 1 to 30 days or more.

Gas-permeable lenses are rigid enough to provide clear vision but are more flexible than the traditional
hard lens. They permit oxy- gen to reach the cornea, thus providing greater comfort, and will not cause
serious damage to the eye if left in place for several days.

EARS

Cerumen (earwax) 


The use of a ceruminolytic (wax-softening agents used to soften the cerumen) or irrigation may be
necessary.

Clients with hearing aids are at greater risk for cerumen impac- tion for two reasons. The hearing aid (a
foreign body) causes excessive cerumen production and the presence of the hearing aid prevents the
body’s normal mechanism for removal of cerumen from functioning. 


A hearing aid is a battery-powered, sound-amplifying device used by people with hearing impairments. It
consists of a microphone that picks up sound and converts it to electric energy, an amplifier that
magnifies the electric energy electronically, a receiver that converts the amplified energy back to sound
energy, and an earmold that di- rects the sound into the ear. There are several types of hearing aids: 


Behind-the-ear (BTE) open fit. BTEs are the newest in hearing aid technology. A BTE has no earmold
and it is barely visible with a clear tube that runs down into the ear canal. It does not occlude the ear
canal 


Behind-the-ear (BTE) with earmold. This is a widely used type because it fits snugly behind the ear. The
hearing aid case, which holds the microphone, amplifier, and receiver, is attached to the earmold by a
plastic tube.

In-the-ear (ITE) aid. This one-piece aid has all its com- ponents housed in the earmold. It is more visible
than other types but has more room for features such as volume control.

In-the-canal (ITC) aid. Compact and barely visible, an ITC aid fits completely inside the ear canal. In
addition to having cosmetic appeal, the ITC does not interfere with telephone use or the wearing of
eyeglasses. However, it is not suitable for clients with progressive hearing loss, it requires adequate ear
canal diameter and length for a good fit, and it tends to plug with cerumen more than other aids.
Completely-in-the-canal (CIC) aid. Almost invisible to an ob- server, the CIC aid has to be custom
designed to fit the individual’s ear.

Eyeglasses aid. This is similar to the behind-the-ear aid, but the components are housed in the temple of
the eyeglasses. A hearing aid can be in one or both temples of the glasses.


Body hearing aid. This pocket-sized aid, used for more severe hearing losses, clips onto an
undergarment, shirt pocket, or har- ness carrier supplied by the manufacturer. The case, containing the
microphone and amplifier, is connected by a cord to the re- ceiver, which snaps into the earpiece.

NOSE

Three types of equipment often installed in an acute care facility are a suction out- let for several kinds of
suction, an oxygen outlet for most oxygen equipment, and a sphygmomanometer to measure the client’s
blood pressure.

ROOM TEMPERATURE

People who are very young, very old, or acutely ill frequently need a room temperature higher than
normal. A room temperature be- tween 20°C and 23°C (68°F and 74°F) is comfortable for most clients.

VENTILATION, NOISE

HOSPITAL BEDS

Hospital beds are usually 66 cm (26 in.) high and 0.9 m (3 ft) wide, narrower than the usual bed, so that
the nurse can reach the client from either side of the bed without undue stretching. The length is usually
1.9 m (6.5 ft).

Mattresses are usually covered with a water-repellent material that resists soiling and can be cleaned
easily.

Side rails, also referred to as bed rails, are used on both hospital beds and stretchers.

A bed can have two full-length side rails or four half- or quarter- length side rails (also called split rails).

Commonly Used Bed Positions

Flat - Mattress is completely horizontal.

Fowler’s position - Semi-sitting position in which head of bed is raised to an angle between 45° and 60°,
typi- cally at 45°. Knees may be flexed or horizontal.

Semi-Fowler’s position - Head of bed is raised between 15° and 45°, typically at 30°.

Trendelenburg’s position - Head of bed is lowered and the foot raised in a straight incline.

Reverse Trendelenburg’s position - Head of bed raised and the foot lowered. Straight tilt in direction
opposite to Trendelenburg’s position.
Footboard or Footboot

These are used to support the immobilized client’s foot in a normal right angle to the legs to prevent
plantar flexion contractures

Intravenous rods (poles, stands, standards), usually made of metal, support IV infusion containers while
fluid is being administered to a client.

An unoccupied bed can be either closed or open. Generally the top covers of an open bed are folded
back (thus the term open bed) to make it easier for a client to get in. Open and closed beds are made the
same way, except that the top sheet, blanket, and bedspread of a closed bed are drawn up to the top of
the bed and under the pillows.

A client can bathe most of her body except for the back, hands, and feet. She also can walk to and from
the bathroom and dress herself when given clothing. Which functional level describes this client?

1. Totally dependent (+4)

2. Moderately dependent (+3)

3. Semidependent (+2)


4. Independent (0) 


The client is unresponsive and requires total care by nursing staff. Which assessment does the nurse
check first before providing special oral care to the client? 


1. Presence of pain


2. Condition of the skin

3. Gag reflex


4. Range of motion

3. A client with diabetes has very dry skin on her feet and lower extremities. The nurse plans to inform the
client to do which of the following to maintain intact skin?

1. Soak her feet frequently.


2. Use a nonperfumed lotion.


3. Apply foot powder.


4. Avoid knee-high elastic stockings.

4. The client wears an in-the-ear (ITE) hearing aid and because of arthritis needs someone to insert the
hearing aid. Which action does the nurse teach the unlicensed assistive personnel (UAP) to do before
inserting the client’s hearing aid?
1. Turn the hearing aid off.


2. Soak the hearing aid in soapy solution to clean it.

3. Turn the volume all the way up.


4. Remove the batteries.

The client is in surgery and will be returning to his bed via a stretcher. Which bed option reflects that the
nurse appropriately planned ahead for this client? 


1. Open bed in low position


2. Occupied bed in low position

3. Closed bed in high position

4. Surgical bed in high position 


The nurse is discussing strategies with the unlicensed assistive personnel (UAP) for bathing a client with
dementia. Which strategies would be appropriate for the client? Select all that apply.


 1. Cover the client as much as possible.


2. Sing or talk to the client.


3. Complete the bath as quickly as possible.

4. Be organized.


 5. Expect the client to protest—finish quickly. 


The nurse is observing the unlicensed assistive personnel (UAP) perform perineal care for a client. Which
action indicates that the nurse needs to discuss additional teaching with the UAP? 


1. Uses a clean portion of the washcloth for each stroke

2. Wipes from the pubis to the rectum


 3. Uses clean gloves


4. Does not retract the foreskin 


The nurse is planning a presentation on oral health at an inter- generational community center. Which
statements will be important to include? Select all that apply.

1. Using a bottle during naps and bedtime can cause dental caries in a toddler. 


2. Schedule a visit to the dentist when your child is ready to go to school. 


.3. It is important for parents to supervise a child’s brushing of their teeth. 


.4. Most older adults have dentures and don’t need to worry about oral care. 


.5. Older adults are at risk for periodontal disease. 


The nurse is discussing foot care with a client who was recently diagnosed with diabetes. Which
statement by the client indicates a need for further teaching?

1. “I am going to use a mirror to check my feet.”


2. “I enjoy walking barefoot around the house.”


3. “I will file my nails.”


4. “I will increase the time that I wear new shoes each day.”

The client is complaining of shortness of breath. His respirations are 28 and labored. The bed is currently
in the flat posi tion. The nurse puts the bed in which position?

1. Fowler’s


2. Semi-Fowler’s


3. Trendelenburg

4. Reverse Trendelenburg