b.Ear: Clean the ear with a washcloth-covered fin-
ger, instructing patient never to insert objects
into the ear for cleaning purposes.
c. Nose: Clean the nose by instructing patient to
blow nose while both nares are patent (nasal
suctioning may be indicated), remove crusted
secretions around the nose, and apply
petroleum jelly to tissue.- a.Contact lenses: Wash hands before touching
eye surfaces or lenses; remove the lenses by
gently grasping the lens near the lower edge
and lifting it from eye. Soft lenses are cleaned,
rinsed, and placed in a container of solution
for storage. Identify as right or left lens.
b.Artificial eye: Assemble a small basin, soap and
water, and solution for rinsing the prosthesis.
Ask the patient how he/she cleans the eye area
(usually flushed with normal saline before
replacing the eye).
c. Hearing aids: Batteries should be checked
routinely and earpieces cleaned daily with mild
soap and water.
d.Dentures: Dentures should not be wrapped in
tissue or disposable wipes. Dentures should be
stored in water to prevent drying and warping
of plastic materials. A few drops of essence of
peppermint may be added to the water. Don
gloves and hold dentures over a basin of water
or a soft towel. Cleanse with cool or lukewarm
water with a brush and nonabrasive powder or
paste. Dentures can be soaked with special
preparations to remove stains and hardened
particles. Rinse well after cleaning; rinse mouth
before replacing dentures.
14.Answers may include: Deficient self-care abilities,
vascular disease, arthritis, diabetes mellitus,
history of biting nails or trimming them improp-
erly, frequent or prolonged exposure to chemicals
or water, trauma, ill-fitting shoes, or obesity
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What patient teaching should be implemented to
help meet the hygienic needs of Ms. Delamordo?
The nurse should investigate Ms. Delamordo’s feel-
ings about being cared for by her daughter since
hygiene is such a personal matter. The nurse should
encourage her to take care of as many hygienic prac-
tices as possible using her left side. Teaching should
include how to adapt a bathroom to the needs of
a disabled person, for example, placing a chair
in the shower and using hand-held shower heads,
checking water temperature, ensuring privacy, help-
ing the patient get in and out of the shower, keep-
ing the bathroom door unlocked, and helping to
wash and dry areas that Ms. Delamordo can’t reach(such as the back). Ms. Delamordo’s daughter
should be taught the proper techniques for caring
for her mother’s hair, dentures, and hearing aids.
2.What would be a successful outcome for this patient?
By next visit, Ms. Delamordo demonstrates washing
areas of her body that she can reach. By next visit,
Ms. Delamordo’s daughter states that she is
comfortable with the plan of care for hygienic
measures instituted for her mother.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: having basic knowledge about hygiene,
hygiene measures, and the products and equipment
that facilitate care.
Technical: ability to adapt hygiene care measures to
meet the needs of an older adult with right-sided
paralysis.
Interpersonal: ability to encourage patients and
their caregivers, as appropriate, in learning new self-
care measures related to hygiene.
4.What resources might be helpful for Ms. Delamordo
and her daughter?
Home healthcare services, information on adaptive
devices for people with paralysis
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Dominic Gianmarco, a 78-year-old retired man with
a history of Parkinson’s disease, lives alonein a
small home. He was recently hospitalized for prob-
lems with cardiac rhythm, and a pacemaker was
installed. The home healthcare nurse visits 1 week
after he was discharged to monitor his recovery and
compliance with his medication regimen. The nurse
observes that his appearance is disheveled and there
are multiple stains on his clothing. Several food
items are in various stages of preparation on the
kitchen counter, and some appear to have spoiled.
Mr. Gianmarco has several days’ growth of beard
and a body odor is apparent. He is pleasant and ori-
ented to place and person but cannot identify the
time or day of the week. “I lose track of what day
it is. Time is not important when you are my
age. The most important thing to me right now
is to be able to take care of myself and stay in
this house near my friends.”There is a walker
visible in a corner of the living room, but Mr. Gian-
marco ambulates slowlyaround the house with a
minimum of difficulty and does not use the walker.
He comments that he keeps busy “reading, watch-
ing old movies, and going to senior citizen activ-
ities with friends who stop by for me.”His
daughter, who lives several hours away, visits him
every weekend and prepares his medications for the
week in a plastic container that is easy for him to
open. The nurse observes that all medications
appeared to have been taken to date:“I don’t messCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 381
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