Personal Care and Hygiene in a Hospitalized Patient

Nurse Melinda works on a medical-surgical floor and is caring for Beatrice, an 80-year-old with a history of iron-deficiency anemia.

In collaboration with the registered nurse, RN Elijah, Nurse Melinda goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Beatrice’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Melinda recognizes important cues including Beatrice’s vital signs, which are temperature 98.6 F or 37 C, heart rate 90 beats per minute, respirations 19 breaths per minute, and blood pressure 123/88 mmHg.

During bedside report, Nurse Melinda learns that Beatrice tires easily, becomes short of breath with activity, and needs assistance to get up to the bathroom.

Nurse Melinda then gathers information from Beatrice. Nurse Melinda: Hi Beatrice, how are you this morning?

Beatrice: I’m tired. I want to get cleaned up, but it takes so much energy.

Nurse Melinda: I can help you get cleaned up. How about you do as much as you can, and when you feel tired, I can take over?

Beatrice: Okay. Nurse Melinda analyzes these cues.

She reviews the electronic health record, or EHR, and notes that prior to admission, Beatrice lived independently, but began having trouble performing activities of daily living, or ADLs, due to fatigue.

Nurse Melinda understands that iron is essential to produce hemoglobin in red blood cells, or RBCs, which deliver oxygen to the tissues, and that iron-deficiency anemia develops when there’s not sufficient iron to sustain normal hemoglobin production.

As a result, there’s not enough hemoglobin to fill a normal-sized RBC, so the bone marrow starts producing microcytic, or smaller, cells that contain less hemoglobin.

She also knows that a lack of hemoglobin can cause decreased oxygenation, leading to symptoms like weakness, fatigue, and reduced exercise tolerance, making it difficult to perform ADLs.

Nurse Melinda recognizes that Beatrice needs assistance with bathing and oral care to promote comfort, maintain hygiene, and prevent infection.

Now using the information she has gathered along with Beatrice’s medical history, Nurse Melinda reports her findings to RN Elijah, and together they choose a priority hypothesis of altered self-care.

Then Nurse Melinda collaborates with RN Elijah to generate solutions to address Beatrice’s altered self-care, and they establish the expected outcome that Beatrice will participate in bathing and oral care with assistance.

Nurse Melinda and RN Elijah then take action to implement these solutions. They assist Beatrice to safely transfer from her bed to the shower chair in the bathroom, where Nurse Elijah closes the curtain to ensure privacy.

Nurse Melinda ensures that the water is at an appropriate temperature before assisting Beatrice to disrobe. Nurse Melinda then gives Beatrice a soap-covered wash cloth and encourages her to wash her hands and face while Nurse Elijah washes her back.

Next, Nurse Melinda assists Beatrice to wash and condition her hair. Nurse Elijah then helps Beatrice to stand and hold onto the shower grab-bars while Nurse Melinda washes her peri-area and legs.

After the shower, Nurse Melinda gently dries Beatrice’s skin and applies lotion before assisting her into a clean gown and fresh non-slip socks.

Nurse Melinda and RN Elijah then assist Beatrice back to bed and provide her with a warm blanket. Beatrice: I feel much better, but I’d like to take a nap before brushing my teeth if that’s okay.

Nurse Melinda: Of course, we’ll let you rest. One hour later, Nurse Melinda re-enters Beatrice’s room to evaluate the outcomes of her actions.

She takes Beatrice’s vital signs which are temperature 98 F or 36.6 C, heart rate 80 beats per minute, respirations 16 breaths per minute, and blood pressure 115/70 mmHg.

Beatrice reports that she’s now ready to brush her teeth, so Nurse Melinda sets up the supplies on the bedside table. Beatrice is able to perform oral care independently following set up.

Alright, as a quick recap… Nurse Melinda recognized and analyzed cues related to Beatrice’s altered self-care and, in collaboration with RN Elijah, prioritized hypotheses, and generated solutions to address this problem.

Nurse Melinda and RN Elijah then implemented measures and evaluated Beatrice's outcomes and compared them to the expected outcome.

Since Beatrice participated in bathing and oral care with assistance, they determined the plan of care was successful.