1. Personal Hygiene

2. Personal Hygiene
It is the nurses responsibility to provide the patient with the opportunity for hygiene
The skill may be delegated but not always, depends on facility policy.

3. Purpose of Bathing Cleansing the skin
Removes perspiration, bacteria, which minimizes skin irritation and reduces chance of infection
Stimulation of circulation
Warm water and gentle strokes from distal to proximal increase circulation and promote venous return
Improve self-image
Promotes feeling of being refreshed, relaxed

4. Purpose of Bathing Reduction of body odors
Especially in axillae and pubic areas
Promotion of Range of Motion
Movement of extremities while bathing

5. Nurse’s Advantage
Provides opportunity to develop a meaningful nurse-patient relationship
Provides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs.

6. Before You Begin Bathing
It is the Nurses Role to:
Assess Your Patient
Activity Tolerance for bathing
Comfort level during movement
Cognitive ability
Musculoskeletal function
Presence of shortness of breath

7. Factors Affecting Personal Hygiene
Cultural / Religious
Developmental Stage
Mobility
Emotional
Physical Illness
Personal Preference

8. Used to clean the patient
Types of Baths
Cleansing Baths
Used to clean the patient

9. Cleansing Baths Complete Bed Bath
Nurse baths entire body of dependent patient in bed
Self-Help Bath
Patients confined to bed are able to bathe themselves with some help
Partial Bath
Parts of the body are washed by the patient and some by the nurse

10. Cleansing Baths
Tub Bath
Much easier for bathing and rinsing than in a bed
Varies in style

11. Types of Baths
Shower
Used by ambulatory patients who require only minimal assistance
Can be used with a shower chair

12. Bath used for treatment Usually requires a doctor’s order
Types of Baths
Therapeutic Baths
Bath used for treatment
Usually requires a doctor’s order

13. Therapeutic Baths
Medicated solutions may be used in bathing (Sage Baths)
Range from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol

14. Back Rub May be performed after drying off the back during the bath.
Position of Patient: Prone or side-lying
Expose only the back, shoulders, upper arms. Cover remainder of body
Lay towel alongside back
Warm lotion in your hands—still explain that it may be cool and wet.

15. Back Rub Start in the sacral area, moving up the back.
Massage in a circular motion over the scapula.
Move upward to shoulders, massage over the scapula
Continue in one smooth stroke to upper arms and laterally along side of back down to iliac crests.
Do NOT allow your hands to leave the patient’s skin
End by telling your patient that you are finished

16. Guidelines for Bathing
Provide Privacy
Maintain Safety
Maintain warmth
Promote the patient’s independence as much as possible

17. Procedure for Bathing
Bed Bath
Potter and Perry p. 797

18. Hygienic measures related to the care of the genitalia.
Part B: Perineal Care
Hygienic measures
related to the
care of the genitalia.

19. Perineal Care Can be embarrassing for the nurse and the patient.
Should not be overlooked because of embarrassment.
If the patient can do it themselves—let them.
Hand them the washcloth and ask if they would like to “finish their bath.”

20. Perineal Care Those patients who may need the nurses assistance:
Vaginal or urethral discharge
Skin irritation
Catheter
Surgical dressings
Incontinent of urine or feces

21. Perineal Care Procedure Normal conditions, Discharge, Menses
Women
Wipe labia majora (outer) from front to back in downward motion using clean surface of wash cloth for each swipe.
Wipe labia minora (inner) from front to back in downward motion using clean surface of wash cloth for each swipe
Wipe down the center of the meatus from front to back. If catheter in place, clean around catheter in circular fashion, using clean surface of wash cloth for each swipe.
Wash inner thighs from proximal to distal

22. Cont. Female Perineal Care
Rinse with warm to tepid water using pour from peri-bottle if available.
Pat dry using clean towel in same order as wash
Remove bedpan if one is used
Verbalize turning patient on side to wash anal area from front to back and dry

23. Perineal Care - Male Retract foreskin of penis if uncircumcised
Wash around the urinary meatus in a circular motion, using clean surface of washcloth for each stroke and around the head of penis in circular motion
Wash down shaft of penis toward the thighs changing washcloth position with each stroke
Wash scrotum – front to back
Wash inner thighs
continued

24. Cont. Perineal Care - Male
Rinse with clean wash cloth or peri- bottle using warm water in same sequence as the wash
Dry with clean towel in the same sequence
Replace foreskin, as appropriate
Turn patient on side to wash anus from front to back and dry
Potter and Perry, p. 801

25. Perineal Care with Catheter
Follow similar procedure in the male patient.
Start at the urethra opening and clean outward.

26. Part C: Oral Hygiene Why do oral hygiene?
Maintains the healthy state of the mouth
Cleanses teeth of food particles, plaque, and bacteria
Massages the gums
Relieves discomfort from unpleasant odors and tastes.
Refreshes the mouth and gives a sense of well-being and thus can stimulate appetite.

27. Assessment: Oral Hygiene
a. Frequency
Depends on the condition of the patient’s mouth.
Some patient’s with dry mouth or lips need care every 2 hours.
Usually done twice a day or after each meal
b. Assistance Needed
Does the patient need assistance to do oral care
*The nurse can help patients maintain good oral hygiene by:
1. Teaching them correct techniques
2. Actually performing for weakened or disabled
patients.

28. Oral Hygiene Assessment
c. Abnormalities
Loose or missing teeth
Swelling and bleeding of gums
Unusual mouth odor
Pain or stinging in mouth structures

29. Brushing Major concerns are: Thoroughness in cleansing
Maintaining the condition of the oral mucosa.
Procedure for Conscious Patient:
Upright position
Get out your textbook—Potter and Perry, p. 808

30. Brushing: Unconscious Patient
Oral hygiene – Unconscious Patient
Turn patient’s head towards you
Place patient in semi- fowler’s
Oral air way can be used to hold mouth open
Use a small brush or swab to clean the mucous membranes and teeth
Use suctions to remove secretions and fluid
Use chap stick or lip moisturizer
Prevent Aspiration

31. Oral Hygiene: Unconscious Patient
Keeping the mouth open
Never place your hand in the patient’s mouth or open with your fingers. Oral stimulation often causes the biting –down reflex and serious injuries can occur.
Potter and Perry p. 811

32. Denture Care Clean dentures as frequently as natural teeth
Dentures are the patient’s personal property and should be handled with care because they can be easily broken.
Care:
Remove before going to bed – allows gums to rest and prevents buildup of bacteria.
Store in a labeled container covered with water or denture cleaner if available

33. Denture Care Procedure: Potter and Perry p. 787 Tips to remember:
Use gauze squares or washcloth to grasp front of dentures to prevent from slipping
Place wash cloth or paper towel in sink to line it while you are cleaning the dentures
Work close to the bottom of the sink in case you drop them.
Use tepid water

34. Part D: Hair Care
A person’s appearance and feeling of well-being often depends on the way their hair looks and feels

35. Major Goals in Hair Care
Stimulate Circulation
Prevents Matting

36. Brushing and Combing
Keeps hair clean and distributes oil evenly along the hair shaft
Combing styles hair and prevents from tangling
Assessment while brushing
Scalp lesions, abrasions
Dandruff
Parasitic infestations
Quality of hair
Appearance

37. Shampooing Hair of Patient Who Is Bed-Bound

38. Hair Care: Shampooing Depends on: Ways to Shampoo
Personal preference of the patient, does not have to occur every day with hygiene
Condition of the hair
Ways to Shampoo
If patient can get up and into a shower or sink, use a hand held nozzle
If patient can not get up, place on stretcher and roll to a shower area
If patient is unable to be moved, may shampoo in the bed – see procedure in Potter and Perry p. 789.
“Shampoo in a Bag” or dry shampoos are available

39. Part E: Shaving
Improves self-esteem and emotional needs of the patient
Usually done after the bath or shampoo
Assessment:
Skin for elevated moles, warts, Rashes, patchy skin lesions, or pustules

40. Shaving
Provide Safety
When using a razor blade, the skin must be softened to prevent pulling, scraping, or cutting
Place a warm wash cloth over area and then apply some gel, cream, foam.
Hold the razor at a 450 angle
Pull the skin taut
Shave in the direction of hair growth

41. Shaving
Safety Precautions
Electric razors must be used in patients who are at risk for bleeding, confused, or depressed

42. Part F: Foot and Nail Care
Usually part of the bath
Purpose:
Eliminate sources of infection and decrease odors
Assessment:
Color, shape length, texture of nails
Condition of skin around nails and between toes and fingers – swollen, inflamed, callused, lesions, temperature

43. Foot and Nail Care Soak the hand or foot to soften the cuticles
Thoroughly cleanse and dry
Trim the nails ONLY if you have permission or it is allowed at that institution. Most institutions do not allow nurses to trim the nails.

44. Foot and Nail Care
Teach patient and family that nails should be cut – straight across. May need to get a referral if no one available to cut nails.
Show close attention to the feet and nails of the diabetic patient and the elderly
** If feet and nails are in bad condition– notify doctor so a consult can be ordered with a podiatrist

45. Part G: Ear Care Usually requires minimal care
Cleanse the external auricle with washcloth when bathing
Avoid insertion of objects into the ear

46. Hearing Aids
Check that the device is functioning correctly and clean any body oils or cerumen from the hearing aid
Make sure the hearing aid is off and volume is down before insertion
Insert hearing aid in ear by pulling earlobe downward while pressing the hearing aid inward
Turn on and adjust volume
Ask the patient if comfortable and can they hear!

47. Part G: Eye Care Assessment: Abnormal lesions Discharge Tearing
Presence of any infection
Use of Visual Aids (contacts, glasses)
Ask when patient needs to use these devices

48. Eye Care
Wash around the eyes with a warm moist washcloth with warm water—NO SOAP!
Clean from the inner canthus to the outer canthus of the eye. Pay special attention to the inner canthus.
Provide special care for the eyes of unconscious patients.
May need to tape the eye lids shut if unable to blink and protect own eyes

50. Nursing Process: Diagnosis
Common diagnoses associated with hygiene:
Activity intolerance
Bathing self-care deficit
Dressing self-care deficit
Impaired physical mobility
Impaired oral mucous membrane
Ineffective health maintenance
Risk for infection
Use the patients’ actual alteration or the alteration for which they are at risk.
Nursing diagnoses are selected from the NANDA-approved list.
Thorough assessment of a patient’s hygiene status and self-care abilities identifies clusters of data or defining characteristics that support actual or at-risk hygiene-related diagnoses. Identification of the defining characteristics leads you to select the NANDA International diagnostic label that best communicates the individual patient’s situation.
[See also Box 39-4 on text p. 779 Nursing Diagnostic Process: Bathing Self-Care Deficit.]
Completing a nursing diagnosis requires identification of the related factor, which will guide your selection of nursing interventions.
[Ask the class to suggest possible data clusters or defining characteristics for each diagnosis listed.]
The patient with an actual alteration requires extensive hygiene care, often more thorough than routine hygiene. Also provide care to promote healing of injured skin surfaces.
If the patient is at risk for a problem, take preventive measures.
Mucositis is painful inflammation of oral mucous membranes.

51. Critical Thinking Situation:
The Nurse enters Mrs. G’s room to do a complete bed bath and she says “I do not want my bath now, I just want to rest”.
What should the nurse do now?

52. Critical Thinking Situation:
The nurse enters Mr. C’s room to do a complete bed bath and he says “I do not want my bath now, I just want to rest”. You notice that his bed is wet and he was incontinent of urine.
Now what should the nurse do?