1. Chapter 50:
Personal Hygiene

2. Care of Mouth, Teeth, Eyes, and Ears
Personal hygiene contributes to a person’s sense of well- being.
It is important to teach clients and their families how to care for the mouth, teeth, eyes, and ears.
Clients will be required to carry out this care when they return home.

3. Reasons for Mouth Care
Disease-causing organisms enter the body through the mouth
*Halitosis, pyorrhea, or periodontitis
Irritation, dryness
*Sordes
*Loss of appetite & taste of food, nutritional deficiencies
Infection or pain locally
Breath odors or decayed teeth

4. Mouth Care (cont.) Teach and encourage future self-care
Flossing the teeth
Removes debris that could cause tooth decay (dental caries) and offensive breath odor
Dentures
Record the presence of dentures
**Remove dentures if a client is unresponsive, out of control, having frequent seizures, or going to have surgery
Guidelines 50-1: store all dentures and mouth appliances in a specially marked opaque denture cup. The container and lid must have clients name on it

5. Dentures Remove dentures Label container Store safely Document
Share reason removed with family

6. The Dependent Client Special mouth care
Breathe through the mouth, are receiving supplemental oxygen or mechanical ventilation
*may need oral hygiene every hour d/t dryness
Are unable to take fluids by mouth or have fluids restricted
Need to be encouraged to take food
Are unresponsive or paralyzed
Are very young, confused, or otherwise unable to perform independent mouth care

7. Routine Eye Care Wash hands and put on gloves.
Soak cotton balls or gauze squares in sterile water or normal saline. If eye care is being given as part of the bath and no infection is present, a clean, damp washcloth may be used. Wash eyes first when giving bath.
Apply a cotton ball or gauze square moistened with sterile water or normal saline to the eyelids to remove secretions.
*Wipe the client’s eyelid from the inner to the outer canthus.
*Repeat steps on the other eyes using clean supplies.

8. The Client Who Wears Contact Lenses
Encourage removal of lenses.
Place them in cleansing or soaking solution.
Label separate containers for each eye and include the client’s name and facility identification number.
Report if client is unable to remove lenses.

9. The Client Who Cannot Blink
Routine cleaning of the eyes
Instill lubricating drops in the eyes or ointment onto the lower lids as ordered by the primary healthcare provider
Close the client’s eyelids
Cover the eye with a sterile eye pad
Secure with paper tape (procedure may vary according to facility)

10. Ear Care External ears are washed during bed bath
Wax removal if necessary
*never insert objects into ears as they can puncture the eardrum, push wax farther in ear*
Care of a hearing aid
Refusal to use a hearing aid or repeated removal of the aid usually indicates discomfort or malfunction of the device
**Guidelines 50-3

11. Care of Hands Caring for fingernails
Preferably done after the client’s hands have been in water
Clip torn or jagged nails with a sterile nail clipper and make them smooth
Artificial nails are not encouraged in clients preparing for surgery or those with respiratory disorders
Hand massage
Therapeutic Touch
Connection between the client and the nurse

12. Care of Feet Caring for toenails
Long and soiled toenails can cause infection if they scratch the client’s skin
Cutting into the corners or rounding the corners of toenails contributes to the development of ingrown toenails
**Special orders are required before cutting the toenails of any client especially those with diabetes, hemophilia, Type I or II diabetes
Foot soak
For the client who has edema, tenderness, or some form of foot infection
Warm water –dilates blood vessels to promote improved circulation and relaxes the feet and legs
mild detergent is often used

13. Shaving If the client can shave without assistance
Prepare the equipment, provide a mirror, and see that the room is well lighted
Allow as much privacy as possible
If the client cannot shave without assistance
The nurse should provide needed assistance
Follow standard precautions
Follow facility protocol
*If the client has unsteady hands, poor eyesight they should not use a disposable razor
*closely monitor clients who are depressed, suicidal or assaultive

14. Daily Hair Care/Shampoo
Giving a shampoo to an ambulatory client
Giving hair care after an accident
Document any debris found, particularly in the case of an assault, accident, or other insurance case
Using the shampoo cap
If there is debris in the client’s hair, do not massage the shampoo cap
The bed shampoo for the immobile client
*guidelines 50-5
Caring for hair

15. Skin Care
The nurse must inspect the skin during baths and other routine daily care
Body fluids such as perspiration, vomitus, urine and feces are generally acidic and irritating to the skin**
Protective devices for the skin
To protect body prominences
Special beds and wheelchair pads
Special elbow and heel pads

16. Patterns Used in the Backrub
*Backrubs prevent skin breakdown
Stroking (effleurage)
Kneading (pétrissage or foulage)
Tapping (tapotement)
Friction
Brushing (frôlement)
Vibration

17. Effleurage

18. Types of Cleansing Baths
Baths: remove waste products of perspiration and excretion, stimulate circulation and refresh the client, a complete daily bath is not essential and often not advisable for every client**
Shower
Tub
Guidelines 50-7
*Perineal Care

19. Bathing Bed: given when client is unable to leave the bed Complete
*given for comatose, catatonic clients
Partial
Partial baths most often include washing the client’s face and hands and giving perineal care

20. Giving Perineal Care

21. Skin Infections *Pediculosis-lice, nits Scabies Bedbugs
When shampooing or bathing a client with suspected pediculosis or scabies, wear a gown and gloves
If it is determined that a client has a parasitic skin infestation, it is vital to alert the family

22. Nursing Procedures
50-3
50-4
50-5
50-6
50-7
50-13