1. Module 8
Personal Hygiene

2. Personal Hygiene
It is the nurses responsibility to provide the patient with the opportunity for hygiene

3. HYGIENE
PART 6-A
Bathing

4. 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

5. Purpose of Bathing Reduction of body odors
Especially in axillae and pubic areas
Promotion of Range of Motion
Movement of extremities while bathing
Cleansing removes perspiration, some bacteria, and dead skin cells which minimizes skin irritation and reduces the chance of infection.

6. 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.
Assessment:
of the skin, hair, nails, feet,
Psychosocial data collection – where live, family members, occupation, what is on their mind—some will open up at this time
Learning needs

7. Before You Begin Bathing
It is the Nurses Role to:
Assess Your Patient
Assess:
preference for bathing, types of hygiene products used
current condition of patient– movement, positions, up, bedridden,
dizzy, confused

8. Factors Affecting Personal Hygiene
Cultural / Religious
Developmental Stage
Mobility
Emotional
Physical Illness
Personal Preference
North American culture places a high value on cleanliness bathing once or twice a day, whereas other cultures bathe once a week.
Body odors may be offensive in some cultures and accepted an normal in other cultures.
Some religious beliefs do not allow bathing for certain days and ceremonial washings are practiced by some religions.
Develop – the very young and elderly have needs for assistance
Mobility – some patients have limited mobility due to weakness or a complete loss of mobility . Determine if the patient can sit without support, stand and amount of range of motion.
Emotional – stress and emotional disturbances can cause disruptions in ability to perform self-care
Physical – ill patient may not have motivation( not a hierarchy of need) or energy to bath. Consider poor vision
Personal preference – each pt. has individual desires and preferences when they want to bath. Consider. Although, realize that it is the “day shift” that bathes pt’s.

9. 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?

10. 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?

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

12. 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

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

14. types of baths
Shower
Used by ambulatory patients who require only minimal assistance
Can be used with a shower chair

15. 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

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

17. 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.

18. 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

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

20. Procedure for Bathing Bed Bath Harkreader p. 799-803
Tub Bath or Shower
Harkreader p

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

22. 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.”

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

24. 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

25. 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

26. 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

27. 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
Procedure 31-2: Harkreader, p

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

29. 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.

30. 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.

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

32. Brushing Major concerns are: Thoroughness in cleansing
Maintaining the condition of the oral mucosa.
Procedure for Conscious Patient:
Upright position
Get out your textbook--Harkreader: p

33. Brushing: Unconscious Patient
See performance checklist in syllabus
Safety is of utmost importance
Prevent aspiration
Positioning—lateral position with head turned to the side or side-lying. Position back of head on a pillow so that the face tips forward and fluid/ secretions will flow out of the mouth, not back into the throat.
Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device.

34. Oral Hygiene: Unconscious Patient
Keeping the mouth open
Use a padded tongue blade to open the patients mouth and separate the upper and lower teeth
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.
Harkreader p

35. 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

36. Denture Care Procedure: Harkreader p. 815 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

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

38. Major Goals in Hair Care
Stimulate Circulation
Prevents Matting

39. 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

40. Hair Care: Shampooing Depends on:
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 Harkreader p
“Shampoo in a Bag” or dry shampoos are available

41. 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

42. 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

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

44. 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

45. 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.

46. 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

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

48. 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!

49. 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

50. 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

51. Part H: Elimination Care
Optimum elimination occurs when the patient can use a toilet and eliminate in private.

52. Elimination Hygiene
There are various circumstances when a patient will have to use a bedpan or urinal for elimination

53. Elimination Hygiene Assist patient’s in a respectful way
Assist to be comfortable especially when using a bed pan
Provide privacy
Do not hurry

54. Elimination Hygiene Types of Devices
Bedside commode
Urinal
Bedpan
Regular
Orthopedic / fracture

55. Elimination Hygiene Procedure for Using Bedpan / Urinal
Bring to the bedside
Warm the bedpan if it is metal
Place bed in appropriate position
Fold the top linen back to allow for placement of bedpan or urinal
Have patient assist by bending knees and lifting up, place hand under lower back and slip into place. or

56. Use of Bedpan Turn to the side and roll back onto the bedpan
Check placement
Bedpan - when the buttocks rest on the rounded edge of the pan
Urinal – penis is inside, urinal rests on the bed

57. Procedure for using bedpan / urinal
Raise head of bed to upright sitting position
Place call light and toilet within reach. Leave the patient if safe to do so, with side rails up
Removal
Same manner as offered; hold steady
Cover the pan

58. May need to clean up the patient
Note character of contents, chart
Clean the pan or urinal
Unglove and Wash hands

59. Assisting with a Condom Catheter
Purpose:
Control incontinence in a male patient without the risk of urinary tract infection
Greater comfort to the patient than an indwelling catheter
Equipment Needed
Condom catheter
Soap and water, washcloth, towel
Disposable gloves
Drainage bag and tubing

60. Condom Catheter - Procedure
Wash hands
Place patient in supine position, provide privacy, close door and drape with only penis exposed
Apply gloves, Cleanse area with soap and water, dry
Assess for any skin breakdown, redness
Wrap adhesive spirally around the shaft of the penis
Place rolled condom over the penis and unroll over the penis and adhesive, press condom to the strip

61. Attach drainage bag and
tubing to the catheter
Check that tubing is not
twisted and lies over top of leg.
Cover the patient, return bed to low position
Assess later to be sure that it is secure and not leaking.
Empty bag as necessary
Remove condom daily to clean the area and assess the skin integrity.

62. Part I: Antiembolic Prevention
Patients who are immobile are at risk for stasis of blood in the lower extremities and development of thrombophlebitis.
Contraction and relaxation of skeletal muscles helps to move blood through veins toward the heart
Valves within the veins prevent the blood from slipping back toward the feet under the influence of gravity.

63. When circulation slows, clots (thrombi) are more likely to form in those patients with limited activity or incompetent valves.
A blood clot can break loose and travel through the blood stream as an embolus leading to potential severe complications.

64. Purpose of Antiembolic Measures
Promote the circulation of blood from the legs back to the heart- increase venous return; decrease venous stasis
Support valves within peripheral leg veins so that blood is less likely to pool in a dependent position- decreases dependent edema
Prevent thrombus formation

65. Assessment
Identify conditions that increase the potential for poor circulation and clot formation
Post-operative
Varicose veins
Thrombophlebitis
Dehydration
Pregnancy
Examine lower extremities for poor circulation (Cold, cyanosis), intact skin or ulcerations, distended leg veins, peripheral pulses
Assess past history for developing blood clots

66. Interventions / Preventive Measures
1. Leg and Foot Exercises
2. Antiembolism stockings
3. Sequential Compression Devices
4. Avoiding compression of leg vessels

67. Leg and Foot Exercises
Alternately flex and extend the foot five times.
Make circular movement with the feet five times to the left and then repeat to the right.
A leg exercise is to bend the knee and draw the foot up to the thigh, and then extend the leg.
These exercises can be active – just have the patient do these ever so often on their own;
Or passive. It is common to include these range of motion exercises as part of the bath for the immobile patient and at least every 2 hours for the post-operative patient.

68. Antiembolism Hose
Antiembolism stockings are elasticized stockings that provide varying degrees of pressure at different areas of the legs.
To provide the optimum amount of pressure, the stockings should fit properly and be free of wrinkles.
To ensure a proper fit, the patients leg is measured in length and circumference and then refer to the manufacturer’s chart to obtain the correct hose size.
Length Circumference

69. Procedure for Applying TED Hose Do not follow procedure in book
Place patient in supine position in bed with leg horizontal for 15 minutes
Turn the stocking inside out by placing one hand into sock, holding the toe with the other hand, and pull inside out
Place patient’s toe into foot of elastic stocking

70. Application of TED Hose
Slide remaining stocking over foot, Now the stocking will be right side out
Never allow to make a tight band around the leg.
Be sure to smooth stocking having no wrinkles.

71. Antiembolism Hose Nursing Care:
1. Assess the lower extremities EVERY SHIFT.
Toe area should have an opening that can be pulled back and the toes and feet assessed for function and any neuro-circulatory problems.
Toes should be warm, pink, good capillary refill, can wiggle toes, has feeling in toes with no tingling.
2. Remove ONCE EACH DAY and inspect the feet and toes.

72. TED Hose
Document
Calf length TED hose applied, skin warm and pink with no lesions. Instructed patient in use, verbalized understanding. Stated they felt good
J. Ward R.N.

73. Sequential Compression Devices SCD’s
Purpose:
Enhance venous return by applying intermittent external compression to the tissues and veins similar to the normal physiologic pumping mechanisms of the muscles.

74. Sequential Compression Device
Disposable plastic sleeve wrapped
around the patients leg and secured with velcro.
The sleeves are then connected
to an air pump that alternately inflates and deflates the air tubes in the sleeves. The sleeves are inflated in sequence from the bottom of the leg to the top, helping to move venous blood out of the leg veins and toward the heart.

75. Sequential Compression Devices
Place patient in supine position with legs horizontal for 15 minutes.
Apply antiembolism hose, if desired
Measure circumference of upper thigh
Open inflatable sleeve on the flat bed, cotton side up, and place
the patients leg on the sleeve
Wrap sleeve snugly around
the leg, fasten with velcro

76. Sequential Compression Devices
Connect tubing on sleeve
to compression controller
Turn on ordered settings
Remove three times
daily and inspect skin

77. Sequential Compression Devices
Document:
0900 – sequential compression devices placed on both legs set on low. Skin on lower extremities warm, dry, pink. Explained use to patient, verbalized understanding J. Ward R.N.
0900 – SCD’s in place on both lower extremities. Toes warm and pink, pedal pulses present J. Ward R.N.

78. Avoid Compression of Legs
Watch positioning of the patient’s lower extremities. Do not allow the tubes, equipment to be placed under the legs to compress circulation
Place lower extremities on pillows to position correctly.
Encourage patient to not cross legs or feet.