HYGIENE CARE

 Hygiene is the science of health and its

maintenance.
 Personal hygiene is the self-care by which
people attend to such functions as bathing,
toileting, general body hygiene, and grooming.
 Hygiene is a highly personal matter determined
by individual values and practices. It involves
care of the skin, feet, nails, oral and nasal
cavities, teeth, hair, eyes, ears, and perineal-
genital areas.
 Hygienic Care
 Early morning care is provided to clients as they awaken in the morning.

This care consists of providing a urinal or bedpan to the client confined to

bed, washing the face and hands, and giving oral care.

 Morning care is often provided after clients have breakfast, although it

may be provided before breakfast. It usually includes providing for

elimination needs, a bath or shower, perineal care, back massages, and

oral, nail, and hair care. Making the client’s bed is part of morning care.
 Hour of sleep or PM care is provided to clients before they
retire for the night. It usually involves providing for elimination
needs, washing face and hands, giving oral care, and giving a
back massage.

 As-needed (prn) care is provided as required by the client. For

example, a client who is diaphoretic (sweating profusely) may
need more frequent bathing and a change of clothes and linen.
 SKIN
The skin is the largest organ of the body. It serves five major
functions:

1. It protects underlying tissues from injury by preventing the

passage of microorganisms. The skin and mucous
membranes are considered the body’s first line of defense.

2. It regulates the body temperature. Cooling of the body occurs

through the heat loss processes of evaporation of
perspiration, and by radiation and conduction of heat from
the body when the blood vessels of the skin are vasodilated.
Body heat is conserved through lack of perspiration and
vasoconstriction of the blood vessels.
3. It secretes sebum, an oily substance that (a)
softens and lubricates the hair and skin, (b)
prevents the hair from becoming brittle, and (c)
decreases water loss from the skin when the
external humidity is low. Because fat is a poor
conductor of heat, sebum (d) lessens the
amount of heat lost from the skin. Sebum (e)
also has a bactericidal (bacteria-killing) action.
4. It transmits sensations through nerve
receptors, which are sensitive to pain,
temperature, touch, and pressure.
5. It produces and absorbs vitamin D in
conjunction with ultraviolet rays from the sun,
which activate a vitamin D precursor present in
the skin.
 Factors Influencing Individual Hygienic Practices

 Culture- North American culture places a high

value on cleanliness. Many North Americans
bathe or shower once or twice a day, whereas
people from some other cultures bathe once a
week. Some cultures consider privacy essential
for bathing, whereas others practice communal
bathing. Body odor is offensive in some
cultures and accepted as normal in others.
 Religion -Ceremonial washings are practiced by some
religions.

 Environment -Finances may affect the availability of

facilities for bathing. For example, homeless people
may not have warm water available; soap, shampoo,
shaving lotion, and deodorants may be too expensive
for people who have limited resources.

 Developmental level -Children learn hygiene in the

home. Practices vary according to the individual’s age;
for example, preschoolers can carry out most tasks
independently with encouragement.
 Health and energy -Ill people may not have the
motivation or energy to attend to hygiene.
Some clients who have neuromuscular
impairments may be unable to perform
hygienic care.

 Personal preferences -Some people prefer a

shower to a tub bath. The time of bathing
varies (e.g., morning versus evening).
 Definitions and Descriptors for
Functional Level
 Completely Independent (0)

 (+1) -Requires Use Of Equipment Or Device

 Semi-dependent (+2)-Requires Help From Another Person For

Assistance, Supervision, Or Teaching

 Moderately Dependent (+3)-Requires Help From Another

Person And Equipment Or Device.

 Totally Dependent (4)-Dependent, Does

Not Participate In Activity
 Etiologies of Self-Care Deficits

■Decreased or lack of motivation

■ Weakness or tiredness
■ Pain or discomfort
■ Perceptual or cognitive impairment
■ Inability to perceive body part or spatial relationship
■ Neuromuscular or musculoskeletal impairment
■ Medically imposed restriction
■ Therapeutic procedure restraining mobility (e.g.,
intravenous infusion, cast)
■ Severe anxiety
■ Environmental barriers
 GENERAL GUIDELINES FOR SKIN CARE
 1. An intact, healthy skin is the body’s first line
of defense.
 Nurses need to ensure that all skin care measures prevent injury
and irritation. Scratching the skin with jewelry or long, sharp
fingernails must be avoided. Harsh rubbing or use of rough
towels and washcloths can cause tissue damage, particularly
when the skin is irritated or when circulation or sensation is
diminished. Bottom bed sheets are kept taut and free from
wrinkles to reduce friction and abrasion to the skin. Top bed
linens are arranged to prevent undue pressure on the toes.
When necessary, bed cradles on footboards are used to keep
bedclothes off the feet.
 2. The degree to which the skin protects the
underlying tissues from injury depends on the
general health of the cells, the amount of
subcutaneous tissue, and the dryness of the
skin.
 Skin that is poorly nourished and dry is less easily protected
and more vulnerable to injury. When the skin is dry, lotions
or creams with lanolin can be applied, and bathing is limited
to once or twice a week because frequent bathing removes
the natural oils of the skin and causes dryness.
3. Moisture in contact with the skin for more
than a short time can result in increased
bacterial growth and irritation.
 After a bath, the client’s skin is dried carefully. Particular
attention is paid to areas such as the axillae, the groin,
beneath the breasts, and between the toes, where the potential
for irritation and fungal infection is greatest. A nonirritating
dusting powder tends to reduce moisture and can be applied
to these areas after they are dried. Clients who are
incontinent of urine or feces or who perspire excessively are
provided with immediate skin care to prevent skin irritation.
4. Body odors are caused by resident skin
bacteria acting on body secretions.
 Cleanliness is the best deodorant. Commercial deodorants
and antiperspirants can be applied only after the skin is
cleaned. Deodorants diminish odors, whereas
antiperspirants reduce the amount of perspiration. Neither is
applied immediately after shaving because of the possibility
of skin irritation, nor are they used on skin that is already
irritated.
5. Skin sensitivity to irritation and injury varies
among individuals and in accordance with their
health.
 Generally speaking, skin sensitivity is greater in infants,
very young children, and older people. A person’s nutritional
status also affects sensitivity. Emaciated and obese persons
tend to experience more skin irritation and injury. The same
tendency is seen in individuals with poor dietary habits and
insufficient fluid intake. Even in healthy persons, skin
sensitivity is highly variable. Some people’s skin is sensitive
to chemicals in skin care agents and cosmetics.
Hypoallergenic cosmetics and soaps or soap substitutes are
now available for these people. The nurse needs to ascertain
whether the client has any sensitivities and what agents are
appropriate to use.
6. Agents used for skin care have selective actions and
purposes.
 Agents Commonly Used on the Skin
• Soap-Lowers surface tension and thus helps in cleaning. Some
soaps contain antibacterial agents, which can change the natural
flora of the skin.
• Detergent -Used instead of soap for cleaning. Some people who
are allergic to soaps may not be allergic to detergents, and vice
versa. Do not use on older clients.
• Bath oil Used in bathwater- provides an oily film on the skin
that softens and prevents chapping. Oils can make the tub surface
slippery, and clients should be instructed about safety measures
(e.g., using nonskid tub surface or mat).
• Skin cream, lotion -Provides a film on the skin that prevents
evaporation and therefore chapping.
 Powder- Can be used to absorb water and prevent friction.
For example, powder under the breasts can prevent skin
irritation. Some powders are antibacterial.
 Deodorant- Masks or diminishes body odors.
 Antiperspirant -Reduces the amount of perspiration.
 BATHING

 Bathing removes accumulated oil, perspiration,

dead skin cells, and some bacteria. The nurse
can appreciate the quantity of oil and dead skin
cells produced when observing a person after
the removal of a cast that has been on for 6
weeks. The skin is crusty, flaky, and dry
underneath the cast. Applications of oil over
several days are usually necessary to remove
the debris.
PURPOSES
 In addition to cleaning the skin, bathing also
stimulates circulation.
 A warm or hot bath dilates superficial arterioles,
bringing more blood and nourishment to the skin.
 Bathing also produces a sense of well-being. It is
refreshing and relaxing and frequently improves
morale, appearance, and self-respect. Some
people take a morning shower for its refreshing,
stimulating effect.
 Bathing offers an excellent opportunity for the nurse
to assess all clients. The nurse can observe the
condition of the client’s skin and physical conditions
such as sacral edema or rashes. While assisting a
client with a bath, the nurse can also assess the
client’s psychosocial needs, such as orientation to
time and ability to cope with the illness. Learning
needs, such as the need for a client who has diabetes
to learn foot care, can also be assessed.
 Categories OF BATH
 Two categories of baths are given to clients:
 Cleaning & Therapeutic
Cleansing baths are given chiefly for hygiene
purposes and include these types:
• Complete bed bath. The nurse washes the entire body of a
dependent client in bed.
• Self-help bed bath. Clients confined to bed are able to bathe
themselves with help from the nurse for washing the back and
perhaps the feet.
• Partial bath (abbreviated bath). Only the parts of the client’s
body that might cause discomfort or odor, if neglected, are
washed: the face, hands, axillae, perineal area, and back.
Omitted are the arms, chest, abdomen, legs, and feet.
• Bag bath. This bath is a commercially prepared product that
contains 10 to 12 presoaked disposable washcloths that contain
no-rinse cleanser solution. The package is warmed in a
microwave. The warming time is about 1 minute.
 Towel bath. This bath is similar to a bag bath but uses regular towels. It

is useful for clients who are bedridden and clients with dementia. The

client is covered and kept warm throughout the bathing process by a bath

blanket. The nurse gradually replaces the bath blanket with a large towel

that has been soaked with warm water and no-rinse soap. The client is

then gently massaged with the warm, wet, soapy towel. The wet towel is

replaced with a large dry towel for drying the client’s skin.
 Tub bath. Tub baths are often preferred to bed baths because
it is easier to wash and rinse in a tub. Tubs are also used for
therapeutic baths. The amount of assistance the nurse offers
depends on the abilities of the client. There are specially
designed tubs for dependent clients. These tubs greatly reduce
the work of the nurse in lifting clients in and out of the tub and
offer greater benefits than a sponge bath in bed.
 Shower bath. Many ambulatory clients are able to use shower
facilities and require only minimal assistance from the nurse.
Clients in long-term care settings are often given showers with
the aid of a shower chair. The wheels on the shower chair
allow clients to be transported from their room to the shower.
The shower chair also has a commode seat to facilitate
cleansing of the client’s perineal area during the shower
process
 Therapeutic baths are given for physical effects, such as
soothe irritated skin or to treat an area (e.g., the perineum).
Medications may be placed in the water. A therapeutic bath is
generally taken in a tub one-third or one-half full. The client
remains the bath for a designated time, often 20 to 30 minutes.
If the client’s back, chest, and arms are to be treated, these areas
need be immersed in the solution. The bath temperature is
generally included in the order; 37.7°C to 46°C (100°F to
115°F) may ordered for adults and 40.5°C (105°F) is usually
ordered for infants.
 FEET

 Assessing
• Assessment of the client’s feet includes a nursing health
history, physical assessment of the feet, and identifying
clients at risk for foot problems.
 NURSING HISTORY
• The nurse determines the client’s history of (a) normal
nail and foot care practices, (b) type of footwear worn,
(c) self-care abilities, (d) presence of risk factors for
foot problems, (e) any foot discomfort, and (f) any
perceived problems with foot mobility. To obtain such
data, the nurse asks the client the questions provided in
the accompanying Assessment Interview.
 PHYSICAL ASSESSMENT
• Inspect each foot and toe for shape, size, and presence
of lesions and palpate to assess areas of tenderness,
edema, and circulatory status. Normally, the toes are
straight and flat. Common foot problems include
calluses, corns, unpleasant odors, plantar warts, fissures
between the toes, fungal infections such as athlete’s
foot, and ingrown toenails.
A callus is a thickened portion of epidermis, a mass of keratotic
material. Most calluses are painless and flat and are found on the
bottom or side of the foot over a bony prominence. Calluses are
usually caused by pressure from shoes. They can be softened by
soaking the foot in warm water with Epsom salts, and abraded with
pumice stones or similar abrasives. Creams with lanolin help to
keep the skin soft and prevent the formation of calluses.

A corn is a keratosis caused by friction and pressure from a shoe.

It commonly occurs on the fourth or fifth toe, usually on a bony
prominence such as a joint. Corns are usually conical(circular and
raised).
 Plantar warts appear on the sole of the foot. These warts are
caused by the virus papovavirus hominis. They are moderately
contagious. The warts are frequently painful and often make
walking difficult.

 Fissures, or deep grooves, frequently occur between the toes

as a result of dryness and cracking of the skin. The treatment of
choice is good foot hygiene and application of an antiseptic to
prevent infection. Often a small piece of gauze is inserted
between the toes in applying the antiseptic and left in place to
assist healing by allowing air to reach the area.
 Foot Care
 ■ Wash the feet daily, and dry them well, especially between the toes.
 ■ When washing, inspect the skin of the feet for breaks or red or swollen areas. Use a mirror if

needed to visualize all areas.

 ■ To prevent burns, check the water temperature before immersing the feet.
 ■ Cover the feet, except between the toes, with creams or lotions to moisten the skin. Lotion will

also soften calluses. A lotion that reduces dryness effectively is a mixture of lanolin and mineral oil.
 ■ To prevent or control an unpleasant odor due to excessive

foot perspiration, wash the feet frequently and change socks and shoes at least daily. Special

deodorant sprays or absorbent foot powders are also helpful.

 ■ File the toenails rather than cutting them to avoid skin injury. File the nails straight across the

ends of the toes. If the nails are too thick or misshapen to file, consult a podiatrist.
 ■ Wear clean stockings or socks daily. Avoid socks with holes

or darns that can cause pressure areas.

 ■ Wear comfortable, well-fitting shoes that neither restrict the foot
nor rub on any area; rubbing can cause corns and calluses. Check
worn shoes for rough spots in the lining. Break in new shoes
gradually by increasing the wearing time 30 to 60 minutes each
day.
 ■ Avoid walking barefoot, because injury and infection may result.
Wear slippers in public showers and in change areas to avoid
contracting athlete’s foot or other infections.
 ■ Several times each day exercise the feet to promote circulation.
Point the feet upward, point them downward, and move them in
circles.
 ■ Avoid wearing constricting garments such as knee-high elastic
stockings and avoid sitting with the legs crossed at the knees,
which may decrease circulation.
 ■ When the feet are cold, use extra blankets and wear warm
socks rather than using heating pads or hot water bottles,
which may cause burns. Test bathwater before stepping into it.
 ■ Wash any cut on the foot thoroughly, apply a mild antiseptic,
and notify the primary care provider.
 ■ Avoid self-treatment for corns or calluses. Pumice stones and
some callus and corn applications are injurious to the skin. Do
not cut calluses or corns. Consult a podiatrist or the primary
care provider first.
 ■ Notify the primary care provider if you notice abnormal
sores or drainage, pain, or changes in temperature, color, and
sensation of the foot.
 TEETH
 Each tooth has three parts: the crown, the root, and
the pulp, cavity). The crown is the exposed part of
the tooth, which is outside the gum. It is covered
with a hard substance called enamel. The ivory-
colored internal part of the crown below the enamel
is the dentin. The root of a tooth is embedded in the
jaw and covered by a bony tissue called cementum.
 The pulp cavity in the center of the tooth contains
the blood vessels and nerves.
 PHYSICAL ASSESSMENT
 Dental caries (cavities) and periodontal disease are the two problems that most
frequently affect the teeth. Both problems are commonly associated with plaque
and tartar deposits.

 Plaque is an invisible soft film that adheres to the enamel surface of teeth; it
consists of bacteria, molecules of saliva, and remnants of epithelial cells and
leukocytes. When plaque is unchecked, tartar (dental calculus) is formed.

 Tartar is a visible, hard deposit of plaque and dead bacteria that forms at the gum
lines. Tartar buildup can alter the fibers that attach the teeth to the gum and
eventually disrupt bone tissue.

 Periodontal disease is characterized by gingivitis (red, swollen gingiva),

bleeding, receding gum lines, and the formation of pockets between the teeth and
gums. In advanced periodontal disease (pyorrhea), the teeth are loose and pus is
evident when the gums are pressed.
 Common Problems of the Mouth
PROBLEM DESCRIPTION NURSING IMPLICATIONS
Halitosis Bad breath Teach or provide regular oral
hygiene.
Glossitis Inflammation of the tongue As above

Gingivitis Inflammation of the gums As above

Periodontal disease Gums appear spongy and As above

bleeding
Reddened or excoriated Check for ill-fitting dentures.
mucosa

Excessive dryness of Increase fluid intake as health

the buccal mucosa permits.
Cheilosis Cracking of lips Lubricate lips, use
antimicrobial ointment
to prevent infection.

Dental caries Teeth have darkened areas, may be Advise client to see a
painful dentist.

Sordes Accumulation of foul matter (food, Teach or provide regular

microorganisms, cleaning.
and epithelial elements) in the mouth

Stomatitis Inflammation of the oral mucosa Teach or provide regular

cleaning.

Parotitis Inflammation of the parotid salivary Teach or provide regular

glands oral hygiene
 Hair
 The appearance of the hair often reflects a person’s
feelings of self-concept and sociocultural well-being.
Becoming familiar with hair care needs and practices that
may be different than our own is an important aspect of
providing competent nursing care to all clients. People
who feel ill may not groom their hair as before.

 A dirty scalp and hair are itchy, uncomfortable, and can

have an odor. The hair may also reflect state of health
(e.g., excessive coarseness and dryness may be associated
with endocrine disorders such as hypothyroidism).
 PHYSICAL ASSESSMENT
 Problems include dandruff, hair loss, ticks,
pediculosis, scabies, and hirsutism.

 Dandruff. Often accompanied by itching,

dandruff appears as a diffuse scaling of the
scalp. In severe cases it involves the auditory
canals and the eyebrows. Dandruff can usually
be treated effectively with a commercial
shampoo. In severe or persistent cases, the
client may need the advice of the primary care
provider.
 Hair Loss. Hair loss and growth are continual
processes. Some permanent thinning of hair
normally occurs with aging. Baldness,
common in men, is thought to be a hereditary
problem for which there is no known remedy
other than the wearing of a hairpiece or a
costly surgical hair transplant, in which hair is
taken from the back or the sides of the scalp
and surgically moved to the hairless area.
Although some medications are being
developed, their long-term outcomes are
unknown.
 Ticks. Small gray-brown parasites that bite
into tissue and suck blood.

 Pediculosis (Lice). Lice are parasitic insects

that infest mammals. Infestation with lice is
called pediculosis. Hundreds of varieties of
lice infest humans. Three common kinds are
Pediculus capitis (the head louse), Pediculus
corporis (the body louse), and Pediculus pubis
(the crab louse).
 Scabies. Scabies is a contagious skin
infestation by the itch mite. The characteristic
lesion is the burrow produced by the female
mite as it penetrates into the upper layers of the
skin.

 Hirsutism. The growth of excessive body hair

is called hirsutism.
THANK YOU