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• Personal hygiene is vital

Nurse's Role

• Nurses are responsible for giving patients hygiene opportunities
• The hygiene task can sometimes be delegated

Scientific Basis of Hygiene

• Personal hygiene promotes comfort, safety, and well-being
• Ill patients usually need assistance with personal hygiene
• The patient's culture and age will affect how they approach hygiene
• Proper hygiene maintains the normal structure and function of tissues
• Pathophysiology knowledge should be used to provide hygiene care

Benefits of Bathing

• For patients, bathing offers skin cleansing, better circulation, comfort and relaxation
• Bathing can improve the patient's self-esteem
• For nurses, bathing allows for skin assessment
• Bathing can establish a nurse-patient relationship

Nursing Knowledge for Hygiene

• Explore the patient's point of view regarding hygiene
• Communicate effectively to build a therapeutic relationship with the patient
• Assess the patient's emotional state, health promotion practices, and health care education needs during hygiene care
• Assessment during hygiene may be based on:
  • Self-care ability
  • Oral cavity condition
  • Skin conditions
  • Foot and nail condition
  • Eyes, ears, and nose condition
• Assess if sensory aids are needed
• Cultural influences also play a role
• Patients may be at risk for hygiene problems

Factors Affecting Hygiene

• Social Patterns: consider ethnic, social, and family influences
• Personal preferences dictate hygiene practices
• Body image: consider subjective concepts of their body appearance
• Socioeconomic status influences the type and extent of hygiene practices used
• Health beliefs and motivation: motivation is the key factor in hygiene
• Cultural variables depend on a person's diverse cultural hygiene rituals
• Developmental stage: affects the patient's ability to perform hygiene care
• Consider if the patient lacks physical energy and dexterity to perform self-care

Critical Thinking for Hygiene Plans

• Integrate nursing knowledge and consider developmental and cultural influences
• Use and draw on your own experiences
• Be nonjudgmental, confident, and rely on professional standards
• Use caring methods to reduce anxiety and promote comfort
• Administer medications for symptoms before providing hygiene
• Monitor patients for anxiety or fear
• Assist and prepare patients to do hygiene independently
• Educate patients on hygiene techniques and signs of problems
• Tell patients about community resources

Hygiene Implementation

• Follow normal grooming routines and personalize care

Bathing and Skin Care

• Examples of bathing and skin care include:
  • Therapeutic baths (Sitz bath or medicated bath)
  • Complete bed bath
  • Showering
  • Partial bed bath
  • Bag baths
  • Perineal care
• Other implementations are:
  • Back rubs
  • Foot and nail care

Levels of Care

• Self-care: The patient is capable of performing ADLs (Activities of Daily Living) without help
• Assisted care: The patient requires some ADL assistance
• Total care: The patient can do very little or nothing for their own care

Bathing Guidelines

• Always provide patient privacy
• Maintain safety and warmth
• Promote independence
• Anticipate patient needs

Responsibilities While Bathing

• Check the skin for rashes, bruises, and other lesions
• Complete bathing in a timely way
• Watch for signs of patient fatigue
• To conserve the patient's energy during the bath, take proper measures

Oral Hygiene Assessment

• Consider the condition of the patient's mouth to determine frequency
  • Assess if Some patients with dry mouth or lips need oral care more often
  • Oral care is usually done twice a day or after each meal
• Assess whether the patient needs help with oral care
• The nurse can help maintain good oral hygiene by:
  • Help patients by providing teaching on correct techniques
  • Actually performing care for weakened or disabled patients

Oral Hygiene Details

• Brushing removes particles, plaque, and bacteria while messaging the gums and improving the odor
• Flossing extracts tartar at the gum line
• Rinsing removes particles and excess toothpaste
• Patients with diabetes, artificial airways, are unconscious, or have chemotherapy need special needs

Special Oral Patients

• Oral hygiene is impacted in patients who:
  • Are NPO
  • Need oxygen by cannula or mask
  • Have a nasogastric or feeding tube
  • Are unconscious
• Assess for abnormalities, such as:
  • Loose or missing teeth
  • Swollen and bleeding gums
  • Unusual mouth odor
  • Pain or stinging in mouth structures

Denture Care

• Grasp the front of dentures with gauze squares or a washcloth to prevent slipping
• Put a washcloth or paper towel in the sink when cleaning dentures
• Clean dentures close to the bottom of the sink
• Dentures should be handled carefully because they can be easily broken
• Before bed, remove dentures so gums can rest and prevent bacterial buildup
• Store dentures in a labeled container covered with water or denture cleaner

Unconscious Patients

• Oral hygiene for unconscious patients requires extra safety is required and aspiration prevention
• Use Positioning of lateral position with head turned to the side or side-lying
• Position the back of head on a pillow so that the face tips forward
• Use a bulb syringe or suction machine with suction equipment nearby
• Use a padded tongue blade to open the patient's mouth and separate the upper and lower teeth
• Never placing your hand in the patient's mouth or open their mouth with your fingers
• An oral airway can be used to hold the mouth open
• Use a small brush or swab to clean the mucous membranes and teeth
• Remove secretions and fluid with suction
• Apply lip moisturizer or chapstick

Implementation: Hair and Scalp Care

• Brushing and combing: Distributes oil and prevents tangling
  • Seek permission before braiding or cutting
• Shampooing
• Shaving
• Mustache and beard care

Brushing and Combing

• Keeps hair clean and distributes oil evenly along the hair shaft
• Combing styles hair and prevents tangling
• While brushing, assessment includes:
  • Scalp lesions and abrasions
  • Dandruff
  • Parasitic infestations
  • Hair health analysis including quality and appearance

Shampooing Hair

• Shampooing frequency depends on:
  • Personal preference of the patient
  • Whether the patient needs it every day
  • Condition of the hair
• Ways to shampoo:
  • Use a hand-held nozzle if a patient can get in a shower or sink
  • Place the patient on a stretcher and wheel them to a shower area if they can not get up
  • Shampoo in bed, if the patient is unable to be moved
  • Use "Shampoo in a Bag" or dry shampoo

Shaving

• Shaving improves self-esteem and attends to emotional needs
• It is usually done after a bath or shampoo
• When shaving, assess: -Skin for elevated moles, warts, rashes, patchy skin lesions, or pustules
• Those at risk for bleeding, confused, or depressed should use electric razors

Provide safe shaving

• Soften the skin when using a razor blade to prevent pulling, scraping, or cutting
• Apply a warm washcloth, gel, cream, or foam over the area
• Hold the razor at a 45° angle
• Pull the skin taut and shave in the direction of hair growth

Care and Hygiene

• Care of the genitalia can be an embarrassing implementation for the nurse and the patient
• It is important not to overlook genital care because of embarrassment
• If possible, allow patient to do this themselves
• Giving patients a washcloth to finish their bath allows them privacy and independence

Peri-Care Defined

• Vaginal or urethral discharge
• Skin irritation
• Catheter
• Surgical dressings
• Incontinence of urine or feces

Female Peri-care

• Use a clean part of the washcloth for each swipe, wipe labia majora (outer) from front to back in downward motion
• Use a clean surface of a washcloth, wipe the labia minora (inner) from front to back in downward motion
• Use a clean surface of a washcloth, wipe down the center of the meatus from front to back
• Clean around the catheter in a circular motion with a clean portion of the washcloth, if one is in place
• Wash inner thighs from proximal to distal

Male Peri- Care

• Retract the foreskin of the penis if uncircumcised
• Use a clean part of the washcloth, and wash around the urinary meatus in a circular motion
• While changing the washcloth's position for each stroke, wash down shaft of penis toward the thighs
• Wash scrotum – front to back
• Wash inner thighs

Foot and Nail Care

• Usually part of the bath
• The purpose is to eliminate sources of infection, as well as decreasing odors
• Assessments include:
  • Color, length, shape, and texture of nails
  • Note condition of the skin around nails and between toes and fingers– swollen, inflamed, callused, lesions, and temperature

Foot and Nail Care Details

• Soak the hand or foot to soften the cuticles
• Thoroughly cleanse and dry
• Only trim the nails if you the patient has given permission
• Most institutions do not allow nurses trim the nails
• Teach patient and family that nails should be blunt or straight across
• If no one available to cut nails, may need to get a referral
• The feet and nails of diabetic or elderly patients is especially important pay attention to
• Notify doctor for consult with podiatrist if feet and nails are in bad condition

Ear Care

• Usually requires minimal care
• Cleanse the external auricle with washcloth when bathing
• Avoid insertion of objects into the ear

Eye Care

• Assessments to conduct:
  • Note abnormal lesions
  • Note discharge, tearing
• Note presence of any infection
• Use of visual aids such as contacts or glasses
• Ask when the patient needs to use these devices
• Wash around the eyes with a warm and moist washcloth with warm water
• DO NOT USE SOAP!
• Cleanse from the inner canthus to the outer canthus of the eye
• Give special care to unconscious patient's eyes
  • This includes taping the eyelids shut if a patient can't blink or protects their eyes

Safety Guidelines

• Communicate clearly with team members
• Consider patient's priorities
• Progress from the cleanest to the least clean areas
• Use clean gloves for contact with nonintact skin, mucous membranes, secretions, excretions, or blood
• Test the temperature of water or solutions
• Apply principles of body mechanics and safe patient handling
• Be sensitive to the invasion of privacy