Hygiene and Hygienic Care Essentials

Hygiene

• Hygiene is the science of health and maintenance
• Personal hygiene involves self-care activities like bathing, toileting, and grooming
• Hygiene is a highly personal matter influenced by individual values and practices
• Its purpose includes promoting cleanliness, comfort, relaxation, self-image, and healthy skin
• It encompasses care for skin, hair, nails, teeth, mouth, eyes, ears, and the perineal area

Hygienic Care

• The type of care provided depends on the client's ability, needs, and practices
• Common types include:
  • Early morning care (provided to clients as they awaken, involves urinal/bedpan, face/hand washing, oral care)
  • Morning care (often provided after breakfast, includes elimination needs, bathing/showering, perineal care, back massages, nail/hair care, and making the bed)
  • Hour of sleep/Afternoon care (provided before clients retire, involves elimination needs, face/hand washing, oral care, and back massage)
  • As-needed care (provided as needed by a client, like if someone is sweating profusely)

Factors Influencing Hygiene

• Culture (ceremonial washing practices)
• Environment and socioeconomic status (finances affect resources for bathing, e.g., homelessness)
• Developmental level
• Health and energy levels
• Personal preferences (type of bath, time of bathing)

Functions of the Skin

• Protection
• Body temperature regulation
• Sensation
• Excretion
• Maintaining water and electrolyte balance
• Vitamin D production in conjunction with sunlight

Assessing Skin and Hygiene Practices

• Assessment includes:
  • Nursing health history (determines client's skin care practices, preferences)
    • Important considerations include: client balance for tub/shower, activity tolerance (fatigue, pain), coordination, vision, appropriate range of motion, muscle strength, client preferences, cognitive and motivational levels, client's functional levels (0-4, completely independent-totally dependent)
  • Physical assessment (inspection and palpation)
    • Data collected includes skin color, uniformity of color, texture, turgor, temperature, intactness, and lesions -Presence of past or current skin problems (abrasions, dryness, ammonia dermatitis, acne, erythema, hirsutism) alerts the nurse to specific interventions or referrals for the client.
• This assessment informs appropriate care plans.

Common Skin Problems

• Abrasions: superficial skin damage
• Excessive dryness: rough skin
• Ammonia dermatitis (Diaper rash): skin irritation due to bacteria and urea
• Acne: inflammatory skin condition
• Erythema: redness
• Hirsutism: excessive hair growth

At-Risk Clients

• Limited joint mobility
• Dehydration
• Chemotherapy or radiation therapy
• Immunosuppression
• Reduced sensation
• Chronic disease
• Excessive secretion
• Malnourished
• Limited sensory ability
• Presence of external devices/tubes

Nursing Diagnoses

• Self-Care Deficit (used for clients with concerns performing hygiene care)
• Self-Care Deficit: Bathing
• Self-Care Deficit: Dressing
• Self-Care Deficit: Toileting
• Self-Care Deficit: Feeding
• Possible associated diagnoses related to self-care deficit: knowledge deficit, lack of experience, unfamiliar devices, low self-esteem

Etiology of Self-Care Deficits

• Decreased or lack of motivation
• Weakness or tiredness
• Pain or discomfort
• Perceptual or cognitive impairment
• Neuromuscular or musculoskeletal impairment
• Medically imposed restrictions
• Therapeutic procedures that restrict mobility (e.g., IVs, casts)
• Severe anxiety
• Environmental barriers

Planning

• In planning care, the nurse, if appropriate, and/or family set outcomes for each nursing diagnosis
• Goals include increasing self-care ability, patient knowledge, promoting self-esteem, and preventing complications like bed ulcers.

Planning in Assisting Clients with Hygiene

• Client's personal preferences
• Client's health limitations
• Best time to provide care
• Available equipment, facilities, and personnel
• Assessing client comfort (gender considerations)

Implementation

• Interventions and activities to achieve client outcomes
• Assisting dependent clients with bathing, skin care, and perineal care
• Providing back massages to promote circulation
• Instructing clients/families about hygiene practices
• Demonstrating assistive equipment usage

General Skin Care Guidelines

• Intact skin is the body's first line of defense
• Degree to which skin protects underlying tissue depends on general health, cell health, and skin dryness.
• Moisture can lead to bacterial growth and irritation
• Body odor is caused by resident bacteria and body secretions.
• Skin sensitivity to irritation and injury varies.

Implementing Bathing

• Purpose of bathing includes removing oils, perspiration, dead skin cells, and some bacteria
• Stimulates circulation
• Promotes well-being, morale, appearance, and self-respect
• Offers a chance for the nurse to assess clients.

Categories of Baths

• Cleaning baths (hygiene purposes)
  • Complete bed bath: nurse washes entire body
  • Partial bath: focuses on specific areas
  • Self-help bath: client takes part but with aide
  • Bag bath: utilizes warm cloths and a cleanser.
• Therapeutic baths (requires physician's order)
  • Temperature, body area, medicated solutions used

Client Teaching

• Dry skin: use cleansing creams instead of soaps, use bath oils, minimize rinsing soap, increase fluid intake, use moisturizing creams.
• Skin rashes: keep area clean and dry, relive itching with lotions. Avoid scratching/avoid harsh fabrics.
• Acne: wash face frequently with soap/hot water, avoid oily creams/cosmetics that block sebaceous glands. Do not squeeze lesions.