Hygiene and Personal Care in Nursing

• Hygiene and personal care are important aspects of patient health

Learning Objectives

• Understanding the connection between hygiene and the skin, hair, nails, and mucous membranes is crucial
• Changes in the skin, hair, nails, and mucous membranes can impact hygiene care
• It is important to evaluate a patient's hygiene status and determine if they need assistance
• Nursing diagnoses should prioritize patients who need help with hygiene or have problems with self-care
• Establish realistic, patient-focused objectives for individuals experiencing issues with hygiene and self-care
• Nursing care plans should be implemented and evaluated to address patients' hygiene requirements

Hygiene

• Hygiene practices include bathing, oral care, perineal care, foot care, and shaving
• Hygiene practices vary depending on personal habits, cultural beliefs, ethnic customs, and age
• Nurses should consider patients' backgrounds and respect their unique habits and customs
• Nurses should communicate with patients, assess their skin, and look for any abnormalities during patient care
• Bathing helps cleanse the skin, eliminate harmful bacteria, reduce odor, promote comfort, and improve overall health

Structure and Function of Skin, Hair, and Nails

• Key components of the integumentary system are skin, nails, hair, sweat glands, and sebaceous glands
• Sweat glands are activated by heat, anxiety, or stress and can lead to body odor
• Nurses cleanse the integumentary system during hygiene care in order to keep tissues healthy, minimize odor, and improve comfort
• Cleansing the skin eliminates microorganisms that can cause infection and odor
• Hair follicles start in the dermis and rise through the epidermis
• Sebaceous glands produce sebum which keeps the hair and skin soft
• Hair will become greasy if it is not washed
• Nails are made of keratinized epithelial cells that grow from the nail matrix, protecting the tips of fingers and toes and should be cut

Structure and Function of Skin, Hair, and Nails, Oral Cavity

• Mucous membranes line the body's passages and cavities which includes the nasal, oral, vaginal, urethral, and anal areas
• The outer layer of mucous membranes is composed of epithelial cells
• Mucus traps particles in the nose, and cilia help move the trapped particles, which helps the throat clear when swallowed
• The salivary glands produce saliva, which promotes chemical digestion and keeps the oral cavity moist
• Digestion starts in the mouth
• Gingivae, which are composed of connective tissue and epithelial cells, surround tooth roots
• Oral health is critical for ingesting and chewing food

Alterations in Structure and Function Affecting Hygenic Care

• Ulcers, incisions, and wounds should be considered as structural alterations
• Excessively dry skin can lead to integumentary system cracks and openings
• Excoriation is a red, scaly condition with surface loss of skin tissue which is common when skin is exposed to fluids such as stool, urine, or gastric juices
• Decreased sensation is an alteration in function
• Patients with neurological problems, e.g. diabetic neuropathy, may not be able to detect hot and cold, and the nurse should monitor water temperature
• Alopecia, or hair loss, can be caused by heredity, illnesses, or drugs such as chemotherapy
• Treatment might involve consulting a beautician or barber

More Structure and Function Alterations Affecting Hygenic Care

• Pediculosis (head lice) is transmitted through contact with infested items like combs, hats, or linens
• Fungal, bacterial, and viral infections can discolor nails which may require the consultation of a primary care practitioner (PCP) or podiatrist for nail trimming
• Gingivitis, broken or missing teeth, and halitosis can affect the oral cavity
• Recent treatments, immobility, or cognitive impairment can cause self-care changes

Assessment

• Assess skin, hair, nails, and oral cavity
• Ask patients about skin changes before giving care
• Observe the condition of exposed skin and note odors
• Check the cleanliness and grooming of the hair
• Observe fingernails and toenails when assessing peripheral vascular status
• Assess oral hygiene as part of a comprehensive head-to-toe assessment
• Assess self-care abilities by asking questions about home care, and observe the patient's ability to complete ADLs
• Refer to community resources for assistance after discharge if needed
• Evaluate the skin for indications of illness caused by inadequate hygiene
• Provide required patient education

Priority Problems

• Nursing diagnoses include self-care deficit, e.g. bathing
• Supporting data includes; labored respirations of 28, strong body odor, uncombed hair, and dry, flaky skin on feet
• Diagnose ability to perform self-care if patient is able to get out of bed, stand at the sink, and express a desire to be independent in ADLs
• Impaired health maintenance can include; a lack of understanding of diabetes care, inability to recall most recent meal, poor hygiene, unkempt appearance, and halitosis

Planning and Implementation

• Prioritize hygiene-related nursing diagnoses based on patient needs and risk factors
• Create individualized nursing care plans focusing on self-care abilities, available resources, and family involvement
• Involve healthcare professionals, patients, and families in creating long-term and short-term goals
• Provide complete or partial bed baths, sink baths, showers, or chair showers for implementation
• Cleanse the female perineal area front to back, note the steps for intact foreskin when caring for a male, as well as the fact that a male may have an reaction during care
• Promote comfort while preventing odors and skin breakdown, and avoid soaking feet of patients with neuropathy
• Avoid nicks or cuts when cutting toenails, especially in those with circulation issues
• After proper washing and drying, lotions should be put on the top and bottom avoiding the area between toes to avoid infection
• In some care settings, a PCP order is necessary before trimming toenails, or patients are referred to a podiatrist for this procedure
• Types of massage include; Effleurage (long hand movements), Pétrissage (kneading motion), and Tapotement (tapping or percussion motion)
• Types of hair care; shampooing, shower, shampoo basin, no-rinse shampoo, shampoo cap, and pediculicidal shampoo

Eye Care

• Visual aids, Glasses, Contact lenses
• For patients whose eyes do not totally close at night, an eye patch and prescribed eyedrops may be necessary to prevent corneal drying
• Most patients can care for their own prothesis
• A prosethic eye can be removed by pulling down on the lower lid with a gloved hand and exerting pressure on the lower edge of the artificial eye to break the suction that holds the eye in the socket and clean with saline
• Moisture is important for the nose, remove moist secretions using suction and remove dried mucus using a moistened, cotton-tipped applicator

Ear Care and Shaving

• Special oil drops is needed for ear wax before ear canal irrigation
• Hearing aids should be kept dry and clean with a dry cloth
• Shaving should not be performed without consent and be aware of patients on anticoagulants
• Bed making should be done in order to reduces the risk of skin breakdown, and beds may be made while unoccupied or occupied

Evaluation of Care

• Observe the patient during care to assess the attainment of self-care goals
• Establish new, longer-term goals once existing goals are reached
• Patients who are able to do more of their own care on a daily basis are showing increased self-care abilities

This quiz covers essential aspects of hygiene and personal care in nursing, including foot care, cultural considerations, shampooing methods for patients with limited mobility, rash identification during bed baths, interventions for dry eyes, and care for patients with prosthetic eyes. It emphasizes patient safety and comfort.