Hygiene Care Schedule

Hygiene Care Schedule

Early Morning Care

• Nursing staff on the night shift offer basic hygiene for patients preparing for breakfast, scheduled tests, or early morning surgery
• "AM care" includes offering a bedpan or urinal if the patient is not ambulatory
• Includes washing the patient's hands and face, and helping with oral care

Routine Morning Care

• Following breakfast, further assistance involves providing a bedpan or urinal to confined patients
• Offering a full or partial bath or shower, incorporating perineal care and oral, foot, nail, and hair care
• Performing back rubs, changing gowns or pajamas, changing linens, and arranging the bedside unit and room
• This is often called complete AM care

Afternoon Care

• Hospitalized patients often undergo diagnostic tests or procedures in the morning
• In rehabilitation settings, patients participate in physical therapy in the morning
• Afternoon hygiene care includes washing the hands and face, helping with oral care, offering a bedpan or urinal, and straightening bed linen

Evening, or Hour-before-Sleep, Care

• Prior to bedtime, assist with personal hygiene
• This helps patients relax and promotes sleep
• "PM care" involves changing soiled bed linens, gowns, or pajamas, helping patients wash the face and hands
• Providing a back massage
• Offering the bedpan or urinal to nonambulatory patients
• Diet should be checked to determine which beverages are allowed

Acute, Restorative, and Continuing Care

• Nursing knowledge and skills are needed for hygiene care
• Hygiene cares are consistent across all health care settings
• Some hygiene skills apply in health promotion
• The timing, variety, and frequency of hygiene vary across healthcare settings and according to individual patient needs
• Frequent diagnostics/ treatments, acute-care-setting-factors, and impact extensive hygiene care
• Patient symptoms/illness and injury impact all contribute

Risks for Injury in Hygiene Care

• There is a risk for bruising and other injuries.
• Skin glands production decreases as production of lubricating substances decreases, causing skin to become dry and itchy.
• Older adults need caution when bathing, turning, repositioning, etc.
• Excessively frequent bathing with hot water or harsh soap cause the skin to become excessively dry.

Foot and Nail Care

• Foot health matters for mobility, overall well-being.
• Patients with aging, continued exposure to walking, weight bearing become more likely to develop chronic foot problems.
• Contributing factors include poor footwear fit, local abnormalities, and systemic disease.
• Morton's neuroma, is common in middle aged women, affects health by causing burning, numbness, pain of the foot on weight-bearing.
• Older adults may lack strength, flexibility, visual acuity, manual dexterity for foot/nail care. Foot problems impact comfort, mobility, quality of life.
• Modifying footwear can reduce risk, improve comfort/safe mobility
• Dry feet result from decreased sebaceous gland secretion, dehydration of epidermal cells.
• Additional foot problems include corns, calluses, bunions, hammertoes, maceration of toes, fungal infections, and arthritis.

The Mouth

• Infants begin teething at approximately 6 to 8 months
• First permanent (secondary) teeth erupt at about 6 years
• Throughout adolescence through middle adulthood, teeth and gums remain healthy if a person follows healthy eating patterns and dental care.
• Avoiding fermentable carbohydrates and sweets helps keep teeth free of dental caries.
• Regular brushing (twice a day) and flossing reduce caries and periodontal disease.

Cultural and Religious Practices: Nursing Assessment Questions

• Consider cultural and religious preferences when discussing the following:
• Bathing and showering
• Preferences about same-sex caregivers
• Hair care
• Foot care

Tolerance of Hygiene Activities: Nursing Assessment Questions

• How comfortable are you with someone helping you with your bathing
• Would you prefer a care provider of the same gender?
• In what way can I best help you with your bath, skin, and hair care?
• Tell me about any symptoms, such as shortness of breath, pain, or fatigue, that you experience during bathing
• What can I do to minimize these symptoms?
• Which aspects of bathing, toothbrushing, hair care, or foot care cause discomfort or fatigue?
• Is there a particular time of day when hygiene activities may be less fatiguing?

Assistance with Hygiene: Nursing Assessment Questions

• Do you use any aids to help you with your bath, such as grab bars in your tub or shower?
• Which parts of the bath, toothbrushing, and foot care can you do for yourself?
• With which parts of hygiene care do you need help?

Skin Care: Nursing Assessment Questions

• Which type of bath do you prefer?
• How often and when do you usually bathe?
• Do you have preferences for bath soap or lotion?
• Have you noticed any skin changes or irritation?
• Do you have any known allergies or reactions to soaps, cosmetics, or skin care products?

Mouth Care: Nursing Assessment Questions

• Do you have any mouth pain or toothaches?
• Have you noticed any sores in your mouth?
• Do your gums bleed during brushing or flossing?
• Do you wear dentures or a partial plate?

Foot and Nail Care: Nursing Assessment Questions

• How do you usually care for your feet and nails?
• Do you soak your feet?
• Do you file or trim your own fingernails and toenails?

Hair and Scalp Care: Nursing Assessment Questions

• Have you recently experienced itching of the scalp or noticed flaking or dandruff?
• Have you noticed any changes in the texture or thickness of your hair?

Hair and Scalp Problems: Characteristics, Implications, and Interventions

Dandruff

• Scaling of scalp is accompanied by itching
• Implications: Causes embarrassment if enters eyes, conjunctivitis often develops
• Intervention: Shampoo regularly with medicated shampoo; severe cases obtain health care provider’s advice

Pediculosis Capitis (Head Lice)

• Characteristics: Head lice are difficult to remove; parasites tend to cling to hair shaft; eggs look like oval particles, be observed behind ears and at hairline.
• Implications: Head lice are difficult to remove and spread to furniture and other people if treated. Do not fly or jump. Can cause adverse reactions
• Intervention: Wearing gloves, check entire scalp by using tongue depressor or special lice comb; use medicated shampoo containing lindane because the ingredient is toxic and known to cause adverse reactions; check hair for nits, comb with a nit comb for 2 to 3 days until all lice and nits have been removed. Consult health care provider.

Pediculosis Pubis (Crab Lice)

• Characteristics: Parasites are in pubic hair; Crab lice are grayish white with red legs
• Implications: Lice spread through bed linen, clothing, or furniture or between people via sexual contact.
• Intervention: Shave hair off affected area. Clean as for body lice; if lice were sexually transmitted, notify partner.

Pediculosis Corporis (Body Lice)

• Characteristics: Patient itches constantly; Scratches seen on skin become infected; hemorrhagic spots appear on skin where lice are sucking blood.
• Implications: Lice spread through bed linen, clothing or linen thoroughly . After skin is dried, apply recommended pediculicide lotion. After 12 to 24 hours take another bath or shower. Bag infested clothing or linen until laundered in hot water; vacuum rooms.
• Intervention: Bathe or shower thoroughly . After skin is dried, apply recommended pediculicide lotion. After 12 to 24 hours take another bath or shower; bag infested clothing or linen until laundered in hot water; vacuum rooms.

Hair Loss (Alopecia)

• Characteristics: Alopecia occurs in all races; Balding patches are in periphery of hairline; Hair becomes brittle and broken.
• Implications: Patches of uneven hair growth and loss alter patient’s appearance.
• Intervention: Stop hair-care practices that damage hair, leasing hair, hair picks tight braiding, excessive heat when blow-drying.

Use of Sensory Aids

• For patients wearing eyeglasses, contact lenses, artificial eyes, or hearing aids: assess knowledge and methods used to care.
• When possible, describe the typical approach used in routine and standard practice.
• Any difference provides an opportunity for patient education.

Assessment of Cultural Influences

• Ask what will make a patient most comfortable during a bath or other hygiene measures
• Perhaps a patient prefers the bathing of more private body parts

Assessment of Hygiene Care Practices

• Assessment of hygiene practices reveals a patient’s preferences for grooming
• For example, a patient chooses to groom hair in a certain style or trim nails in a special safety way
• For example, teach a patient with diabetes mellitus proper foot hygiene or a bariatric patient adaptive bathing methods.
• Safe and effective patient-centered care improves patient satisfaction, health outcomes, adherence to treatments, and reduces costs.

Common Foot and Nail Problems

• Common foot and nail problems include:
• Calluses
• Thickened portion of epidermis, consisting of masses of horny, keratin-like cells, usually flat and painless, caused by pressure
• Corns
• Keratinized lesions caused by friction and pressure from shoes; mainly on toes, over bony prominence
• Plantar Warts
• Warts are sometimes contagious, are painful, and make walking difficult
• Athlete's Foot
• Athlete's foot can spread to other body parts, especially hands. It is contiguous and often recurs
• Ingrown nails
• Ingrown nails cause localized swelling and pain at the lateral nail corners

Cultural Aspects of Care

• Culture can influence hygiene practices
• Cultural variations, socioeconomic status, and health beliefs influence a patient's hygiene practices
• It's important to provide a culturally congruent plan for hygiene care

Hygiene Practices

• Important to provide a patient with a culturally congruent plan
• Provide equitable and ethical care that is based on respect for people with diverse backgrounds

Implications for Patient-Centered Care

• Maintain patient privacy
• Collaborate with community leaders when providing health education
• Be aware of cultural practices that may affect the timing of hygiene activities
• Recognize that some cultures prohibit or restrict touching
• Be aware that different cultures have preferences about hot water and cold water

Nursing Knowledge Base

• A number of factors influence personal preferences for hygiene and the ability to maintain hygiene
• Requires knowing the patient and using therapeutic communication skills

Factors Influencing Hygiene

• Social practices, personal preferences, body image, socioeconomic status, and health beliefs
• Socioeconomic status influences the type and extent of hygiene

Function of the Skin and Implications for Care

Protection

• Description: Epidermis is relatively impermeable layer that prevents entrance of microorganisms.
• Implications for Care: Weakening of the epidermis occurs by scraping or stripping its surface (use of dry razors, tape removal).

Sensation

• Description: Skin contains sensory organs for touch, Pain, heat, cold, and pressure.
• Implications for Care: Smooth linen out to remove sources of mechanical irritation. Make sure that bath water is not excessively hot or cold.

Temperature Regulation

• Description: Radiation, evaporation, conduction, and convection control body temperature.
• Implications for Care: Factors that interfere with heat loss after temperature control; wet bed linen or gowns increase heat loss.

Excretion and Secretion

• Description: Sweat promotes heat loss by evaporation. Sebum lubricates skin and hair.
• Implications for Care: Perspiration and oil sometimes harbor microorganisms; Bathing removes excess body secretions, but excessive bathing causes dry skin.