Personal Hygiene and Care

• Personal hygiene promotes comfort, safety, and health

• Intact skin and mucous membranes provide the body's defense against disease by preventing microbes from entering the body and causing infection

• Some clients require minimal help with their personal hygiene, while otters need all their hygiene done for them

• Illness, disability, and changes associated with aging affect the ability to practice hygiene

• Good hygiene cleanses the body, prevents body and breath odors, is relaxing, and increases circulation

• Culture and personal choice affect hygiene, influencing rituals around washing, frequency of bathing, and washing & prayer

• Factors affecting hygiene and skin care include perspiration, elimination, vomiting, drainage from wounds or body openings, bed rest, and activity

• Care plans identify the personal hygiene measures for clients and require following the nurse's directions

• Hygiene routines typically include early morning care, morning care, afternoon care, and HS care (PM or evening care before sleep)

• Assistance with hygiene should be offered whenever it is needed

• Clients may feel frustrated, angry, or embarrassed because of needing help with personal care

Bathing

• Bathing removes microbes, dead skin, perspiration, and excess oils.
• Bathing cleans the mucous membranes of the genital and anal areas.
• Additional benefits include relaxation, stimulated circulation, exercised body parts, and time with the person
• Complete or partial baths, tub baths, or showers can be given.
• Bathing method depends on the client's condition, self-care abilities, and personal choice
• Client's choice of bath time is respected whenever possible
• Bathing frequency is a personal matter, but the weather, physical activity, and illness may affect bathing frequency

Observations for Bathing a Client

• Swelling of the feet and legs
• Color of skin, lips, nail beds, and sclera
• Location and description of rashes
• Drainage or bleeding from wounds or body openings
• Dry skin
• Pale or reddened area
• Bruises or open skin areas

Complete Bed Bath

• A complete bed bath entails washing the client's entire body in bed.
• The clients that usually require complete bed baths are unconscious, paralyzed, in casts or traction, or weak from illness or surgery

Partial Bed Bath

• A partial bed bath involves bathing the face, hands, underarms, back, buttocks, and perineal area
• Some clients bathe themselves in bed or at the sink, requiring assistance as needed

Tub Bath or Shower Safety

• Clients may become faint, weak, or very tired during the bath.
• Tubs are cleaned before and after use to prevent the spread of microbes and infection
• When using hydraulic lifts, all safety devices should be applied
• Follow employer policy for staffing, lock the wheels of the shower chair, and test water temperature

Tub Bath and Shower Risks

• Falls, burns, and chilling from water.
• Safety requires no oils in bath and protection of the client's privacy.
• Tub baths should be no longer than 20 minutes.
• Follow the nurse's directions and the care plan

Bathing Problem Actions

• The client has the right to refuse a bath if they give informed consent
• Inform a supervisor of the refusal, and do not bathe clients against their wishes
• Try to determine whether their potential reasons for a bathing refusal include feeling ill or weak, fear of falling or getting chilled, or embarrassment
• Use a calm, pleasant voice with a client who has dementia and may be frightened by bathing procedures.
• If a client urinates or defecates drain the tub, remove stool, and control verbal and nonverbal reactions
• Privacy is important during erections, provide safety and time alone, if possible

Soaps & Powders

• Soaps are needed for removing dirt and microbes, but can be drying and cause scratching. They may not be needed for every bath, but must be rinsed well
• Powders absorb moisture, prevent friction, and should be used sparingly to avoid encouraging bacterial growth
• Powders can irritate the lungs, require sprinkling on your hands first, and should not be shaken all over clients

Back Massage (Back Rubs)

• Back massages relax muscles and stimulate circulation
• Back massages are given after the bath and with evening care
• Massage can be given after repositioning to help the client relax and usually lasts 3-5 minutes
• Observe the skin before the massage before using warmed lotion during the massage with firm strokes
• Lotion should be applied to the elbows, knees, and heels after the massage

Perineal Care (Pericare)

• It involves cleaning the genital and anal areas
• Cleaning prevents infection and odors while promoting comfort
• Important to provide daily during the bath and always when the area is soiled with urine or feces; clients do their own perineal care if they can
• The procedure embarrasses many clients and requires following Standard Practices by wearing gloves

Perineal Care Practices

• Use warm water, not hot
• Always work from the cleanest (urethra) to the dirtiest (anal) area
• Use washcloths or towelettes according to agency policy and rinse thoroughly, pat dry after rinsing

Report Observations at Once

• Redness, swelling, discharge, or irritation.
• Presence of hemorrhoids and odors
• Complaints of pain, burning, or other discomfort
• Signs of urinary or fecal incontinence
• A male client's foreskin is not retracting

Menstrual Care Definition

• Menstruation is a woman's monthly bleeding, when blood flows from the uterus through the vaginal opening
• Sanitary pads should be changed often (every 3-5 hours) to promote good hygiene, comfort, and prevent odors and infection
• Gloves should be worn , and sanitary pads should be disposed of according to employer policy (usually in a biohazard bag)

Reporting Actions

• Odors and fevers
• Report redness, swelling, or irritation in the perineum
• Complaints of pain, burning, difficulty urinating, or other discomforts
• Heavy bleeding for example, sanitary pad soaked within one hour requires being reported at once), or a large number of blood clots on the pad are reported at once.
• Personal hygiene involves activities to clean the skin, teeth, mouth, genital area, and anus
• Clients may feel embarrassed that they need help with these personal activities. Ensure privacy and promote their dignity
• Bathing helps keep skin, genital and anal areas clean by removing microbes, dead skin, perspiration, and excess oils, while also stimulating circulation and body parts
• Make important observations about clients and note any changes
• The provision of partial baths, complete bed baths, showers, and tub baths depends on client's needs and available equipment
• When providing perineal care to both females and males, always work from the cleanest area to the dirtiest area