Chapter 39
Hygiene
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Scientific Knowledge Base
Physical hygiene is necessary for comfort,
safety, and well-being.
Ill patients require assistance with personal
hygiene.
Several factors influence a patient’s hygiene
practices, such as culture and age.
Good hygiene techniques promote normal
structure and function of tissues.
Apply knowledge of pathophysiology to
provide preventive hygiene care.
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Case Study
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Mrs. Winkler is a 58-year-old white woman
admitted recently to an assisted-living nursing
facility. She has a medical history of multiple
sclerosis (MS) and diabetes mellitus plus a
family history of coronary artery disease.
Mrs. Winkler uses a wheelchair for mobility.
She has recently become weaker (in both
upper and lower extremities), is unable to
push the chair herself, and requires
assistance in transferring to and from the
chair.
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The Skin
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Functions include
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Two layers
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Protection, secretion, excretion, temperature
regulation, and sensation
Epidermis: shields underlying tissue
Dermis: contains bundles of collagen, nerve fibers,
blood vessels, sweat glands, sebaceous glands,
and hair follicles
Subcutaneous: tissue lies just beneath the
skin; contains blood vessels, nerves, lymph,
and loose connective tissue filled with fat cells
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The Feet, Hands, and Nails
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Feet, hands, and nails require special
attention to prevent infection.
The hand in contrast to the foot is used for
manipulation rather than for support.
The condition of a patient’s hands and feet
influences his or her ability to perform
hygiene care.
The normal nail is transparent, smooth, and
convex, with a pink nail bed and a white tip.
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The Oral Cavity
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Cavity is lined with mucous membranes.
Normal oral mucosa is light pink, soft, moist,
smooth, and without lesions.
Medications, exposure to radiation, and
mouth breathing can impair salivary
secretion.
Xerostomia—dry mouth
Gingivitis—inflammation of the gums
Dental caries—tooth decay
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Case Study (cont’d)
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Jamie Johnson is a 20-year-old nursing student
assigned to the nursing facility. She is single and
works part-time in a skilled nursing facility near her
home. Jamie knows how important it is for patients to
feel comfortable and to have their basic needs met.
To provide basic hygiene, Jamie needs to learn about
what is important for Mrs. Winkler’s comfort. When
hygiene needs are not fulfilled, patients experience
complications such as oral lesions and infections.
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Hair
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Growth, distribution, and pattern indicate
general health status.
Hormonal changes, nutrition, emotional
stress, physical stress, aging, infection, and
other illnesses can affect the hair.
Sun, chemicals, hair products, permanents,
and straightening and coloring agents can
also affect the hair.
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Eyes, Ears, and Nose
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When hygiene care is provided, the eyes,
ears, and nose require careful attention.
Clean the sensitive sensory tissues in a way
that prevents injury and discomfort for a
patient, such as by taking care to not get
soap in his or her eyes.
The sense of smell is an important aid to
appetite.
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Case Study (cont’d)
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Jamie needs to review the effect of dependency on
the patient’s self-esteem and to review ways to give
patients opportunities to maintain self-care needs. At
an optimal level of functioning with assistance, Mrs.
Winkler is at risk for potential self-care deficits,
impaired skin integrity, impaired oral mucosa, and
altered health maintenance.
During hygiene care, Jamie interacts with Mrs.
Winkler to assess her readiness to learn and to teach
health promotion practices.
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Nursing Knowledge Base
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Factors influence a patient’s personal
hygiene.
Use communication skills to promote the
therapeutic relationship.
Hygiene care is never routine.
During hygiene, assess:
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Emotional status
Health promotion practices
Health care education needs
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Factors Influencing Hygiene
Social patterns
Ethnic, social, and
family influences on
hygiene patterns
Personal preferences
Dictate hygiene
practices
Body image
A person’s subjective
concept of his or her
body appearance
Socioeconomic status
Influences the type and
extent of hygiene
practices used
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Factors Influencing Hygiene
(cont’d)
Health beliefs and
motivation
Motivation is the key
factor in hygiene.
Cultural variables
People from diverse
cultures practice
different hygiene
rituals.
Developmental stage
Physical condition
Affects the patient’s
May lack physical
ability to perform
energy and dexterity to
hygiene care
perform self-care
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Factors Influencing Hygiene
(cont’d)
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Developmental stage
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Skin (sensitive neonate skin, active glands in
puberty, thinning and drying with age)
 Feet and nails (dry skin, systemic disease
footwear problems, chronic foot problems)
 Mouth
• Teeth (teething, caries, gum disease, edentulous)
 Hair (shaving, puberty, aging)
 Eyes, ears, nose
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Critical Thinking
Integrate nursing knowledge.
Consider developmental and cultural
influences.
Think creatively.
Be nonjudgmental and confident.
Draw on your own experiences.
Rely on professional standards.
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Quick Quiz!
1. You are caring for a non–English-speaking
male patient. When preparing to assist him
with personal hygiene, you should
A. Use soap and water on all types of skin.
B. Ensure that culture and ethnicity influence
hygiene practices.
C. Shave facial hair to make the patient more
comfortable.
D. Know that all patients need to be bathed
daily.
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Case Study (cont’d)
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Before entering Mrs. Winkler’s room, Jamie
reviews knowledge about the effects of
chronic illness on body image and
independence, principles of communication
and the pathophysiology for MS, diabetes,
and oral lesions.
Previous clinical experience has taught Jamie
that patients need to have an opportunity to
determine how nurses implement nursing
care.
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Nursing Process: Assessment
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Explore the patient’s viewpoint.
Assess:
Self-Care Ability
Oral cavity
Use of sensory
aids
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Skin
Hair and hair
care
Hygiene care
practices
Feet and Nails
Eyes, ears, and
nose
Cultural
influences
Patients at risk for hygiene problems
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Nursing Assessment
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Case Study (cont’d)
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Jamie learns that Mrs. Winkler likes to have her face
and hands washed first and then her teeth brushed
before breakfast. But then, she tells Jamie that it is
really not important.
Mrs. Winkler says, “I am not going to have breakfast
today because my mouth is sore. I took my dentures
out yesterday. They hurt my mouth too much. I guess
I just can’t wear them anymore.” Jamie determines
that assisting Mrs. Winkler with oral care is a priority.
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Nursing Process: Diagnosis
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Common diagnoses associated with hygiene:
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Activity intolerance
 Bathing self-care deficit
 Dressing self-care deficit
 Impaired physical mobility
 Impaired oral mucous membrane
 Ineffective health maintenance
 Risk for infection
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Use the patients’ actual alteration or the
alteration for which they are at risk.
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Case Study (cont’d)
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Mrs. Winkler states that she wants to be able to wear
her teeth and to feel clean.
Mrs. Winkler reports mouth pain and sores.
Jamie’s examination reveals reddened oral mucosa,
red sores and patchy white lesions, a thick coating on
the gums and tongue, and some bleeding from
swollen tissues.
Mrs. Winkler states that she has trouble holding her
arms above her waist and trouble holding small
things like her brush because her muscles are so
weak.
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Nursing Process: Planning
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Goals and outcomes
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Partner with the patient and family
Measurable, achievable, individualized
Set priorities based on assistance required,
extent of problems, nature of diagnoses
Teamwork and collaboration
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Health care team members
Family
Community agencies
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Case Study (cont’d)
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Goals:
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Knowledge: illness care
• Mrs. Winkler will verbalize preventive and routine oral
and denture care by the time of discharge.
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Oral hygiene
• Mrs. Winkler will have return of intact oral mucosa within
1 week.
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Implementation
Use caring to reduce anxiety, promote comfort.
Administer meds for symptoms before hygiene.
Be alert for patient’s anxiety or fear.
Assist and prepare patients to perform hygiene as
independently as possible.
Teach techniques and signs of problems.
Inform patients about community resources.
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Implementation (cont’d)
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Health promotion
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Make instructions relevant.
 Adapt instruction to patient’s facilities and
resources.
 Teach the patient ways to avoid injury.
 Reinforce infection control practices.
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Acute, restorative, and continuing care
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Hygiene measures vary by patient needs and
health care setting.
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Implementation (cont’d)
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Consider normal grooming routines, and
individualize care.
Bathing and skin care
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Therapeutic: sitz, medicated
 Complete bed bath, shower
 Partial bed bath
• Bag baths
• Perineal care
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Back rub
Foot and nail care
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Bath Guidelines
Provide privacy.
Maintain safety.
Maintain warmth.
Promote independence.
Anticipate needs.
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Implementation
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Oral hygiene
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Brushing removes particles, plaque, and bacteria;
massages the gums; and relieves unpleasant
odors and tastes.
 Flossing removes tartar at the gum line.
 Rinsing removes particles and excess toothpaste.

Patients with special needs: diabetes, artificial
airways, unconscious, chemotherapy
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Care of Dentures
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Implementation
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Hair and scalp care
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Brushing and combing
• Distributes oil
• Prevents tangling, as does braiding
• Obtain permission before braiding or cutting.
• Procedures for head lice
 Shampooing
 Shaving
 Mustache and beard care
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Shampooing Hair of Patient
Who Is Bed-Bound
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Shaving
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Quick Quiz!
2. A young girl with long hair is experiencing a
problem with matting. The most appropriate
action to take would be
A. Cutting the matted hair away.
B. Braiding the hair to reduce tangles.
C. Using a grease-type product to tame the
hair.
D. Keeping the hair oil free by applying powder
every morning.
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Implementation
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Care of the eyes, ears, and nose:
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Basic eye care
 Eyeglasses
 Contact lenses
 Artificial eyes
 Ear care
 Hearing aid care
 Nasal care
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Removal of a Prosthetic Eye
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Hearing Aids: In the Canal
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Hearing Aids: In the Ear
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Hearing Aids: Behind the Ear
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Implementation
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Patient’s room environment
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Maintaining comfort: temperature, noise, lighting,
ventilation, odors
Beds
• Features: raising, adjusting, side rails
• Clean, comfortable, and safe
Bed making
• Occupied
• Unoccupied
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Room Equipment
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Foot Boots
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Communication
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Linen Care
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Surgical or Recovery Bed
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Case Study (cont’d)
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What interventions are appropriate for
restoration of oral health?
What is the rationale supporting each
intervention?
Example intervention: Remove, clean, and do
not replace dentures except for meals (if
desired).
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Rationale: This promotes healing during cases of
mild to moderate stomatitis.
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Evaluation
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Evaluate during and after each intervention.
Observe for changes in patient’s behavior.
Consider the patient’s perspective.
Often it takes time, repeated measures, and a
combination of interventions for improvement.
Expected outcomes met?
Patient’s expectations met?
Ask questions to determine appropriate
changes to interventions.
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Case Study (cont’d)
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Jamie asks Mrs. Winkler about reporting of
symptoms.
Mrs. Winkler states she now knows that her
oral discomfort and sores are related to how
she cares for her dentures, and that she will
report these symptoms if they recur.
Achievement of outcome is shown because
Mrs. Winkler is able to participate in
prevention of oral problems by reporting
symptoms indicating a problem.
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Safety Guidelines
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Communicate clearly with team members.
Incorporate patient’s priorities.
Move from the cleanest to less clean areas.
Use clean gloves for contact with nonintact skin,
mucous membranes, secretions, excretions, or blood.
Test the temperature of water or solutions.
Use principles of body mechanics and safe patient
handling.
Be sensitive to the invasion of privacy.
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