Personal Hygiene

It is the nurses
responsibility to provide
the patient with the
opportunity for hygiene
HYGIENE
PART 6-A
Purpose of Bathing



Cleansing the skin
 Removes perspiration, bacteria, which
minimizes skin irritation and reduces
chance of infection
Stimulation of circulation
 Warm water and gentle strokes from
distal to proximal increase circulation
and promote venous return
Improve self-image
 Promotes feeling of being refreshed,
relaxed
Purpose of Bathing


Reduction of body odors
 Especially in axillae and pubic areas
Promotion of Range of Motion
 Movement of extremities while
bathing
Nurse’s Advantage


Provides opportunity to develop a
meaningful nurse-patient relationship
Provides opportunity for assessment of
the patient including condition of
patient, psychosocial and learning
needs.
Before You Begin Bathing
It is the Nurses Role to:

Assess Your Patient
Factors Affecting
Personal Hygiene
1. Cultural / Religious
2. Developmental Stage
3. Mobility
4. Emotional
5. Physical Illness
6. Personal Preference
Critical Thinking

Situation:
The Nurse enters Mrs. G’s room to do
a complete bed bath and she says “I do
not want my bath now, I just want to
rest”.
What should the nurse do now?
Critical Thinking

Situation:
The nurse enters Mr. C’s room to do
a complete bed bath and he says “I
do not want my bath now, I just want
to rest”. You notice that his bed is
wet and he was incontinent of urine.
Now what should the nurse do?
Types of Baths

Cleansing Baths
 Used to clean the patient
Cleansing Baths



Complete Bed Bath
 Nurse baths entire body of dependent
patient in bed
Self-Help Bath
 Patients confined to bed are able to bathe
themselves with some help
Partial Bath
 Parts of the body are washed by the patient
and some by the nurse
Cleansing Baths

Tub Bath
 Much easier for
bathing and rinsing
than in a bed
 Varies in style
types of baths

Shower
 Used by ambulatory
patients who require
only minimal assistance
 Can be used with a
shower chair
Types of Baths

Therapeutic Baths
 Bath used for treatment
 Usually requires a doctor’s
order
Therapeutic Baths


Medicated solutions may be used in
bathing
Range from warm water baths, cool
water baths, cornstarch, oatmeal,
Aveno, alcohol
Back Rub





May be performed after drying off
the back during the bath.
Position of Patient: Prone or side-lying
Expose only the back, shoulders, upper arms.
Cover remainder of body
Lay towel alongside back
Warm lotion in your hands—still explain that
it may be cool and wet.
Back Rub


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Start in the sacral area, moving up the back.
Massage in a circular motion over the
scapula.
Move upward to shoulders, massage over
the scapula
Continue in one smooth stroke to upper arms
and laterally along side of back down to iliac
crests.
Do NOT allow your hands to leave the
patient’s skin
End by telling your patient that you are
finished
Guidelines for Bathing
1. Provide Privacy
2. Maintain Safety
3. Maintain warmth
4. Promote the patient’s independence
as much as possible
Procedure for Bathing


Bed Bath
 Harkreader p. 799-803
Tub Bath or Shower
 Harkreader p. 806-807
Part B: Perineal Care
Hygienic measures
related to the
care of the genitalia.

Perineal Care



Can be embarrassing for the nurse and
the patient.
Should not be overlooked because of
embarrassment.
If the patient can do it themselves—let
them.
 Hand them the washcloth and ask if
they would like to “finish their bath.”
Perineal Care

Those patients who may need the
nurses assistance:
 Vaginal or urethral discharge
 Skin irritation
 Catheter
 Surgical dressings
 Incontinent of urine or feces
Perineal Care Procedure
Normal conditions, Discharge, Menses
Women




Wipe labia majora (outer) from front to back in
downward motion using clean surface of wash cloth for
each swipe.
Wipe labia minora (inner) from front to back in
downward motion using clean surface of wash cloth for
each swipe
Wipe down the center of the meatus from front to back.
If catheter in place, clean around catheter in circular
fashion, using clean surface of wash cloth for each
swipe.
Wash inner thighs from proximal to distal
Cont. Female Perineal Care

Rinse with warm to tepid water using pour from peribottle if available.

Pat dry using clean towel in same order as wash

Remove bedpan if one is used

Verbalize turning patient on side to wash anal area
from front to back and dry
Perineal Care - Male



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Retract foreskin of penis if uncircumcised
Wash around the urinary meatus in a circular motion,
using clean surface of washcloth for each stroke and
around the head of penis in circular motion
Wash down shaft of penis toward the thighs
changing washcloth position with each stroke
Wash scrotum – front to back
Wash inner thighs
continued
Cont. Perineal Care - Male

Rinse with clean wash cloth or peri-bottle using warm
water in same sequence as the wash

Dry with clean towel in the same sequence

Replace foreskin, as appropriate


Turn patient on side to wash anus from front to back
and dry
Procedure 31-2: Harkreader, p. 804-805
Perineal Care with Catheter


Follow similar
procedure in the male
patient.
Start at the urethra
opening and clean
outward.
Part C: Oral Hygiene

Maintains the healthy state of the mouth


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Cleanses teeth of food particles, plaque, and
bacteria
Massages the gums
Relieves discomfort from unpleasant odors and
tastes.
Refreshes the mouth and gives a sense of
well-being and thus can stimulate appetite.
Assessment: Oral Hygiene
a. Frequency
 Depends on the condition of the patient’s mouth.
 Some patient’s with dry mouth or lips need care
every 2 hours.
 Usually done twice a day or after each meal
b. Assistance Needed
 Does the patient need assistance to do oral care
*The nurse can help patients maintain good oral
hygiene by:
1. Teaching them correct techniques
2. Actually performing for weakened or disabled
patients.
Oral Hygiene
Assessment
c. Abnormalities



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Loose or missing teeth
Swelling and bleeding of gums
Unusual mouth odor
Pain or stinging in mouth structures
Brushing


Major concerns are:
 Thoroughness in cleansing
 Maintaining the condition of the oral
mucosa.
Procedure for Conscious Patient:
 Upright position
 Get out your textbook--Harkreader:
p. 813-814
Brushing: Unconscious Patient
See performance checklist in syllabus
Safety is of utmost importance

Prevent aspiration
1. Positioning—lateral position with head turned to
the side or side-lying. Position back of head on a
pillow so that the face tips forward and fluid/
secretions will flow out of the mouth, not back
into the throat.
2. Place a bulb syringe or suction machine with
suction equipment nearby. Yankuer end on
suction device.
Oral Hygiene: Unconscious Patient
 Keeping the mouth open
1. Use a padded tongue blade to open the
patients mouth and separate the upper and
lower teeth
2.Never place your hand in the patient’s
mouth or open with your fingers. Oral
stimulation often causes the biting –down
reflex and serious injuries can occur.
Harkreader p. 814-815
Denture Care


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Clean dentures as frequently as natural teeth
Dentures are the patient’s personal property
and should be handled with care because they
can be easily broken.
Care:
 Remove before going to bed – allows gums
to rest and prevents buildup of bacteria.
 Store in a labeled container covered with
water or denture cleaner if available
Denture Care


Procedure: Harkreader p. 815
Tips to remember:

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Use gauze squares or washcloth
to grasp front of dentures to
prevent from slipping
Place wash cloth or paper towel in
sink to line it while you are
cleaning the dentures
Work close to the bottom of the
sink in case you drop them.
Use tepid water
Part D: Hair Care

A person’s appearance and
feeling of well-being often
depends on the way their
hair looks and feels
Major Goals in Hair Care
Stimulate Circulation
Prevents Matting
Brushing and Combing


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Keeps hair clean and distributes oil evenly
along the hair shaft
Combing styles hair and prevents from
tangling
Assessment while brushing
 Scalp lesions, abrasions
 Dandruff
 Parasitic infestations
 Quality of hair
 Appearance
Hair Care: Shampooing


Depends on:
 Personal preference of the patient, does not have
to occur every day with hygiene
 Condition of the hair
Ways to Shampoo
 If patient can get up and into a shower or sink,
use a hand held nozzle
 If patient can not get up, place on stretcher and
roll to a shower area
 If patient is unable to be moved, may shampoo in
the bed – see procedure in Harkreader p. 817-818.
 “Shampoo in a Bag” or dry shampoos are available
Part E: Shaving
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Improves self-esteem and emotional
needs of the patient
Usually done after the bath or shampoo
Assessment:
 Skin for elevated moles, warts,
Rashes, patchy skin lesions, or
pustules
Shaving

Provide Safety
 When using a razor blade, the
skin must be softened to
prevent pulling, scraping, or
cutting
 Place a warm wash cloth over
area and then apply some gel,
cream, foam.
0
 Hold the razor at a 45 angle
 Pull the skin taut
 Shave in the direction of hair
growth
Shaving


Safety Precautions
Electric razors must be used in
patients who are at risk for
bleeding, confused, or
depressed
Part F: Foot and Nail Care



Usually part of the bath
Purpose:
 Eliminate sources of infection and
decrease odors
Assessment:
 Color, shape length, texture of nails
 Condition of skin around nails and between
toes and fingers – swollen, inflamed,
callused, lesions, temperature
Foot and Nail Care



Soak the hand or foot to
soften the cuticles
Thoroughly cleanse and dry
Trim the nails ONLY if you
have permission or it is
allowed at that institution.
Most institutions do not
allow nurses to trim the
nails.
Foot and Nail Care


Teach patient and family that nails should be
cut – straight across. May need to get a
referral if no one available to cut nails.
Show close attention to the feet and nails of
the diabetic patient and the elderly
** If feet and nails are in bad condition–
notify doctor so a consult can be ordered
with a podiatrist
Part G: Ear Care


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Usually requires minimal care
Cleanse the external auricle with
washcloth when bathing
Avoid insertion of objects into the ear
Hearing Aids
a.
Check that the device is functioning correctly and
clean any body oils or cerumen from the hearing aid
b. Make sure the hearing aid is off and volume is down
before insertion
c.
Insert hearing aid in ear by pulling earlobe
downward while pressing the hearing aid inward
d. Turn on and adjust volume
e.
Ask the patient if comfortable and can they hear!
Part G: Eye Care

Assessment:
 Abnormal lesions
 Discharge
 Tearing
 Presence of any infection
 Use of Visual Aids (contacts, glasses)
 Ask when patient needs to use these
devices
Eye Care
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
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Wash around the eyes with a warm moist
washcloth with warm water—NO SOAP!
Clean from the inner canthus to the outer
canthus of the eye. Pay special attention to
the inner canthus.
Provide special care for the eyes of
unconscious patients.
 May need to tape the eye lids shut if
unable to blink and protect own eyes
Part H: Elimination Care

Optimum elimination occurs
when the patient can use a
toilet and eliminate in
private.
Elimination Hygiene

There are various circumstances when a
patient will have to use a bedpan or
urinal for elimination
Elimination Hygiene


Assist patient’s in a respectful way
Assist to be comfortable especially
when using a bed pan

Provide privacy

Do not hurry
Elimination Hygiene
Types of Devices

Bedside commode

Urinal

Bedpan
 Regular
 Orthopedic / fracture
Elimination Hygiene
Procedure for Using Bedpan / Urinal
1.
2.
3.
4.
Bring to the bedside
Warm the bedpan if it is metal
Place bed in appropriate position
Fold the top linen back to allow for
placement of bedpan or urinal
5. Have patient assist by bending knees
and lifting up, place hand under lower
back and slip into place.
or
Use of Bedpan
6. Turn to the side
and roll back onto
the bedpan
7. Check placement

Bedpan - when the buttocks rest on the
rounded edge of the pan

Urinal – penis is inside, urinal rests on the
bed
Procedure for using bedpan / urinal
8. Raise head of bed to upright sitting
position
9. Place call light and toilet within reach.
Leave the patient if safe to do so,
with side rails up
10.Removal
• Same manner as offered; hold
steady
• Cover the pan
8. May need to clean up
the patient
9. Note character of
contents, chart
10.Clean the pan or urinal
11.Unglove and Wash
hands
Assisting with a Condom Catheter

Purpose:



Control incontinence in a male patient
without the risk of urinary tract infection
Greater comfort to the patient than an
indwelling catheter
Equipment Needed
 Condom catheter
 Soap and water, washcloth, towel
 Disposable gloves
 Drainage bag and tubing
Condom Catheter - Procedure
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Wash hands
Place patient in supine position, provide
privacy, close door and drape with only penis
exposed
Apply gloves, Cleanse area with soap and
water, dry
Assess for any skin breakdown, redness
Wrap adhesive spirally around the shaft of
the penis
Place rolled condom over the penis and unroll
over the penis and adhesive, press condom to
the strip
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Attach drainage bag and
tubing to the catheter
Check that tubing is not
twisted and lies over top of leg.
Cover the patient, return bed to
low position
Assess later to be sure that it is
secure and not leaking.
Empty bag as necessary
Remove condom daily to clean the
area and assess the skin integrity.
Part I: Antiembolic Prevention



Patients who are immobile are at risk for
stasis of blood in the lower extremities and
development of thrombophlebitis.
Contraction and relaxation of skeletal
muscles helps to move blood through veins
toward the heart
Valves within the veins prevent the blood
from slipping back toward the feet under the
influence of gravity.


When circulation slows, clots (thrombi) are
more likely to form in those patients with
limited activity or incompetent valves.
A blood clot can break loose and travel
through the blood stream as an embolus
leading to potential severe complications.
Purpose of Antiembolic Measures
1. Promote the circulation of blood from
the legs back to the heart- increase
venous return; decrease venous stasis
2. Support valves within peripheral leg
veins so that blood is less likely to pool
in a dependent position- decreases
dependent edema
3. Prevent thrombus formation
Assessment
1. Identify conditions that increase the potential for
poor circulation and clot formation
• Post-operative
• Varicose veins
• Thrombophlebitis
• Dehydration
• Pregnancy
2. Examine lower extremities for poor circulation
(Cold, cyanosis), intact skin or ulcerations, distended
leg veins, peripheral pulses
3. Assess past history for developing blood clots
Interventions / Preventive Measures

1. Leg and Foot Exercises

2. Antiembolism stockings

3. Sequential Compression Devices

4. Avoiding compression of leg vessels
Leg and Foot Exercises
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Alternately flex and extend the foot five times.
Make circular movement with the feet five times
to the left and then repeat to the right.
A leg exercise is to bend the knee and draw the
foot up to the thigh, and then extend the leg.
These exercises can be active – just have the
patient do these ever so often on their own;
Or passive. It is common to include these range
of motion exercises as part of the bath for the
immobile patient and at least every 2 hours for
the post-operative patient.
Antiembolism Hose


Antiembolism stockings are elasticized stockings
that provide varying degrees of pressure at
different areas of the legs.
To provide the optimum amount of pressure, the
stockings should fit properly and be free of wrinkles.
 To ensure a proper fit, the patients leg is
measured in length and circumference and then
refer to the manufacturer’s chart to obtain the
correct hose size.
Length
Circumference
Procedure for Applying TED Hose
Do not follow procedure in book



Place patient in supine
position in bed with leg
horizontal for 15 minutes
Turn the stocking inside out
by placing one hand into sock,
holding the toe with the
other hand, and pull inside
out
Place patient’s toe into foot
of elastic stocking
Application of TED Hose

Slide remaining stocking
over foot, Now the
stocking will be right side
out
Never allow to make a
tight band around the
leg.

Be sure to smooth stocking
having no wrinkles.
Antiembolism Hose

Nursing Care:
1. Assess the lower extremities EVERY SHIFT.
Toe area should have an opening that can be pulled
back and the toes and feet assessed for function
and any neuro-circulatory problems.
 Toes should be warm, pink, good capillary refill,
can wiggle toes, has feeling in toes with no
tingling.
2. Remove ONCE EACH DAY and inspect the feet
and toes.
TED Hose

Document
0830 -- Calf length TED hose applied, skin warm and
pink with no lesions. Instructed patient in use,
verbalized understanding. Stated they felt good
--------------------------------------J. Ward R.N.
Sequential Compression Devices
SCD’s

Purpose:
 Enhance venous return by
applying intermittent
external compression to
the tissues and veins
similar to the normal
physiologic pumping
mechanisms of the
muscles.
Sequential Compression Device


Disposable plastic sleeve wrapped
around the patients leg and
secured with velcro.
The sleeves are then connected
to an air pump that alternately
inflates and deflates the air
tubes in the sleeves. The sleeves
are inflated in sequence from the
bottom of the leg to the top,
helping to move venous blood out
of the leg veins and toward the
heart.
Sequential Compression Devices
Place patient in supine position with legs
horizontal for 15 minutes.
 Apply antiembolism hose, if desired
 Measure circumference of upper thigh
 Open inflatable sleeve on the flat bed,
cotton side up, and place
the patients leg on the sleeve
 Wrap sleeve snugly around
the leg, fasten with velcro

Sequential Compression Devices
Connect tubing on sleeve
to compression controller


Turn on ordered settings
Remove three times
daily and inspect skin

Sequential Compression Devices

Document:
0900 – sequential compression devices placed on
both legs set on low. Skin on lower extremities
warm, dry, pink. Explained use to patient,
verbalized understanding. -----------J. Ward R.N.
0900 – SCD’s in place on both lower extremities.
Toes warm and pink, pedal pulses present--------------------------------------------------J. Ward R.N.
Avoid Compression of Legs



Watch positioning of the patient’s lower
extremities. Do not allow the tubes,
equipment to be placed under the legs to
compress circulation
Place lower extremities on pillows to position
correctly.
Encourage patient to not cross legs or feet.