K & E CH 33 Hygiene

Learning Outcomes
1. Describe hygienic care that nurses

provide to clients.
2. Identify factors influencing personal
hygiene.
3. Identify normal and abnormal
assessment findings while providing
hygiene care.
Kozier & Erbs Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition
Audrey Berman Shirlee Snyder
Copyright 2012 by Pearson Education, Inc.

All rights reserved.
Learning Outcomes (cont'd)

4. Apply the nursing process to common
problems related to hygienic care of the
skin, feet, nails, mouth, hair, eyes, and ears.
5. Identify the purposes of bathing.
6. Describe various types of baths.
7. Compare and contrast the task-centered
approach and the person-centered
approach to bathing.

Learning Outcomes
8. Describe guidelines for bathing persons
with dementia.
9. Discuss the different types of contact
lenses.
10.Identify the steps to removing contact
lenses.
11.Discuss the different types of hearing
aids.


12.Describe steps for removing, cleaning,
and inserting hearing aids.
13.Discuss factors that support a positive
and safe environment for the client.
14.Identify safety and comfort measures
underlying bed-making procedures.


15.Verbalize the steps used in:
a)
b)
c)
d)
e)
Bathing an adult client

Providing perineal-genital care
Providing foot care
Brushing and flossing the teeth
Providing special oral care


15.Verbalize the steps used in:
f) Providing hair care
g) Shampooing the hair of a client confined to
bed
h) Removing, cleaning, and inserting a hearing
aid
i) Changing an unoccupied bed
j) Changing an occupied bed


16.Recognize when its appropriate to
delegate hygiene skills for clients to
unlicensed assistive personnel.
17.Demonstrate appropriate documentation
and reporting of hygiene skills.

Hygienic Care
Involves care of:
Skin
Feet
Nails
Oral and nasal cavities
Teeth
Hair
Eyes

Hygienic Care (cont'd)

Involves care of:
Ears
Perineal-genital area

Types of Hygienic Care

Early morning care
Urinal or bedpan
Washing face and hands
Oral care

Types of Hygienic Care (cont'd)

Morning care
Usually after breakfast
Elimination
Bath or shower
Perineal care
Back massage
Oral, nail, and hair care

Types of Hygienic Care

Hour of sleep (HS) or P.M.
Elimination
Washing face and hands
Oral care
Back massage
As needed (prn)
As required by client need
More frequent bathing
Changes of clothes

Factors Influencing Personal

Hygiene
Culture
Religion
Environment
Developmental level
Health and energy
Personal preferences

Common Skin Problems
Abrasion
Excessive dryness
Ammonia dermatitis
Acne
Erythema
Hirsutism

Nursing Process: Assessment

Nursing history to determine:
Clients skin care practices
Self-care abilities
Past or current skin problems
Physical assessment of the skin

Nursing Process: Nursing

Diagnoses
Bathing Self-Care Deficit
Dressing Self-Care Deficit
Toileting Self-Care Deficit

Nursing Process: Planning

Nurse and, if appropriate, the client and/or
family set outcomes for each nursing
diagnosis
Nurse performs nursing interventions and
activities to achieve the client outcomes

Nursing Process: Interventions

Assisting dependent clients with bathing,
skin care, and perineal care
Providing back massages to promote
circulation
Instructing clients/families about
appropriate hygienic practices and
alternative methods to dressing


(cont'd)
Demonstrating use of assistive equipment
and adaptive activities

General Guidelines for Skin Care

An intact, healthy skin is the bodys first
line of defense
The degree to which the skin protects the
underlying tissues from injury depends on
the general health of the cells, the amount
of subcutaneous tissue, and the dryness
of the skin

General Guidelines for Skin

Care(cont'd)
Moisture in contact with the skin for more
than a short time can result in increased
bacterial growth and irritation
Body odors are caused by resident skin
bacteria acting on body secretions

General Guidelines for Skin

Care(cont'd)
Skin sensitivity to irritation and injury
varies among individuals and in
accordance with their health
Agents for skin care have selective actions
and purposes

Purposes of Bathing
Removes accumulated oil, perspiration,
dead skin cells, and some bacteria
Stimulates circulation
Produce a sense of well-being

Categories of Baths
Cleaning baths
Therapeutic baths

Cleansing Baths
Complete bed bath

Self-help bed bath
Partial bath
Bag bath
Towel bath
Tub bath
Shower

Figure 33-3 A shower chair.

Therapeutic Baths
Given for physical effects

Soothe irritated skin
Treat a certain area (e.g. the perineum)
Medication may be placed in the water

Bathing an Adult Client Remove top sheet from under the bath blanket.

Bathing an Adult Client Making a bath mitt, triangular method. A, Lay your hand on the washcloth; B, fold the top
corner over your hand; C, fold the side corners over your hand; D, tuck the second corner under the cloth on the palm
side to secure the mitt.
A

B

C

D

Bathing an Adult Client Making a bath mitt, rectangular method. A, Lay your hand on the washcloth and fold one
side over your hand; B, fold the second side over your hand; C, fold the top of the cloth down and tuck it under the
folded side against your palm to secure the mitt.
A

B

C

Bathing an Adult Client Using a separate corner of the washcloth for each eye, wipe from the inner to the outer
canthus.

Bathing an Adult Client Washing the arm using long, firm strokes from wrist to shoulder area.

Bathing an Adult Client Washing the chest and abdomen.

Bathing an Adult Client Washing far leg.

Bathing an Adult Client Soaking a foot in a basin.

Photographer: Jenny Thomas.

Bathing an Adult Client Washing the back.

Bathing an Adult Client Secure the seat belt before moving the client in a hydraulic bathtub chair.

Providing Perineal-Genital Care Draping the client for perineal-genital care.

Providing Perineal-Genital Care Cleaning the labia.

Providing Perineal-Genital Care Male genitals.

Long Term Care Setting

Todays nursing world the bath is seen as
necessary, routine task and is often
delegated to UAP

Long Term Care Setting (contd)

Person-Centered Approach
Becoming less about tasks
More about people and the relationships
between people
Bathing needs to focus on the experience for
the client rather than the outcomes (i.e.
getting a bath or shower)

Box 33-2
General
Guidelines for
Bathing
Persons with
Dementia

Box 33-2 (continued) General Guidelines for Bathing Persons with Dementia

Common Foot Problems
Calluses
Corns
Unpleasant odors
Plantar warts
Fissures between the toes
Fungal infections
Ingrown toenails


Normal nail and foot care practices
Type of footwear worn
Self-care abilities
Presence of risk factors for foot problems
Any foot discomfort
Any perceived foot problems with foot mobility
Physical assessment of the feet


Nursing Process: Nursing

Diagnoses
Bathing Self-Care Deficit (foot care)

Risk for Impaired Skin Integrity
Risk for Infection
Deficient Knowledge (diabetic foot care)


Identify nursing interventions that will help
the client maintain or restore healthy foot
care practices
Establishing desired outcomes for each
client


Teaching the client about correct nail and
foot care
Proper footwear
Wearing the correct size
Ways to prevent potential foot problems
Physical assessment of the feet

Nails
Normally present at birth
Continue to grow throughout life
Nails tend to be tougher, more brittle, and
some cases thicker as we get older
Older person may grow slower and be
ridged and grooved


Normal nail care practices
Self-care abilities
Any problems associated with them
Physical assessment of the nails

Nursing Process:
Nursing Diagnoses
Bathing Self-Care Deficit
Risk for Infection


Identify measures that will assist the client
to develop or maintain healthy nail care
practices
A schedule of nail care needs to be
established


Check agencys policy regarding nail care
One hand or foot is soaked, if needed,
and dried
Nail is cut or filed straight across beyond
the end of the finger or toe
Avoid trimming or digging at the lateral
corners


(cont'd)
Diabetics should have them filed rather
than cut
Infections around the cuticle or
inflammation of the tissues should be
recorded and reported

Common Problems of the Mouth
Halitosis
Glossitis
Gingivitis
Periodontal disease
Reddened or excoriated mucosa
Excessive dryness of the buccal mucosa
Cheilosis

Common Problems of the Mouth

(cont'd)
Dental caries
Sordes
Stomatitis
Parotitis


Oral hygiene practices
Dental visits
Self-Care abilities
Past or current mouth problems
Physical assessment of the mouth

Nursing Process:
Nursing Diagnoses
Impaired Oral Mucus Membrane
Deficient Knowledge


The nurse and, if appropriate, the client
and/or family set outcomes for each
nursing diagnosis
The nurse performs nursing interventions
and activities to achieve the client
outcome


Daily stimulation of the gums
Mechanical brushing and flossing of the
teeth
Flushing of the mouth

Brushing and Flossing the Teeth The sulcular technique: Place the bristles at a 45-degree angle with the tips of the
outer bristles under the gingival margins.

Brushing and Flossing the Teeth Brushing from the sulcus to the crown of the teeth.

Brushing and Flossing the Teeth Brushing the biting surfaces.

Brushing and Flossing the Teeth Stretching the floss between the third finger of each hand.

Brushing and Flossing the Teeth Flossing the lower teeth by using the index fingers to stretch the floss.

Brushing and Flossing the Teeth Removing the top dentures by first breaking the suction.

Brushing and Flossing the Teeth Inserting the dentures at a slight angle.

Providing Special Oral Care for the Unconscious Client Position of client and placement of curved basin when
providing special mouth care.

Problems of the Hair
Dandruff
Hair loss
Ticks
Pediculosis
Scabies
Hirsutism


Usual hair care
Self-Care abilities
History of hair or scalp problems
Conditions known to affect the hair
Physical assessment of the hair

Nursing Process:
Nursing Diagnoses
Dressing Self-Care Deficit

Impaired Skin Integrity
Risk for Infection
Disturbed Body Image


The nurse and, if appropriate, the client
and/or family set outcomes for each
nursing diagnosis
The nurse performs nursing interventions
and activities to achieve the client
outcome


Hair needs to be brushed or combed daily
Washed as needed to keep it clean

Shampooing the Hair of a Client Confined to Bed Shampooing the hair of a client confined to bed. Note the
shampoo basin and the receptacle below.

Eyes
Require no special hygiene
Lacrimal fluid washes the eye
Eyelids and eyelashes prevent entrance of
foreign particles


Clients eyeglasses or contact lenses
Recent examinations by ophthalmologist
Any history of eye problems and related
treatments
Physical assessment of the eye

Nursing Process:
Nursing Diagnoses
Risk for Infection
Risk for Injury


The nurse identifies nursing activities that
will assist the client to maintain the
integrity of the eye structures
Prevent eye injury and infection


Teaching clients how to insert, clean, and
remove contact lenses
Ways to protect the eyes from injury and
strain

Figure 33-11 Removing hard contact lenses.

Figure 33-11 (continued) Removing hard contact lenses.

Figure 33-11 (continued) Removing hard contact lenses.

Ears
Minimal hygiene
May have excessive cerumen or wear
hearing aids may require nursing
assistance
Hearing aids are usually removed before
surgery

Types of Hearing Aids
Behind-the-ear open fit

Behind-the-ear with earmold
In-the-ear aid
In-the-canal aid
Completely-in-the-canal aid
Eyeglasses aid
Body hearing aid

Removing, Cleaning, and

Inserting Hearing Aids







Practice Guidelines Bed-Making

Wash hands thoroughly after handling a
clients bed linen
Hold soiled linen away from uniform
Linen for one client is never placed on
another clients bed
Place soiled linen directly in a portable
hamper or tucked into a pillow case at the
end of the bed for disposal

Practice Guidelines Bed-Making

(cont'd)
Do not shake soiled linen into the air
Conserve time and energy, make one side
of the bed first
Gather all linen before starting to strip a
bed

Unoccupied Bed
Closed
Top sheet, blanket, and bed-spread are drawn
up to the top of the bed and under the pillows
Open
Top covers are folded back
Makes it easier for the client to get in

Changing an Occupied Bed

Maintain the client in good body alignment
Move the client gently and smoothly
Explain what you plan to do throughout
the procedure before you do it
Use the bed-making time, like the bed
bath time, to assess and meet the clients
needs


K & E CH 33 Hygiene

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Learning Outcomes

1. Describe hygienic care that nurses

Copyright 2012 by Pearson Education, Inc.

Learning Outcomes (cont'd)

Copyright 2012 by Pearson Education, Inc.

Copyright 2012 by Pearson Education, Inc.

Learning Outcomes (cont'd)

Copyright 2012 by Pearson Education, Inc.

Learning Outcomes (cont'd)

Bathing an adult client

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Learning Outcomes (cont'd)

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Learning Outcomes (cont'd)

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Hygienic Care (cont'd)

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Types of Hygienic Care

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Types of Hygienic Care (cont'd)

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Types of Hygienic Care

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Factors Influencing Personal

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Common Skin Problems

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Nursing Process: Assessment

Physical assessment of the skin

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Nursing Process: Nursing

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Nursing Process: Planning

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Nursing Process: Interventions

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Nursing Process: Interventions

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General Guidelines for Skin Care

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General Guidelines for Skin

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General Guidelines for Skin

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Complete bed bath

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Figure 33-3 A shower chair.

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Given for physical effects

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Copyright 2012 by Pearson Education, Inc.