Handouts in HYGIENE

Hygiene - is the science of health and its maintenance.

 Personal hygiene is the self-care by which people attend to such function as bathing, toileting,
general body hygiene, and grooming.

 a highly personal matter determined by individual values and practice. It involves care of the skin,
feet, nails, oral and nasal cavities, teeth, hair, eyes, ears and perineal-genital areas.

 Early morning care- is provided to clients as they awaken in the morning.

 Morning Care- is often provided after clients have breakfast.
 Hour of sleep or PM care- is provided to clients before they retire for the night.
 As-needed (prn care) – is provided as required by client

Factors Influencing Individual Hygienic Practices

Culture Factor Variables
Religion Ceremonial washings are practiced by some religion
Environment Finances may affect the availability of facilities for
bathing
Developmental Level Children learn hygiene in the home.
Health and Energy Ill people may not have the motivation or energy to
attend to hygiene.
Personal Preferences Some people prefer a shore to a tub bath.

Skin - is the largest organ of the body.

 Five major functions:
 It protects underlying tissues from injury by preventing the passage of organism.
 It regulates the body temperature.
 It secretes sebum, an oily substance.
 It transmit sensations through nerve receptors.
 It produces and absorbs Vitamin D.

 Sudoriferous (sweat) glands- are on all body surface excepts the lips and parts of the genitals.
a. Epocrine gland- located largely in the axillae and anogenital areas, begin to function at
puberty
b. Eccrine glands- are important physiologically. They are more numerous than
apocrine glands and are found chiefly on the palms of the hands, soles of the head and forehead
Common Skin Problems:’
 ABRASION - Superficial layers of the skin are scraped or rubbed away.
 Nursing Implication:
 Prone to infection, therefore wound should be kept clean and dry
 Do not use jewelry
 Lift, do not pull, a client across a bed
 Use two or more people for assistance
  EXCESSIVE DRYNESS - Skin can appear flaky and rough
 Nursing Implication:
 Provide alcohol-free lotions
 Bathe client less frequently, use no soap or nonirritating soap
 Encourage increased fluid intake
 AMMONIA DERMATITIS (DIAPER RASH)
 Caused by skin bacteria reacting with urea in the urine
 Nursing Implications:
 Keep skin dry and clean by applying protective ointments with zinc oxide to areas at risk
 Boil an infants diaper or wash them with antibacterial detergent to prevent infection
 Keep the skin clean to prevent secondary infection. Treatment varies widely
 ACNE - Inflammatory condition with papules and pustules
 Keep the skin clean to prevent secondary infection
Treatment varies widely
 HIRSUTISM - Excessive hair on a persons body and face
 Remove unwanted hair by using depilatories , shaving, electrolysis or tweezing
 Enhance clients self-concept
 BATHING - removes accumulated oil, perspiration, dead skin cells, and some bacteria.
- produces a sense of well-being .
2 CATEGORIES OF BATH:
1. Cleansing Bath- are given for hygiene purposes.
Types of Cleansing Bath
 Complete Bed Bath- washes the entire body of a dependent client in bed.
 Self –help bed bath- clients confined to bed are able to bathe themselves with help from the
nurse.
 Partial Bath (abbreviated bath)- Only the parts of the clients body that might cause discomfort or
odor, if neglected are washed.
 Bag bath- bath is commercially prepared product that contains 10-12 presoaked disposable
washcloths that contain no rinse cleanser solution.
 Towel bath- bath is similar to a bag bath but uses regular towels.
 Tub bath- are often preferred to bed baths because it is easier to wash and rinse in a tub. Tub are
also used for therapeutic baths.
 Shower- clients are able to use shower facilities and require minimal assistance from nurse.
2. Therapeutic bath - are given for physical effects, such as to soothe irritated skin or to treat an area.
 Designated time- 20 to 30 minutes
 Bath Temperature-46C(100F - 115F

Bathing an adult client:

Purposes:
 To remove transient microorganisms, body secretions and secretions and dead skin cells.
 To stimulate circulation of the skin
 To promote sense of well-being
 To produce relaxation and comfort
 To prevent and eliminate unpleasant body odors
 Assessment:
 Physical or emotional factors
 Condition of the skin
 Presence of pain
 Range of motion of the joints
 Any other aspect of health that may affect the clients bathing process.
Equipment:
 Basin with warm water (between 43C & 46C)
 Soap and soap dish
  Linens: bath blankets, two bath towels, washcloth, clean gown, or pajamas or clothes as needed,
dditional bed linen & towels if required.
 Clean gloves if appropriate
 ersonal hygiene articles
 Shaving equipment for male clients
 Table for equipment
 Laundry bag
Procedure:
1. Wash hands
2. Provide for clients privacy
3. Prepare the client and the environment
4. Prepare the bed and position appropriately
5. Make a bath mitt with a washcloth
6. Wash the face
7. Wash the arms and the hands
8. Wash the chest and the abdomen
9. Wash the legs and feet
10. Wash the back and then the perineum
11. Assist the client with grooming

Perineal-Genital care (perineal care or pericare)

Purposes:
To remove normal perineal secretions and odors
To promote client comfort
Assessment:
Presence of irritation, excoriation, inflamation and swelling
Excessive discharge
Odor pain or discomfort recent rectal or perineal surgery
Urinary or fecal incontinence indwelling catheter
Equipment and supplies:
Perineal-genital care provided in conjunction w/ bed bath
Bath towel
Bath blanket bath basin with water at 43 - 460C
Clean gloves soap
Wash cloth
Special perineal-genital care
Bath towel
Bath blanket
Cotton balls or swabs
Solution bottle or pitcher filled w/ warm water or prescribed solution
Bedpan
Perineal pad
Procedure:
 Explain to the client what you are going to do, why it is necessary and how he or she can cooperate.
 Wash hands
 Provide privacy
 Position and drape the client
o For females: back lying position
o For males: supine position
 . Inspect the perineal-genital area
 Wash and dry the perineal-genital area
 .Clean between the buttocks
 Document
FEET - are essential for ambulation and merit attention even when people are confined to bed.
- each foot contains 20 bones, 107 ligaments, and 19 muscles

COMMON FOOT PROBLEMS:

 Callus - Is a thickened portion of epidermis, a mass of keratotic material
 Softened by soaking the foot in warm water
 Apply cream w/ lanolin to keep the skin soft
 Corn - Is a keratotic caused by friction and pressure from a shoe
 Massage the tissue to promote circulation
 Corn are generally removed surgically
 Plantar warts - Appear on the sole of the foot. These warts are caused by the papovavirus hominis virus. They
are moderately contagious.
 . Apply salicylic acid
 May curettage the warts
 Fissures - Or deep grooves, frequently occur between the toes as a result of dryness and cracking of the skin
 Application of antiseptic to prevent infection
 Good foot hygiene
 Tinea pedis –ringworm of the foot caused by fungus.
 Application of antifungal ointments or powder
 Application of antifungal ointments or powder
 Soak in hot antiseptic
 Surgical removal of the portion of nail
PROVIDING FOOT CARE:
Purposes:
 To maintain the skin integrity of the feet
 To prevent foot infections
 To prevent foot odors
 To assess or monitor foot problems
 Assessment:
 Determine history of any problems w/ foot discomfort and circulatory problems
 Determine usual foot care practices
 Assess surface for cleanliness, odor, dryness, intactness
 Assess each foot and toe for shape, size, presence of lession
 Heels for erythema, blisters or breaks in the skin integrity
 Skin temperature of both feet
 Self care abilities
Equipment and supplies:
 wash basin containing warm water
 Pillow
 Moisture resistant disposable pad
 Towels
 Soap
 Washcloth
 Toenail-cleaning and trimming equipment
 Lotion and foot powder
NAILS - are normally present at birth. They continue to grow throughout life and change very little until people are
older.
MOUTH - the opening in the lower part of the human face, surrounded by lips, through which food is taken in.
- is normally moist, lined with mucous membrane and contains the teeth
 COMMON PROBLEMS OF THE MOUTH
PROBLEM DESCRIPTION NURSING IMPLICATION

Halitosis Bad breath Provide regular oral hygiene

Glossitis Inflammation of the tongue As above
Gingivitis Inflammation of the gums As above
Periodontal disease Gums appear spongy and bleeding As above
Excessive dryness Increase fluid intake
Cheilosis Cracking of lips Lubricate lips, use antimicrobial ointment
Dental carries Teeth has darkened areas, painful Advise client to see the dentist
Sordes Accumulation of foul matter Provide regular cleaning
Stomatitis Inflammation of the oral mucosa Provide regular cleansing
Parotitis Inflammation of the parotid salivary glands Regular hygiene
Plaque Invisible soft film Provide regular cleaning
Tartar Visible hard deposit of plaque Provide regular cleaning
Pyorrhea Teeth are loose and pus is evident See the dentist

HAIR: - a numerous fine, usually cylindrical, keratinous filaments growing from the skin of humans and animals.
LANUGO- the fine hair on the body of the newborn, also referred to as down or woolly hair over the shoulder, back and
sacrum.
PROBLEMS
PROBLEM DESCRIPTION NURSING IMPLICATION
Alopecia Hair loss No known remedy
Dandruff Diffuse scaling scalp Treated effectively with commercial shampoo
Ticks Small gray brown parasites Remove ticks & wash the area with antibacterial soap
Pediculosis (lice) Parasitic insects that infest  Apply topical pediculosides agents (eg.
 Pediculus capitis mammals Kwell shampoo)
(head louse)  home remedies such as olive oil, mayonnaise
 Pediculus or petroleum jelly to smother lice
corporis(body louse)  Removal of nit (eggs)
 Pediculus pubis (crab
louse)
Scabies Contagious skin infestation Cleansing with soap and water then apply scabicide
by the itch mite lotion
Hirsutism Growth of excessive body No known remedy
hair
PROVIDING HAIR CARE/SHAMPOOING
Purposes: 1. To stimulate blood circulation to the scalp
2.To distribute hair oils and provide a healthy sheen
Assessment:
 History of the ff. conditions /therapies: recent chemotherapy, radiation of the head and other scalp problem
 Activity tolerance of the patient
 Determine the type of shampoo to be used
Equipment and supplies:
Comb/brush Cotton balls
Plastic sheet/pad Pitcher of water
Two bath towels liquid or cream shampoo
Shampoo basin hair dryer
Washcloth/ pad
Bath blanket
 Explain the procedure
 Wash hands
 Provide for client privacy
 Position and prepare the client appropriately
  Arrange the equipment
 Protect the clients eyes and ears
 Shampoo the hair
 Dry the hair thoroughly
 Ensure client comfort
 Document the shampoo and any assessments
BEARD AND MUSTACHE CARE
 Wear gloves in case facial nicks occur and you come in contact with blood
 Apply shaving cream or soap and water
 Hold the taut, particularly around creases
 Hold the razor so that the blade is at a 45-degree angle to the skin and shave in short, firm strokes
 After the entire area, wipe the clients face with wet washcloth
 Dry the face well, then apply aftershave lotion or powder
 Pat on the lotion with the fingers and avoid rubbing the face
EYES
 Wear gloves in case facial nicks occur and you come in contact wit blood
 Apply shaving cream or soap and water
 Hold the taut, particularly around creases
 Hold the razor so that the blade is at a 45-degree angle to the skin and shave in short, firm strokes
 After the entire area, wipe the clients face with wet washcloth
 Dry the face well, then apply aftershave lotion or powder
 Pat on the lotion with the fingers and avoid rubbing the face
GENERAL EYE CARE
 Avoid home remedies for eye problems
 If dirt or dust gets into the eyes, clean them copiously with clean, tepid water as an emergency treatment
 Take measures to guard against eyestrain and to protect vision
 Schedule regular eye examinations, particularly after age 40 to detect problems such as cataracts and glaucoma
EARS
 Cleaning of ears- the auricles of the ear are cleaned during the bed bath.
 Care of hearing aids
 Hearing aids a battery-powered, sound amplifying device used by people with hearing impairments.
 Types of hearing aids
 Behind-the-ear(BTE) open fit- the newest in hearing aid technology. No earmold and visible a clear tube that
runs down into the ear canal.
 Cleaning of ears- the auricles of the ear are cleaned during the bed bath.
 Hearing aids - a battery-powered, sound amplifying device used by people with hearing impairments.
Types of hearing aids:
 Behind-the-ear(BTE) open fit- the newest in hearing aid technology. No earmold and visible a clear tube that
runs down into the ear canal.
o is widely used type because it fits snugly behind the ear.
o Hearing aid case which holds the microphone, amplifier and receiver is attached to the earmold by
plastic tube.
 In-the-ear (ITE) aid
o this one-piece aid has all its components housed in the earmold.
o It is more visible than other types but more room for features such as volume control.
 In-the-canal (ITC) canal
o compact and barely visible,
o an ITC aid fits completely inside the ear canal.

Eyeglasses aid
o is similar to the behind the ear aid but the components are housed in the temple of the eyeglasses.
Body hearing aid
o the pocket-sized aid, use for more severe hearing looses,
o clips onto an undergarment, shirt pocket, or hardness carrier supplied by the manufacturer.
Removing, Cleaning and Inserting a Hearing Aid:
Purposes:
o To maintain proper hearing aid function.
Equipment:
o Clients hearing aid o Provide client privacy
o Soap, water and towels or a damp cloth o Remove the ITE hearing aid
o Pipe cleaner or toothpick o Clean the earmold
o New battery o Insert the hearing aid
o Procedure o Document pertinent data
o Explain the procedureS
o Wash hands
MAKING BEDS
 UNOCCUPIED BED -- an occupied bed can be either closed or open.
 Open bed- the top covers are folded back to make it easier for a client to get in.
 Closed bed- the top sheet, blanket, and bedspread are drawn up to the top of the bed and under the
pillow.
CHANGING UNOCCUPIED BED
Purposes:
o To promote the clients comfort
o To provide a clean, neat environment for the client
o Assessment
o Assess clients status
o Client pulse and respirations
o Note all tubes and equipment connected to the client
Procedure:
o Explain the procedure
o Wash hands
o Provide for client privacy
o Place the fresh linen on the clients chair or overbed table
o Assess and assist the client out of bed
o Strip the bed:
 Fold reusable linens into fourths when removing them from the bed
 Roll soiled linen inside the bottom sheet and hold away from the body
 Apply the bottom sheet and draw sheet
o Move to the other side and secure the bottom lines
o Apply or complete the top sheet, blanket, and spread.
 Vertical toe pleat
 Horizontal toe pleat
 Making a cuff of the top lines
o Put clean pillowcases on the pillows as required.
o Provide for client comfort and safety
o Document and report pertinent data
Variation:
Surgical bed - is used for client who is having surgery and will return to bed for the operative phase.
o Strip the bed
o Place and leave the pillow on the bedside chair.
o Apply bottom lines as for an unoccupied bed.
o Place the top covers (sheet, blanket, and bedspread)on the as you would for an unoccupied bed.
o On the side of the bed where the client will be transferred, fold the two outer corners of the top linens so they
met in the middle of the bed forming triangle.
o Pick up the apex of the triangle and fanfold the top linens lengthwise to the other side of the bed.

CHANGING AN OCCUPIED BED

Purposes:
  To conserve the clients energy
 To promote client comfort
 To provide clean, neat environment for the client
 To provide a smooth, wrinkled-free bed foundation, thus minimizing sources of skin irritation
Assessment:
 Assess skin condition and a need for a special mattress.
 Assess clients ability to reposition self
 Determine presence of incontinence or excessive drainage
 Note specific orders or precautions
 Procedure:
 Introduce yourself and explain the procedure
 Hand washing
 Provide client privacy
 Remove the top bedding
 Change the bottom sheet and draw sheet,
 Move the soiled linen as close as possible to the client.
 Place a new bottom sheet on half of the bed
 Place a clean draw sheet
 Instruct the client to hold the top edge of the sheet while the nurse removes the bath blanket
 Ensure continued safety of the client
 Bed – making is not normally recorded
Practice Guidelines in Bed-Making
 Use a glove while handling a client’s used bed linen
 Hold soiled linen away from uniform
 Linen for one client is never placed on another client’s bed
 Place soiled linen directly in a portable linen hamper or tacked into a pillow case at the end of the bed before
it is gathered up for disposal
 Do not shake soiled linen in the air
 When stripping and making a bed, conserve time and energy
 Complete your set of linens to avoid trips to the linen supply area

BACK MASSAGE
Assessment:
 Assess behaviors indicating potential need for a back massage (muscle stiffness, tension in back and shoulders
or difficulty of falling asleep related to tension and anxiety
 Determine if the client is willing to have a massage, as some individuals may not enjoy a massage.
 Assess for contraindications of back massage (impaired skin integrity, back surgery, vertebral, rib fracture).
 Determine if the client is willing to have a massage, as some individuals may not enjoy a massage.
 Assess for contraindications of back massage (impaired skin integrity, back surgery, vertebral, rib fracture).
Planning:
 Delegation: but before delegating assess first the patient
Implementation:
 Equipment:
o Lotion
o Towel for excess lotion
 Determine: Previous assessments of the skin.
Special lotions to be used.
Positions contraindicated for the client.
o Arrange for a quiet environment with no interruptions to promote maximum effect of the back
massage
o Previous assessments of the skin.
o Special lotions to be used.
 Performance:
o Explain to the client what, why and how.
 oEncourage client to give you feedback as to the amount of pressure you are using during the backrub.
oWash hands and obtain appropriate infection control procedures.
oProvide client for privacy.
oPrepare the client.
 Assist the client to move to the near side of the bed within your reach and adjust the bed to a
comfortable working height.
 Establish which position the client prefers.
 Prone position: recommended for a back rub.
 Side lying position: can be used if the client cannot assume the prone position.
 Expose the back from the shoulders to the inferior sacral area.
 Massage the back.
 Pour a small amount of lotion onto the palms of your hands and hold it for a minute.
 Using your palm begin from the sacral area using smooth circular strokes
 Move your hands up the center of the back and then over both scapulae.
 Massage in circular motion over the scapulae.
 Move your hands down the sides of the back. Massage the areas over the right and left iliac
crests.
 Apply firm, continuous pressure without breaking contact with the client’s skin.
 Repeat above for 3 to 5 minutes obtaining more lotion as necessary.
 While massaging the back, assess for skin redness and areas of decreased circulation.
 Pat dry any excess lotion with a towel
 Document.
TYPES OF MASSAGE
 Effleurage - is a slow, rhythmic, relaxing and soothing.
o It is used to aid lymphatic circulation, venous circulation, removal of metabolic waste, and tissue
absorption of oxygen and nutrients from the blood.
o It is also used to relax the client and reduce fluid retention by assisting in tissue fluid exchange.
 Petrissage and Kneading
o Are more invasive movements intended to aid mobilisation of fatty and adhesive tissue, dispersal and
removal of metabolic wastes and mobilisation of skin and fibrous tissue.
o Lymph drainage is aided by the lifting and pressure on the skin, which also relaxes muscles and eases
discomfort.
 Frictions
o Movements are more compressive and intended to aid mobilisation of fatty tissue and break down
fibrous tissue and adhesions.
o Friction can also be applied to stretch tight scar tissue, and if use is prolonged can promote an
anaesthetic result
 Vibrations
o Intended to ease discomfort, stimulate nerves and muscles and promote local stimulation of blood and
lymphatic circulation
 Tapotement
o Used to improve blood flow particularly affecting the skeletal structure, and to stimulate nerve and
muscle
 Neuromuscular
o Particularly affective in spinal areas – uses to stimulate nerves in the cranium and the spine, and to
release adhesions between vertebrae.

 Acupressure
o Applied on specific points on the back, face and cranium, to promote positive energy flow in the
body’s meridians

Prepared By:
ROMELDA D. LUCERO, RN, MN
MAC - CON