Chapter11.4

Basic Human Needs:

Hygiene

Introduction

Hygiene is the science of health and its maintenance. Maintenance and promotion of hygiene is

very important aspect of human physiological needs. Many kinds of disease or illness can be prevented

by maintaining personal hygiene. If hygiene is promoted and maintained, the individual has a feeling of

comfort, well being, safety and self confidence.

Personal hygiene is a self-care by which people attend to such as functions as bathing, toileting,

general body hygiene and grooming. Hygiene is determined by individual values and practices. It

involves the care of skin, hair, nails, teeth, oral and nasal cavities, eye and perineal areas.

Anatomy and Physiology of the Skin

• It is the largest organ of the body.

• The functions of the skin are as follows:

- It is the first line of defense against injury and microorganisms.

- It maintains body temperature.

- It is secretory organ. It secretes sebum, an oily substances which lubricates the hair

and the skin; prevents the hair from becoming brittle; decreases water loss from

the skin; lessens the amount of heat lost from the skin and has bactericidal action.

- It is a sensory organ. It has numerous nerve receptors which are sensitive to pain,

temperature, touch and pressure.

- It produces and absorbs vitamin D through the action of ultraviolet rays from the sun

which activate vitamin D precursor present in the skin.

Two Types of Sweat Glands

1. Apocrine glands

• They are primarily located in the axilla and anogenital areas

• They begin to function at puberty under the influence of androgen.

• The secretion of these glands is odorless, but may become musky/unpleasant

when acted upon by microorganisms.

2. Eccrine glands

• They are found primarily on the palms of the hands, the soles of the feet and

forehead.

• The sweat they produce cools the body through evaporation.

• The sweat is composed of water, sodium, potassium, chloride, glucose, urea

and lactate.

Common Problems of the Skin

1. Abrasion

• Superficial layers of the skin are scraped or rubbed away.

• The area appears red, with localized bleeding or serous weeping.

Nursing Interventions

• Keep the wound clean and dry to prevent infection.

• Lift instead of sliding, pulling or pushing the client in bed.

• Do not wear jewelries when performing procedures to the client.

2. Excessive dryness

• Skin is scaly and rough.

Nursing Interventions

• Encourage to increase fluid intake. This is most effective measure to relieve dryness of the

skin.

• Apply cream or lotion to moisturize the skin and prevent cracking.

• Avoid use of alcohol on the skin.

• Bathe the client less frequently, rinse skin thoroughly.

3. Acne

• An inflammatory condition of the skin which of the skin which of the skin which occurs in

and around sebaceous glands.

• Characterized by papules, pustules and comedones ( black heads).

Nursing Interventions

• Encourage daily bath.

• Keep the skin clean and dry.

• Adequate rest, sleep and exercise.

• Have exposure to natural sunlight.

• Avoid foods with high carbohydrate and fat content

E.g. chocolates, nuts and colas.

• Reduce emotional stress and anxiety.

• Avoid picking or squeezing of pimples.

• Use of medications as prescribed:

▪ topical ointment

▪ systemic antibiotics

▪ estrogen with progesterone

Hygienic Measures

Skin Care

4. Erythema

• Redness of the skin which may be associated with rashes, exposure to sun, elevated body

temperature.

Nursing Interventions

• Wash skin thoroughly to minimize microorganisms.

• Apply antiseptic spray or lotion to relieve pruritus.

• Promote healing and prevent impairment of the skin integrity.

5. Hirsutism

• Excessive growth of the hair among women.

Nursing Interventions

• Shave excessive hair growth

• Use depilatory cream

• Enhance client`s self concept

6. Hyperhidrosis is excessive perspiration.

7. Bromhidrosis is foul-smelling perspiration.

8. Vitiligo are patches of hypopigmented skin caused by destruction of melanocytes in the

area.

A. Primary Skin Lesion

• Macule. A flat, circumscribed area of color with no elevation of its surface; 1mm to 1 cm

e.g. freckle, flat nevi (moles).

• Patch. Same as macule but larger than 1 cm e.g. port wine birth mark.

• Papule. A circumscribed, solid elevation of skin; less than 1 cm, e.g.

warts, acne.

• Plaque. Same as papule but larger than 1 cm , e.g. eczema.

• Nodule. A solid mass that extends deeper into the dermis than that of a papule, e.g.

pigmented nevi.

• Tumon. A solid mass larger than a nodule, e.g. epithelioma.

• Vesicle. A circumscribed elevation containing serous fluid or blood; less than 1 cm, e.g.

blister, chicken pox.

• Bulla. A large fluid-filled sac.

• Pustuie. A vesicle or bulla filled with pus, e.g. acne vulgaris, impetigo.

• Wheal. A relatively reddened, elevated, localized collection of edema fluid; irregular in

shape, e.g. mosquito bite.

• Cyst. Elevated, thick-walled lesion containing fluid or semisolid matter.

• Telangiectasia. Dilated capillary; fine red lines, e.g. liver cirrhosis.

Types of Skin Lesion

• Petechiae. Pinpoint red spots.

B. Secondary Skin Lesions

• Scale. Thickened epidermal cells that take off. E.g. dandruff, psoriasis.

• Crust. Dried serum or pus on the skin surface. E.g. impetigo.

• Fissure. A deep linear crack. E.g. athlete’s foot.

• Erosion. Loss of all or part of the epidermis. Appears moist demarcated depressed area.

E.g. ruptured chicken pox vesicle.

• Excoriation. A superficial linear or hollowed out crushed area exposing dermis. E.g.

scratch.

• Atrophy. A decrease in the volume of epidermis. E.g. striae, aged skin.

• Scar. A formation of connective tissue. E.g. healed wound.

• Ulcer. An excavation extending into the dermis or below. E.g. decubitus ulcer.

• Lichenification. Epidermal thickening resulting in elevated plaque with accentuated skin

markings. Results from repeated rubbing or scratching. E.g. chronic atopic dermatitis.

General Guidelines for Skin Care

1. An intact, healthy skin is the body’s first line of defense.

2. The degree to which the skin protects the underlying tissues from injury depends on the

amount of subcutaneous tissue and the dryness of the skin.

3. Moisture in contact with the skin can result in increased bacterial growth and irritation.

4. Body odors are caused by resident skin bacteria acting on the body secretions. Cleanliness is

the best deodorant.

5. Skin sensitivity to irritation and injury varies among individuals and accordance with their

health.

6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent, bath oil,

cream, lotion, powder, deodorant and antiperspirant.

Methods of Bathing

• Tub bath

• Stand-up shower

• Sit-down shower with shower chair.

• Bed bath

Clients who suffer dizziness, weakness or mental confusion should not be allowed to take stand-

up showers. Obese clients may find it difficult to maneuver into a bathtub and might risk falling.

For these clients, a sit-down shower chair may be more appropriate.

Purposes of Bed Bath

1. To remove microorganisms, body secretions and excretions and dead skin cells.

2. To improve circulation.

3. To promote relaxation and comfort.

4. To prevent or eliminate body odors and promote self-esteem.

5. To promote sense of well-being.

6. To assess the client’s skin and body parts.

7. To provide activity and exercise.

Nursing Interventions During Bed Bath

• Inform the client and explain purpose of the procedure.

• Provide privacy by closing curtains around bed or shut room door. This is to maintain client’s

dignity.

• Close windows and doors to prevent drafts.

• Turn-ff electric fan or air conditioning unit prevent chills.

• Encourage to void before start of the procedure. To ensure comfort.

• Place the bed in flat position, if admissible. To facilitate movement and change of position.

• Move the client to one side of the bed. To prevent overreaching and prevent muscle strain.

• Remove the patient’s grown. Cover up to shoulder level with the top sheet or bath blanket. To

provide comfort, warmth and privacy.

• Use warm water (110 – 115ᵒF).

• Make bath mitt with the washcloth and prevent water from dripping on client.

• Wash the body parts as follows:

a. Eyes, face, ears, neck

b. Farther arm

c. Nearer arm

d. Hands

e. Chest and abdomen

f. Farther leg

g. Nearer leg

h. Feet

i. Back and buttocks

j. Perineum ( “finishing the bath”)

• Exposure, wash and dry one body part a time. To promote privacy and prevent chills.

• Rinse off soap thoroughly. To prevent skin irritation.

• May apply cream, lotion or powder on the skin.

• Change gown. Do bed making.

• Do after-care of equipment and articles.

• Document relevant data.

Special Nursing Considerations When Bathing a Client in Bed

1. Cleanse eye with water only, wiping from inner to outer canthus. Use separate corner of mitt

for each eye.

Rationale: Washing eye from inner to outer canthus prevents secretions from entering

Bed Bath

and irritating nasolacrimal ducts. Using separate corner for each eye prevents transfer of

microorganisms from one eye to the other.

2. Determine if client would like to use soap on the face. Consider individual preferences.

Rational: Soap can be drying especially to the face. Some clients use special cleansing

solution for their faces.

3. Wash, rinse and dry the arms and legs using long, firm strokes from distal to proximal areas.

Rationale: Stroking from distal to proximal areas stimulates venous blood return.

4. Assess bath water temperature and change water as necessary.

Rationale: to ensure warm temperature of water for comfort. Changing water as

necessary ensures cleanliness of the water used for bathing the client.

Back Rub

The Backrub is a massage of the back with two chief objectives: to relax and relieve

muscle tension and to stimulate blood circulation to the tissues and muscles.

Types of Techniques that can be Used in Back Rub

• Effleurage. Is a smooth, long stoke, moving the hands up and down the back. The hands are

moved lightly down the sides of the back, maintaining contact with the skin but are moved

firmly up the back.

• Tapotement. In here the little side of each hand is used in a sharp hacking movement on the

back. Care must be taken with this type of rub to not hurt the patient. Also called tapping.

• Petrissage. Is a large pinch of the skin, subcutaneous tissue and muscle quickly done. The

pinches are taken first up the vertebral column and the over the entire back. It is called

kneading.

Nursing Interview in back Rub

• Help client to side-lying or prone position.

• Expose back, shoulders, upper arms and sacral area. Cover remainder of the body with bath

blanket. This prevents unnecessary exposure and chilling while maintaining dignity.

• Wash hands in warm water. Warm lotion by holding container under running warm water.

Warm hands and lotion prevent startle response and muscle tension from cold hands and lotion.

• Poor small amount of lotion into palms. Lubricating palms reduces friction on skin d uring

massage.

• Massage sacral area with circular motion. Move hands upwards to shoulders, massaging over

scalpulae in smooth, firm strokes. Without removing hands from skin, continue in smooth

strokes to upper arms and down sides of back to iliac crest. Continue for 3 to 5 minutes.

Continuous, firm strokes promote relaxation and stimulate circulation.

• Use petrissage over shoulders and gluteal area and tapoitement up and down the spine.

To ensure asepsis, always wash from clean areas to dirty areas when possible.

• End massage with long, continuous, stroking movements. Stroking is the most relaxing of the

massage movements.

Purposes of Perineal-Genital Care:

1. To remove normal perineal secretions and odor.

2. To prevent infection.

3. To promote comfort.

Nursing Interventions During Perineal-Genital Care

• Inform the client and explain purpose of the procedure.

• Provide privacy. To maintain client dignity.

• Position and drape the client as follows:

- Female : dorsal recumbent position; drape the client diagonally.

- Male: supine position.

- For female clients, use forceups to hold cotton balls for cleansing the

perineum.

- For male clients, wear clean gloves.

• For female clients

a. Use anterior to posterior (front to back) stoke to prevent contamination of

urethral meatus and vagina with microorganisms from the anus.

b. Use one cotton ball for each stroke.

c. Cleanse perineum with soap/antiseptic solution. Include the inner thigh.

d. Rinse the area with copious amount of water. To remove soap adequeately

and prevent irritation of the perineal area.

e. Dry perineum thoroughly. Moisture supports microbial growth.

• For male clients

a. Wash and dry penis using firm strokes, to prevent erection of the penis.

b. Use circular motion, from the tip of glans penis towards the penile shaft.

c. If the client is uncircumcised, retract the prepuce (foreskin). This is to

remove smegma that collects under the foreskin and facilitates bacterial

growth.

d. Wash and dry the scrotum and buttocks.

• For post-delivery or menstruating females, apply a perineal pad as needed from front

to back. This prevents contamination of urethra and vagina from anal area.

• Keep the client comfortable

• Do the after-care of equipment and articles

• Document relevant data

Perineal-Genital Care

• Wash the feet daily, and dry them well especially the interdigital spaces.

• Use warm water for foot soak, to soften the nails and loosen debris under them.

Caution: soaking the feet of diabetic clients is no longer encouraged because excessive

moisture can contribute to skin breakdown.

• Use cream or lotion to moisten the skin and soften calluses.

• Use deodorant sprays or foot powder to prevent or control unpleasant odor.

• File toenails straight across. To prevent nail splitting and tissue injury around nail.

• Change socks or stocking daily.

• Wear comfortable, well-fitted pair of shoes

• Do not go barefooted.

• Exercise the feet to improve circulation

• Avoid using constricting clothing or round garters which may decrease circulation.

• Avoid crossing the legs.

• Avoid self-treatment for corns or calluses.

Common Foot Problems

1. Callus. Painless, flat, thickened epidermis, a mass of keratotic material. Often

caused by pressure from the shoe on bony prominence.

2. Corn. Keratosis caused by friction and pressure from a shoe. It commonly affects the

fourth and fifth toe. It appears circular and raised.

3. Unpleasant odors. This results from perspiration and its interaction with

microorganisms.

4. Plantar warts. Caused by virus papova-virus hominis. They appear on the sole of the

foot and are moderately contagious. They are painful and make walking difficult.

5. Fissures. Caused by dryness and cracking of the skin.

6. Tinea pedis. Characterized by scaling and cracking of the skin, particularly between

the toes, caused by a fungus. There may be blisters. (Also Athlete’s foot, ringworm

of the foot) .

7. Ingrown Toenail. Inward growth of the nail, causing trauma into soft tissues. It is

usually due to trimming the lateral edges of the toenails.

• Trim nails straight across, or follow the contour of the fingers.

• File nails to have smooth edges.

• Do not trim nails at the lateral corners to prevent ingrown.

• Diabetic clients are advised against cutting hangnails or cuticles.

• Ingrown is also called unguis incarnatu.

• Separation of the nail from the nailbed is onycholysis.

Foot Care

Nail Care

• Inflammation of the skin fold at the nail margin is paronychia.

Measures to Prevent Tooth Decay

• Brush the teeth thoroughly after meals and at a bedtime.

• Floss the teeth daily.

• Ensure adequate intake of food rich in calcium, phosphorus, Vitamin A, C and D and

fluoride.

• Avoid sweet foods and drinks between meals.

• Eat coarse, fibrous foods ( cleansing foods) such as fresh fruits and raw vegetables.

• Have dental check up every 6 moths.

• Have topical fluoride applicants as prescribed by the dentists.

Brushing and Flossing the Teeth

Purposes

a. To remove food particles from around and between the teeth.

b. To remove dental plaque.

c. To enhance the client’s feelings of well-being.

d. To prevent sordes and infection of the oral tissues.

Nursing Interventions When Providing Oral Care

• Inform the client and explain purpose of the procedure.

• Provide privacy.

• Assist in sitting or side-lying position.

• Place towel under the client’s chin.

• Moisten bristles of toothbrush and apply dentrifice.

• Hold kidney basin under the chin.

• Allow the client to brush his teeth, if possible.

• Use downward strokes for upper front teeth; upward strokes for lower front teeth;

back and forth strokes for the biting surfaces of the teeth; and hold the brush against

the teeth with bristles at 45 degrees angle to penetrate and clean under the gingival

margins.

• Rinse the mouth with adequate amount of water. Floss the teeth.

• Keep the client comfortable.

• Do after-care of equipment and articles.

• Document relevant data.

For unconscious Client:

• Place in side – lying position to prevent aspiration.

• Have suction apparatus readily available.

• Use padded tongue blade to open the mouth.

• Brush teeth and gums, using toothbrush or soft sponge – ended swab.

Mouth Care

• Apply thin layer of petroleum jelly to lips to prevent drying or cracking.

Note: Lemon glycerin swabs can be drying to the oral mucosa if used for extended

periods.

Care of Artificial Dentures

• Wear gloves when handling and cleansing dentures.

• Place a washcloth in a basin or bowl of the sink when brushing dentures to prevent

damage if the dentures are dropped.

• Store the dentures in a container with water.

Common Problems of the Mouth

1. Plaque. An invisible soft film of bacteria, saliva, epithelial cells and leukocytes that

adhere to the enamel surface of the teeth.

2. Tartar. A visible, hard deposit of plaque and bacteria that forms at the gum lines.

3. Halitosis. Bad breath.

4. Glossitis. Inflammation of the tongue.

5. Gingivitis. Inflammation of the gums.

6. Stomatitis. Inflammation and dryness of the oral mucosa.

7. Parotitis. Inflammation of the parotid salivary glands (mumps).

8. Sordes. Accumulation of foul matter (food, microorganisms, and epithelial

elements) on the gums and teeth.

9. Perlodontal disease. Gums appear spongy and bleeding (pyorrhea).

10. Cheilosis. Cracking of the lips.

11. Dental caries. Teeth have darkened area, may be painful (cavities).

• The appearance of the hair may reflect a person’s sense of well being and health

status.

• Brushing and combing the hair stimulate circulation of blood in the scalp; distribute

the oil along the hair shaft; help to arrange the hair.

Purposes

a. To stimulate the circulation of the blood in the scalp through massage.

b. To clean the hair and improve the client’s sense of well -being.

Nursing Interventions During Hair Shampoo.

• Determine if the institution requires doctor’s order for hair shampoo.

Hair Care

Hair Shampoo

• Place client diagonally in bed.

• Remove pins from hair. Comb and brush hair thoroughly. This is to remove tangles.

• Place Kelly pad under the head, with neck hyperextended.

• The trough of the Kelly pad should be directed to a pail. To prevent spillage of water

onto the floor.

• Cover the eyes with wash cloth. To protect them from irritation.

• Plug the ears with cotton balls. To prevent entry of water into the external auditory

canal.

• Apply small amount of shampoo.

• Massage the scalp with the fatpads of the fingers and make a rich lather. Massage

promotes circulation in the scalp. Rich lather ensures through cleansing of the hair.

• Rinse the hair thoroughly. Soap residue in hair may cause irritation of the scalp and

may dry hair.

• Dry the hair thoroughly.

• Keep the client comfortable.

• Do after-care of equipment and articles.

• Make relevant documentation.

Common Hair and Scalp Problems

1. Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus (seborrheic

dermatitis).

2. Alopecia. Hair loss or baldness.

3. Pediculosis. Infestation with lice.

a. Pediculosis capitis is head louse.

b. Pediculosis corporis is body louse.

c. Pediculosis pubis is crab louse.

4. Scabies. Contagious skin infestation by the itch mite. The characteristic of the lesion

is the burrow produced by the female mite as it penetrate the skin. The burrows are

short, wavy brown or black threadlike lesions.

5. Hirsutism. Excessive growth of body hair.

• The usual treatment for pediculosis is gamma benzene hexachloride (Kwell),

which comes in lotion, cream and shampoo. Pubic lice are difficult to remove, so

the shampoo may be applied and left on for 12 to 24 hours.

• Linens and clothings used by clients should be washed in hot water.

Nursing Interventions

• Cleanse the eyes from the inner canthus to the outer canthus. Use a new cotton ball

for each wipe. To prevent contamination of the nasolacrimal ducts.

• If the client is comatose, cover the eyes with sterile moist compresses. To prevent

dryness and irritation of the cornea.

• Eyeglass should be cleansed with warm water and soap; dried with soft tissue.

• Clean contact lens as directed by the manufacturer.

• To remove artificial eyes, wear clean gloves, depress the client’s lower eyelid.

• Hold the artificial eye with warm normal saline, then place in a container with water or

saline solution.

• Avoid rubbing the eyes. This may cause infection.

• Maintain adequate lightning when reading.

• Avoid regular use of eyedrops.

• If dirt/foreign bodies get into the eyes, clean them with copious, clear tepid water as

an emergency treatment.

Nursing Interventions

• Cleanse the pinna with moist wash cloth.

• Remove visible cerumen by retracting the ears downward. If this is ineffective, irrigate

the ear as ordered.

• Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen.

These can rupture the tympanic membrane or traumatize the ear canal. Cotton - -tipped

applicators can push wax into the ear canal, which can cause blockage.

Nursing Interventions

• Clean nasal secretions by blowing the nose gently into soft tissue.

• Both nares should be open when blowing the nose to prevent forcing debris into the

middle ear, via the Eustachian tube.

• May use cotton-tipped applicator moistened with saline or water to remove

encrusted, dried secretions. Insert only up to cotton tip.

Eye Care

Ear Care

Nose Care