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 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 ProcedureNormal 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

peri-bottle 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 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 31-2Procedure 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 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 Hygienea. 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 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 open1.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 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:

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

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

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 SafetyProvide 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.

Hold the razor at a 450 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

Usually requires minimal care

Cleanse the external auricle with washcloth when bathing

Avoid insertion of objects into the ear

Hearing Aidsa. 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 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 HygieneProcedure for Using Bedpan / Urinal

1. Bring to the bedside2. Warm the bedpan if it is metal3. Place bed in appropriate position4. Fold the top linen back to allow for

placement of bedpan or urinal5. 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

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

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 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.