HYGIENE
in patient care
Supplementary Resources:
Watch the Video Clips!
Personal Hygiene
• Necessary for comfort, safety & well-being
• Requires close contact, utilize communication
skills
• Integrate assessment, ROM, education
• Time to learn about client-needs & practices
• Most client’s require some assistance
• Several factors influence hygiene practices
Scientific Knowledge Base
– Hygiene requires understanding of A & P
– Skin & mucosa cells exchange O2, nutrients, fluids
with underlying blood vessels
– Cells require adequate nutrition, hydration,
circulation to resist injury & disease
– Learn to recognize those diseases that create
pathology
– Adapt hygiene to anticipate needs & minimize injury
Skin
• Protects, secretes, excretes, regulates temp,
senses
• If skin is intact & healthy = optimal
physiological fxn
• Note changes in color, thickness, texture,
turgor, temp, hydration
• Bacteria reside on the outer epidermis
– Normal flora
– Abnormal flora
Feet, Hands & Nails
• Feet- assess for intact skin, pain, deformity
• Hands-assess for dexterity to permit self care
• Nails-transparent, smooth, convex
– Disease causes change in shape, thickness,
curvature
Oral Cavity
• Lined with mucous membranes continuous
with the skin
• Assess-lips, teeth, gum tissue, buccal mucosa
• Ensure oral care is completed frequently
Hair
• Growth, distribution, pattern indicates general
health status
• Hormones, stress, aging, infection, nutrition &
genetics affect characteristics
• Assess color, condition, distribution, brittleness
Eyes, Ears & Nose
• Ask about any changes in vision, hearing or
smell
• Clean these sensitive sensory tissues &
prevent discomfort
– No soap in eyes
– Soap on face
Factors Influencing Hygiene
Social practices Personal preferences
Ethnic, social & family influences Dictates hygiene practices
hygiene patterns: frequency, time, & Different products, water temp
type of products used
Body image Socioeconomic status
Is a person’s subjective concept of Influences the type & extent of hygiene
their body appearance practices used
If unkempt-require education how regular people can wash,
Body image can change with availability of supplies
hospitilization
Health beliefs & motivation Cultural variables
Motivation is the key factor to People from diverse cultures practice
hygiene: see risk as personal may different hygiene rituals
take reasonable action
Physical condition
Lack energy or dexterity to perform
hygienic care
Risk Factors for Hygiene Problems
• Oral problems
– dehydration; NPO, NGT, O2 tubing
• Skin Impairment
– Immobility, sensation, malnutrition, moisture,
vascular insufficiency, external devices (TEDs & SCDs)
• Upper Extremity Weakness
– Dexterity & hand coordination
• Foot problems
– Unable to bend over
• Vision problems
Nursing Knowledge Base
• During hygiene assess:
– Physical limitations
• Integument, oral cavity, ENT
– Health promotion practices & needs
– Emotional needs—great time to talk to your pt!
Tell me more about…
Health Promotion
– Make it relevant
– Adapt instruction to client
– Teach ways to avoid injury
– Reinforce infection control
Nursing Process - Assessment
• Prepare to provide hygiene
• Determine areas to provide care
• Assess as you perform hygiene
– Utilize inspection & palpation
– Skin & mocosal integrity, smoothness
– Examine bony prominences
– Examine all skin folds
• Be cautious of painful areas
– Decreased sensation
Risk factors for Skin Impairment
• Immobilization
• Reduced sensation
• Nutrition & hydration status
• Secretions or excretions on skin
• Vascular insufficiency
• External devices
Nursing Diagnosis-Hygiene
• Assessment may reveal a need or inability to
meet optimal personal hygiene
• As you gather data: review knowledge, prior
experiences & clusters of data
• Identify actual or potential health problems
Sample Nursing Diagnoses:
Deficient knowledge about hygiene practices
Risk for infection
Disturbed body image
Impaired physical mobility
Nursing Process- Planning
• Synthesize info from relevant sources
• Plan of care integrates all known data about client
• Professional standards utilize EBG for care
• Set goals & outcomes with client & family
• SMART
• Outcome examples:
– Clients maintains skin that is clean, dry, intact
– Clients skin is free from areas of pressure
Nursing Process- Implementation
• Take into consideration- client’s anxiety
• Promote comfort & relaxation
• Use a soft, gentle voice
• Try to relieve fears or concerns
• Manage symptoms prior to hygiene
• Educate on proper hygiene techniques
Bathing & Skin Care
• Consider client’s normal hygiene routine
• Individualize care based on client’s preferences
• A complete bed bath can be exhausting
– Able to tolerate-VS, priority
• Partial bed bath
Complete Bed Bath
• Prepare supplies & equipment
• Start with eyes & move down, clean peri area last
• Provide privacy, maintain safety, maintain
warmth, promote independence, anticipate needs
• Partial bed bath
– Hands, face, axillae & perineal area
Nursing Process - Evaluation
• Occurs during & after each skill
• Ask & assess if comfort & relaxation have
improved
• Consider the goals of care & evaluate if
expected outcomes have been achieved
Hygiene Schedule
• Early Morning or AM Care
– Offer bedpan/urinal
– Hand & face washing
– Oral care
• Routine Morning Care
– Offer toileting
– Provide bath with oral care, hair care, foot, nail &
perineal care
– Give back rub, change gown, change linens,
straighten bedside & room
Hygiene schedule (cont.)
• Afternoon Care
– Wash hands & face
– Assist with oral care
– Offer bedpan or urinal
– Straighten bed linens
• HS Care
– Change soiled gown or linens
– Oral care
– Back massage
– Toileting
– Wash hands & face
– HS snack
Back Rubs
• Promotes relaxation, relieves muscular
tension & decreases perceptions of pain
• Effleurage—long slow gliding strokes
reduces anxiety
• Reductions in BP, RR & HR
• 3 minutes or longer = provides comfort &
relaxation
Acute & Restorative Care
• Foot & nail care
Read Skill 39-3, page 880
– Prevent infection-teach s/s, promote circulation-signs of
poor circulation (Box 39-10, page 883)
• Oral Hygiene-brushing and flossing
– Read Skill 39-4, page 886
– Read Skill 39-5, page 888
• Hair & Scalp Care
– Brushing & Combing
– Shampooing
– Shaving
Acute & Restorative Care
• Care of Eyes, Ears & Nose
– Basic eye care
– Glasses/Contacts
– Hearing aid care
• Client’s Room Environment
– Read Box 39-17, page 899
– Read Skill 39-6, page 900
– Maintaining comfort
– Room equipment—beds
– Bed Making
Making beds
• Clean, smooth, wrinkle free beds are more
comfortable & reduce risk of pressure sores
• Occupied bed making (Skill 39-6) can be
challenging!!
