HYGIENE

DEFINITION: The science of health and its maintenance.

PERSONAL HYGIENE – Is the self-care by which people attend to functions as bathing, toileting, general body
hygiene, and grooming.
SKIN CARE
A. Common Skin Problems
1. Abrasion – superficial layer of the skin are scrapped or rubbed away. The area appears red, with localized
bleeding or serous weeping.
Nursing Intervention:
• Keep wound clean
• Lift instead of sliding, pulling or pushing the client in bed • Do not wear jewelry when performing
procedures to the client
2. Excessive Dryness – skin is scaly and rough.
Nursing Intervention:
• Encourage to increase fluid intake
• Apply cream or lotion to moisturize skin and prevent cracking
• Avoid use of alcohol on skin
• Rinse skin thoroughly
3. Acne – an inflammatory condition of the skin which occurs in and around sebaceous glands.
Characterized by papules and pustules.
Nursing Intervention:
• Keep skin clean and dry. Use warm water
• Adequate rest, sleep and exercise
• Have exposure to natural sunlight
• Avoid foods with high carbohydrate and fat content (nuts, chocolate, cola)
• Reduce emotional stress and anxiety
• Avoid pricking or squeezing pimples
• Use medications as prescribed:
- Topical treatment
- Systemic antibiotics
- Estrogen with progesterone
4. Erythema – skin redness which may be associated with rashes, exposure to sun.
Nursing Intervention:
• Wash skin thoroughly to minimize microorganisms
• Apply antiseptic spray or lotion to relieve pruritus
• Promote healing and prevent impairment of skin integrity.
5. Hirsutism – excessive growth of body hair among women.
Nursing Intervention:
• Shave excessive hair growth
• Use depilatory cream
6. Hyperhidrosis – excessive perspiration
7. Bromhidrosis – foul smelling perspiration
8. Vitiligo – patches of hypo-pigmented skin caused by destruction of melanocytes in area.

B. 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 tissue from injury depends on the amount of
subcutaneous tissue and the dryness of the skin.
3. Moisture in contact with skin can result to increase bacterial growth and irritation.
4. Body odors is caused by resident skin bacteria acting on the body secretions. Cleanliness is the best
deodorant.
5. Skin sensitivity to irritation & injury varies among individuals & in accordance with their health.
6. Agents used for skin care have selective actions and purposes (soap, bath oil, cream, lotion, powder,
deodorant, or antiperspirant.
 C. Hygienic Measures:
BED BATH
Purpose:
1. To remove microorganisms, body 4. To prevent and eliminate body odor.
secretions and excretions and dead skin 5. To promote sense of well-being.
cells. 6. To assess the client.
2. To improve circulation to the skin. 7. To provide activity and exercise.
3. To promote relaxation and comfort.

Procedure:
STEPS RATIONALE

1. Inform client and explain the purpose of procedure. • Promotes client’s cooperation and participation

2. Pull curtain around the bed or close door • Maintains client’s privacy

3. Avoid drafts – close doors and windows • Prevents rapid loss of body heat during bath.

4. Prepare necessary equipment and supplies: • Conserves time and energy

- 2 bath towels
- 2 wash cloths
- 2 wash basins
- Soap in soap dish
- Bath blanket or top sheet / spread
- Clean gown / pajamas
- Lotion, deodorant and powder (optional)
- Bed pan or urinal and toilet paper
- Linen hamper or laundry bag
- Disposable gloves
5. Encourage to void before the start of the procedure. • Client feels more comfortable after voiding. Prevents
interruption during bathing.

6. Wash hands. Apply gloves if required. • Reduces transmission of microorganisms

7. Lower side rails closest to you and assist client in • Aids access to the client. Maintains client’s comfort.
assuming comfortable position maintaining body
alignment.

8. Bring client towards the side closest to you. Raise • Over reaching may lead to strain on back muscles.
bed height.

9. Remove patient’s gown. Cover up to the shoulder • Provides full exposure of body parts during bath.
level with bath blanket.

10. Fill wash basin 2/3 full, use warm water 4346°C Warm water promotes comfort and prevents chilling.
(105-110°F). Have client place fingers in water to Prevents accidental burning of skin.
test temperature tolerance.

11. Place bath towel over client’s head. • Prevents soiling of bed linen

12. Make bath mitt with washcloth. • Mitt retains water and heat better than loosely held
washcloth. Keeps cold edges from brushing against
client’s skin.
13. Wash body parts as follows: • Starts from cleaner to dirtier body parts.
• Eyes, face, ears, neck
• Farther arm
• Nearer arm
• Hands
• Chest and abdomen
• Farther leg
• Nearer leg
• Feet
• Back and buttocks
Perineum (finishing bath)
14. Expose, wash and dry one body part at a time. • Prevents unnecessary exposure and maintains client’s
15. Rinse soap thoroughly. May apply cream, lotion or warmth and comfort.
powder.

13. Wash body parts as follows: • Starts from cleaner to dirtier body parts.
• Eyes, face, ears, neck
• Farther arm
• Nearer arm
• Hands
• Chest and abdomen
• Farther leg
• Nearer leg
• Feet
• Back and buttocks
• Perineum (finishing bath)

16. Expose, wash and dry one body part at a time. • Prevents unnecessary exposure and maintains client’s
17. Rinse soap thoroughly. warmth and comfort.
18. May apply cream, lotion or powder.

17. Change client’s gown. Do bed making. • Maintains warmth and comfort.

18. After care. • Prevents transmission of microorganisms.

19. Document relevant data. • Ensures accurate and timely data of care.
PERINEAL / GENETAL CARE
Purpose:
1. To remove normal perineal secretions and odor.
2. To prevent infection. 3. To promote comfort.

Procedure:
STEPS RATIONALE

1. Inform client, explain purpose of procedure. • Helps minimize anxiety during procedure that is
embarrassing to you and client.

2. Prepare necessary equipment and supplies: • Conserves time and energy.

- Wash basin
- Soap in soap dish
- 2 or 3 washcloths / cotton balls or swabs
- Bath towel and Bath blanket
- Diamond drape
- Water proof pad
- Bedpan / Urinal
- Toilet tissue
- Solution bottle or container field with warm
water or prescribed rinsing solution.
- Disposable gloves / transfer forceps
- Waterproof bag
3. Assemble supplies at bed side. • Ensures orderly procedure.

4. Perform handwashing. Reduces transmission of microorganisms.

5. Pull curtain around the bed or close room door. • Maintains client’s privacy. Facilitates good body mechanics.
Raise bed to comfortable working position.
6. Lower side rails and assist client in assuming • Provides easy access to genitalia.
dorsal recumbent position.
7. Don gloves. • Decreases contact with bodily secretions.

8. Fold top sheet towards foot part of bed and raise • Exposes perineal area for easy accessibility.
client’s gown above the genital area.
9. Position water proof pad and bedpan under • Prevents bed linen from being soiled.
client’s buttocks.
10. Fill basin with water (approximately 4143°C or • Prevents chills or accidental burns.
105-109°F).
11. Flush and dry the perineal area. Clean the • Cleaning from an area of least contamination to one of more
inner thighs and general perineal area first. contamination prevents spreading of microorganisms.
(Clean to Dirty)
FEMALE

12. Apply diamond drape by placing 1 corner • Prevents unnecessary exposure of body parts and maintains
between client’s legs, 1 corner over the chest client’s warmth and comfort.
and tuck side corners under the hips.

13. Using cleansing solution (antiseptic or soap)

and sponge, clean perineal area:
1st – Symphysis Pubis to Umbilicus in side-to- • Build-up of perineal secretions can contaminate
side motion. surrounding surfaces.
2nd – Far Labia Majora to mid-thigh in updown • Movement of sponge is from inward to outward to prevent
motion. carrying discharges from surrounding area to vaginal
3rd – Near Labia Majora to mid-thigh in outlet.
updown motion.
th
4 – Far Labia Minora in a single downward • Starts from cleaner to dirtier part.
stroke.
5th – Near Labia Minora in a single downward
stroke. • Reduces transfer of microorganisms to urinary meatus.
6th – Clean vestibule starting from the clitoris,
vaginal os in a single downward stroke. Fecal material contains microorganisms that can cause
7th – Fourchette to anus (optional) infection.
 MALE

14. Apply fenestrated drape. • Prevents unnecessary exposure of body parts and maintains
client’s warmth and comfort.

15. Using cleansing solution (antiseptic or soap) • Wiping from an area of least contamination to one of more
and sponge, clean genital area using firm contamination prevents spreading microorganisms.
strokes.
1st – Begin in circular motion at the glans
penis. • Smegma collects under the foreskin, which can harbor
NOTE: For uncircumcised patients, retract the bacteria and should be removed. Replacing the foreskin
foreskin exposing the tip of the penis, clean the prevents constriction of the penis, which may cause edema.
glans penis, and replace the foreskin.
2nd – Shaft toward the base The scrotum may be more soiled than the penis since it is in
3rd – Clean the scrotum. Pay particular closer proximity to the rectum. Therefore, the penis is
attention to the posterior scrotal folds. usually cleaned first.
(The posterior folds of the scrotum may • Fecal material contains microorganisms that can cause
be cleaned more easily when the rectum infection.
is cleaned).
Remove the fenestrated drape.
16. Using warm water, rinse perineal / genital area. • Removes soap and microorganisms more effectively than
wiping.

17. Dry thoroughly. • Retained moisture harbors microorganisms.

18. Carefully remove the bedpan. • Prevents dripping of water to client’s linen.
19. Replace diaper or underwear. Remove gloves • Moisture and body secretions on gloves can harbor
and dispose in proper receptacle together with microorganisms.
soiled sponges.
20. Assist client in assuming comfortable position • Client’s comfort minimizes emotional stress.
and cover with sheet.

21. Remove bath blanket and dispose all soiled • Reduces transmission of infection.
bed linen. Return unused equipment to
storage area.

22. Raise side rail and lower bed to appropriate • Prevents client from accidental falling.
height.

23. Perform handwashing. • Reduces transmission of microorganisms.

FOOT CARE
Purpose:
1. To remove dirt
2. To eliminate odor.
3. To prevent infection.

Procedure:
NURSING MEASURES RATIONALE

1. Wash feet daily, dry well, especially the interdigital • To reduce number of microorganisms.
spaces.
2. Use warm water for foot soak. • To soften nails and loosen debris under them.

3. Use cream or lotion. • To moisten skin and soften calluses.

4. Use deodorant sprays or foot powder. • To control unpleasant odor.

5. File toenails straight across. • To prevent ingrown toenails.

6. Change socks or stockings daily. • Microorganisms develop faster on soiled socks

7. Wear well fitted pair of shoes. • To prevent pressure and provide comfort.

8. Do not walk barefooted. • To avoid injury due to sharp or pointed objects

9. Exercise the feet. • To improve circulation.

10. Avoid using constricting clothing or round garters.
11. Avoid crossing legs.
12. 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 shoe or bony
prominence.
2. Corn – keratosis caused by friction and pressure from a shoe. It commonly affects the 4 th and 5th toe. It appears circular
and raised.
3. Unpleasant Odor – results from perspiration and its interaction with microorganisms.
4. Plantar Warts – caused by papova-virus hominis. They appear on the sole of the foot and are moderately contagious.
They are painful and make walking difficult.
5. Fissures – occur in the dryness and cracking of the skin.
6. Tinea Pedis – also known as “Athletes Foot or Ringworm of the Foot”. Characterized by scaling and cracking of the
skin, particularly between the toes, caused by a fungus. There may be blisters.
7. Ingrown Toenails – inward growth of the nail, causing trauma into the soft tissues. It is usually due to trimming of
the lateral edges of the toenails.

NAIL CARE
NURSING MEASURES RATIONALE

1. Trim nails straight across or follow the contours • Do not trim lateral corners to prevent ingrown.
of the fingers.
2. File nails after trimming. • To have smooth edges.

3. Diabetic clients are advised against cutting • To prevent pedal wounds.

hangnails or cuticles.

Common Nail Problems:

1. Unguis Incarnatus – ingrown.
2. Oncholysis – separation of the nail from the nailbed.
3. Paronychia – inflammation of the skin fold at the nail margin.

MOUTH CARE
1. Brush teeth thoroughly after meals and at bedtime.
 2. Floss teeth daily.
3. Ensure adequate intake of food reach in Calcium, Phosphorus, Vitamins A, C, and D, and Fluoride.
4. Avoid sweet foods and drinks between meals.
5. Eat coarse, fibrous foods (cleansing foods) such as fresh fruits and raw vegetables.
6. Have dental check-up every six months.
7. Have topical fluoride application as prescribed by the dentist.

BRUSHING AND FLOSSING THE TEETH

Purposes:
1. To remove food particles from around and between the teeth.
2. To remove dental plaque.
3. To enhance the client’s feeling of well-being.
4. To prevent sores and infection of the oral tissues.

Nursing Interventions when Providing Oral Care

Conscious Client

NURSING MEASURES RATIONALE

1. Inform client and explain purpose of the procedure. • Helps minimize anxiety during procedure that is
embarrassing to you and client.

2. Prepare necessary equipment and supplies: • Conserves time and energy.

- Towel/washcloth
- Toothbrush
- Toothpaste
- Kidney basin
- Glass of water
- Dental floss (optional)
- Mouth wash (optional)
- Paper towel
- Disposable gloves
- Waste receptacle
3. Pull curtain around the bed or close door • Maintains client’s privacy
4. Assemble supplies at bed side. • Ensures orderly procedure.
5. Perform handwashing. • Reduces transmission of microorganisms.
6. Assist in sitting or side-lying position. • Avoids aspiration of fluid; Prevents soiling of linen
7. Place towel under the client’s chin. • Prevents wetting/ soiling of client’s gown.
8. Moisten bristle of toothbrush. • Forms enough lather while brushing.
9. Assist client to gurgle, old kidney basin under the • Prevents spilling of soiled water on client’s gown.
chin.
10. Allow client to do the brushing, if possible. • Facilitates maximum performance of client.
• Use upward-downward strokes for upper and lower • For thorough cleansing of teeth.
incisors; back and forth strokes for the biting Penetrates and cleans under the gingival margins
surfaces of the molar and pre-molar teeth
• Hold brush against the teeth with bristles at 45°
angle
11. Rinse mouth with adequate amount of water or • Keeps mouth clean and dry.
gurgle with mouth wash. Dry with paper towel. Floss Thoroughly cleanses in between teeth
teeth (optional).
12. Put client back to comfortable position •
13. Do after care of equipment and articles. • Reduces transmission of microorganisms.
14. Perform handwashing
15. Document relevant data. • Reports client’s response to procedure and oral
condition should further treatment be necessary.

Unconscious Client

NURSING MEASURES RATIONALE

 1. Prepare necessary equipment and supplies. • Conserves time and energy.
All of the above +:
- Padded tongue depressor
- Asepto syringe
- Suction apparatus (optional)
- Waterproof pad - Petroleum jelly
2. Perform nos. 3-5 measures for conscious client
3. Place client in side-lying position. • Prevents aspiration.

4. Place kidney basin, washcloth, and waterproof pad • Avoids spilling of soiled water on client’s gown
under client’s side of the mouth. and linen.
5. Use padded tongue depressor • Keeps the client’s mouth open.

6. Rinse with water-filled asepto syringe pointed on the • Prevents aspiration.

sides of the mouth.

7. Brush and gums, using soft-bristled toothbrush or soft • Avoids accidental injury to the gums and oral
sponge-ended swab. mucosa.

8. Rinse with water-filled asepto syringe, pat dry. • Keeps mouth clean and dry.

9. Apply thin layer of petroleum jelly to lips. • Prevents drying or crackling of lips.

10. Perform nos. 12-15 for measures for conscious client

Care of Dentures

NURSING MEASURES RATIONALE

1. Perform handwashing. • Reduces transmission of microorganisms.

2. Wear clean disposable gloves when handling and

cleansing dentures.
3. Place a basin or bowl with wash cloth or half-filled • Prevents damage of dentures in case accidentally
water over the sink. dropped while cleansing.
4. Store dentures in denture cup with water or denture • Maintains cleanliness of dentures.
antiseptic solution.

Common Mouth Problems:

1. Plaque – invisible soft film of bacteria, saliva, epithelial cells and leukocytes that adhere to the enamel surface of
the teeth.
2. Tartar – visible, hard deposit of plaque and bacteria that forms at the gum lines.
3. Halitosis – also known as “Bad breath”
4. Glossitis – inflammation of the tongue.
5. Gingivitis – inflammation of the tongue.
6. Stomatitis – inflammation of the oral mucosa.
7. Parotitis – inflammation of the parotid or salivary glands. Also known as “Mumps”.
8. Sordes – accumulation of foul matter (food, microorganisms and epithelial elements) on the gums and teeth.
9. Periodontal Disease – gums appear spongy and bleeding. Also known as “Pyorrhea”.
10. Cheilosis – cracking of lips.
11. Dental Carries – teeth have darkened area, may be painful. Also known as “Cavities”.

HAIR CARE
• 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;
helps to arrange the hair.
HAIR SHAMPOO
Purposes:
1. To stimulate circulation of blood in the scalp through massage.
2. To clean the hair and improve the client’s sense of well-being.

Procedure:
NURSING MEASURES RATIONALE

1. Determine if institution requires doctor’s order for • Prevents risks of injury due exposure to moisture,
hair shampoo. positioning, manipulation of scalp. Special shampoo
may be ordered for lice infestation or dandruff.
2. Explain procedure to client. • Facilitates client cooperation and allay anxiety.
3. Prepare necessary equipment and supplies. • Conserves time and energy.
- bath towel
- face towel or wash cloth
- shampoo
- dipper
- wash basin with warm water (43-44°C)
- bath blanket
- water proof pad
- draw sheet
- Kelly pad
- cotton balls
- comb or brush - newspaper
- receptacle pail
- conditioner, hair dryer (optional)
4. Wash hands. • Prevents spread of microorganisms.

5. Lay water proof pad and draw sheet under client’s • Avoids soiling of bed linen.
head then, position Kelly pad with its trough
directed to receptacle pail.
6. Place newspaper under the receptacle pail. • Newspaper absorbs water from the floor.

7. Roll a towel under the client’s neck and across the • Hyperextension of neck minimizes draining of water to
shoulders. the back of client.
8. Place washcloth over the client’s eyes. • Prevents eye irritation due to shampoo or water

9. Plug ears with cotton balls. • Water that enters the ears may lead to infection

10. Check water temperature then, wet hair using the • Hot water may cause burns, cold may cause chills.
dipper.
11. Apply shampoo, form enough lather, and massage • Facilitates cleansing of hair and circulation on scalp,
scalp with finger pads. prevents accidental scratching of scalp by nails.
12. Rinse hair thoroughly. • Assesses scalp condition.

13. Squeeze excess water, dry hair and cover with • Prevents scalp irritation.
towel. • Drying prevents chilling and dripping of water to
linen.
14. Remove water proof pad, draw sheet and Kelly pad
under the client’s head
15. Assist client to comfortable position.

16. Comb or brush hair. • Removes tangles.

17. Do after care and perform handwashing. • Prevents spread of microorganisms.

18. Make relevant documentation. • Reports client’s response to procedure and the hair and
scalp’s condition should further treatment be
necessary.

Common Hair and Scalp Problems

1. Dandruff – diffuse scaling of the scalp with pruritus. Also known as “Seborrheic Dermatitis”.
2. Alopecia – hair loss or baldness.
 3. Pediculosis – infestation with lice.
a. Pediculosis Capitis – head louse
b. Pediculosis Corporis – body louse
c. Pediculosis Pubis – crab louse
4. Scabies – contagious skin infestation by the itch mite. The characteristic lesion is burrow produced by the female
lice as it penetrates the skin. The burrows are short, wavy, brown or black threadlike lesions.
5. Hirsutism – excessive growth of body hair.

EYE CARE
Nursing Intervention:
1. Cleanse each eye from inner to outer canthus.
2. For comatose clients, cover eyes with sterile moist compress.
3. Eyeglasses should be cleansed with warm water and soap.
4. Clean contact lenses as directed by the manufacturer.
5. To remove artificial eyes:
- Wear clean gloves, depress the client’s lower eyelid.
- Hold artificial eye with thumb and index finger.
- Clean with warm normal saline.
- Place in container with water or saline solution.
6. Avoid rubbing eyes.
7. Maintain adequate lighting when reading.
8. Avoid regular use of eye drops.
9. If dirt or foreign object get into the eyes, clean with copious, clean, tepid water as emergency treatment.

EAR CARE
Nursing Intervention:
1. Cleanse pinna with moist wash cloth.
2. Remove visible cerumen by retracting the ears. If ineffective, irrigate as ordered.
3. Avoid using bobby pins, toothpick, or cotton tipped applicators to remove cerumen.

NOSE CARE
Nursing Intervention:
1. Clean nasal secretions by gently blowing both nares.
- To prevent forcing debris into the middle ear via the Eustachian tube.
2. May use cotton tipped applicator moistened with saline or water to remove encrusted, dried secretions.