Manila Adventist College

1975 cor. San Juan and Donada Sts., Pasay City 1300

School of Nursing

NCM 103: Fundamentals of Nursing Module

Introduction:

Fundamentals of nursing are the basic concepts that teach the basic principles and procedures of nursing.
The course highlights the importance of the fundamental needs of each individual and the fundamental
skills that each nursing student should learn in providing nursing care.

Hygiene
I - Learning Objectives:

After completing this module in Hygiene, the students will be able to:

1. Describe hygienic care that nurses provides to clients.

2. Identify factors influencing personal hygiene
3. Identify descriptors for functional level
4. Identify normal and abnormal assessment findings while providing hygiene care.
5. Apply the nursing process to common problems related to hygienic care of the
a. Skin
b. Feet
c. Nails
d. Mouth
e. Hair
f. Ears
6. Identify the purpose of bathing
7. Describe various types of baths
8. Discuss the different types of hearing aids
9. Identify safety and comfort measures underlying bed-making procedures.
10. Verbalize the steps used in:
a. Bathing an adult client Providing perineal-genital care
b. Providing foot care
c. Brushing and flossing the teeth
d. Providing hair care
e. Removing, cleaning, and inserting a hearing aid
f. Changing an unoccupied bed
g. Changing an occupied bed
11. Demonstrate appropriate documentation and reporting of hygiene skills
II - Content

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

FACTOR VARIABLES

Culture Some cultures values cleanliness. Others considers privacy. Body odor in
some cultures is normal.
Religion Ceremonial washings are practiced by some religion
Environment Finances may affect the availability of facilities for bathing (Ex: Shower,
soap, shampoo, deodorants, warm water, ) due to limited resources.
Developmental Children learn hygiene in the home.
Level
Health and Energy Ill people may not have the motivation or energy to attend to hygiene.
Personal Some people prefer a shower to a tub bath. Some bath in the evening.
Preferences

Skin - is the largest organ of the body.

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

Sudoriferous (sweat) glands- are on all body surface except the lips and parts of the genitals.
Classified as:
a. Apocrine gland- located largely in the axillae and anogenital areas, begin to function at
puberty (odorless but when acted on by bacteria on skin gives musky, unpleasant odor).

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 feet and forehead
• Helps in thermoregulation
• The sweat produced cools the body through evaporation.

Common Skin Problems:’

1. 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
2. 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

3. 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.

4. ACNE - Inflammatory condition with papules and pustules

Nursing Implication:
• Keep the skin clean to prevent secondary infection
• Treatment varies widely.

5. HIRSUTISM - Excessive hair on a persons body and face

• Remove unwanted hair by using depilatories , shaving,

electrolysis or tweezing
• Enhance clients self-concept

DEFINITIONS AND DESCRIPTORS FOR FUNCTIONAL LEVEL

(0) Completely (+1) Requires (+2) Semi- (+3) Moderately (+4) Totally
Independent use of dependent Dependent Dependent
equipment or Requires help from Requires help from Does not participate
device another person for another person and in activity
assistance, Equipment or
supervision, or Device
teaching
BATHING Nurse provides all Nurse supplies all Client needs complete
equipment, equipment; bath; cannot assist at
positions client in positions client, all.
bed/bathroom. washes back, legs,
client completes perineum, and all
bath except back oter parts as
and feet needed. Client can
assist.
 ORAL HYGIENE Nurse provides Nurse prepares Nurse completes
equipment; client brush, rinses entire procedure.
does the task mouth, positions
client.
DRESSING/GROOMING Nurse gathers items Nurse combs Client needs to be
for client; may client’s hair, assists dressed and cannot
button, zip, or tie with dressing, assist the nurse comb
clothing. Client buttons and zips client’s hair.
dresses self. clothing, ties shoes.
TOILETING Client can walk to Nurse provides Client is incontinent;
bathroom/commode bedpan, positions nurse places client on
with assistance; client on or off bedpan or commode.
nurse helps with bedpan, places
clothing. client on commode.

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

A. Complete Bed Bath- washes the entire body of a dependent client in bed.
B. Self –help bed bath- clients confined to bed are able to bathe themselves with help from the
nurse.
C. Partial Bath (abbreviated bath)- Only the parts of the clients body that might cause discomfort
or odor, if neglected are washed.
D. Bag bath- bath is commercially prepared product that contains 10-12 presoaked disposable
washcloths that contain no rinse cleanser solution.
E. Towel bath- bath is similar to a bag bath but uses regular towels.
F. 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.
G. 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: (Refer to your textbook Chapter 33 page 702 – 706)

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,
additional bed linen & towels if required.
• Clean gloves if appropriate
• personal hygiene articles
• Shaving equipment for male clients
• Table for equipment
• Laundry bag

Procedure: (Watch the instructional video)

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 (Refer to your textbook Chapter 33 pages 708 – 709)

Purposes:
To remove normal perineal secretions and odors
To promote client comfort

Assessment:
Presence of irritation, excoriation, inflammation and swelling
Excessive discharge
Odor, pain or discomfort
Urinary or fecal incontinence
Recent rectal or perineal surgery
Presence of 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
Wash cloth
Soap

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 and clean the inner upper thighs
o For females: back lying position with knees flexed and spead well apart
o For males: supine position with knees slightly flexed and hips slightly
externally rotated.
• . Inspect the perineal-genital area
• Wash and dry the perineal-genital area ( from front to back to prevent contamination from anus)
• 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:

A. Callus - Is a thickened portion of epidermis, a mass of keratotic material.

a. Softened by soaking the foot in warm water
b. Apply cream w/ lanolin to keep the skin soft

B. Corn - Is a keratotic caused by friction and pressure from a shoe

a. Massage the tissue to promote circulation
b. Corn are generally removed surgically

C. Plantar warts - Appear on the sole of the foot. These warts are caused by the
papovavirus hominis virus. They are moderately contagious.
a. Apply salicylic acid
b. May curettage the warts

D. Fissures - Or deep grooves, frequently occur

between the toes as a result of dryness and cracking of the skin
a. Application of antiseptic to prevent infection
b. Good foot hygiene

E. Tinea pedis –ringworm of the foot caused by fungus.

a. Application of antifungal ointments or powder
b. 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.
• Fingernails should be trimmed straight across
• Nails of older person grows slower than younger persons
• Older person’s nails maybe ridged and grooved.

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
Brushing and Flossing the Teeth ( Refer to your textbook by Kozier, chapter 33 pages 718 – 721)

Purpose:
• To remove food particles from around and between the teeth.
• To remove dental plaque
• To promote the client’s feeling of well – being.
• To prevent sores and infection of the oral tissues.

Assessment:
• Determine the extent of the client’s self-care abilities.
• Assess the client’s usual mouth care practices.
• Inspect lips, gums, oral mucosa, and tongue for deviations from normal.
• Identify presence of oral problems such as tooth caries, halitosis,gingivitis, and loose of broken teeth.
• Check if the client has bridgework or wears dentures. If the client has dentures, ask if there is any tenderness or
soreness. (assess for location)

Equipment:
• Towel
• Clean gloves
• Curved basin (emesis basin)
• Toothbrush (soft bristle)

Procedure:
• Assemble all the needed equipments
• Introduce self and identify the client’s identity.
• Perform hand hygiene and observe other appropriate infection control procedure. Rationale: Wearing gloves
prevents nurse from being infected and prevents cross-contamination.
• Provide client privacy
• Assist client to sitting position. Rationale: This position prevents fluids from draining down the client’s throat.
• Place towel under the client’s chin.
• Apply clean gloves
• Moisten bristle of the toothbrush with tepid water and apply toothpaste/dentrifice to the toothbrush.

• For client’s who must remain in bed, place or hold the curved basin under the client’s chin, fitting the small
curve around the chin or neck.

• Inspect the mouth and teeth.

• Brush the teeth

o Hand the toothbrush to the client or brush teeth as follows:

§ Hold brush against the teeth with bristles at a 45 degree angle. Tips of the outer bristles
should rest against and penetrate under the gingival sulcus.
§ The brush will clean under the sulcus of 2 or 3 teeth at one time. (sulcular technique)
§ Rationale: This technique removes plaque and cleans under the gingival margins.
§ Move the bristles up and down from the sulcus to the crowns of the teeth.
§ Repeat until all ae cleaned.
§ Clean biting surfaces by moving the brush back and forth over them in short strokes.
o Rinse . Hand to the client the water cup or mouthwash to rinse mouth vigorously. Rationale: Vigorous
rinsing loosens food particles and washes out already loosened out food particles.
o Floss the teeth.
o Remove and dispose used equipments
o Perform hand hygiene
 o Document assessment done.

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:
o recent chemotherapy
o 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

Procedure: (Watch the instructional video uploaded in Teams)

• 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:

1. Behind-the-ear(BTE) open fit - the newest in hearing aid technology.

o 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.

2. Behind the ear (BTE) with earmold - widely used type because it fits snugly behind the ear.
o the Hearing aid case which holds the microphone, amplifier and receiver is attached to the earmold by
plastic tube.

3. 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.

4. In-the-canal (ITC) canal

o compact and barely visible,
o an ITC aid fits completely inside the ear canal.

5. Completely – in – the – canal (CIC) aid – almost invisible

o Customized to fit the individual’s ears.
 6. Eyeglasses aid
o is similar to the behind the ear aid but the components are housed in the temple of the eyeglasses.

7. Body hearing aid

o the pocket-sized aid, use for more severe hearing losses,
o clips onto an undergarment, shirt pocket, or harness 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 (See instructional video in MS Teams)

UNOCCUPIED BED -- an unoccupied 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.

OCCUPIED BED – A bed with patient on it.

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.
o Encourage client to give you feedback as to the amount of pressure you are using during the
backrub.
o Wash hands and obtain appropriate infection control procedures.
o Provide client for privacy.

o Prepare 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
o body’s meridians

PROCEDURES

BATHING A CLIENT ON BED

Preparation

1. Explain procedure to patient. Assess patient’s ability to assist in bathing process and personal hygiene
preferences. Check for any limitations in physical activity.
Place necessary equipment to bedside stand or over bed table. Remove compression devices (anti-embolic
2.
stockings) from lower extremities according to agency protocol.
3. Provide client’s privacy.
4. Offer bedpan or urinal.
5. Perform hand hygiene.
6. Raise patient’s bed to your waistline.
Lower the side rails nearer to you and assist patient to the side of the bed where you will work. Have patient
7.
lie on his/her back.
Loosen top covers and remove all except top sheet. Place bath blanket over patient and then remove top sheet
8. while patient holds bath blanket in place. If linen is to be reused, fold it over a chair. Plac soiled linen in
laundry bag.
9. Assist patient with oral hygiene.
Remove patient’s gown and keep bath blanket in place. If patient has an intravenous line and is not wearing a
10. gown with snap sleeves, remove gown from other arm first. Lower intravenous container and pass gown over
tubing and container. Rehang container and check the drip rate.
Raise side rail. Fill basin with a sufficient amount of comfortably warm water. Change as necessary
11.
throughout the bath. Lower side rail closer to you when you return to the bedside to begin the bath.
12. Fold washcloth like a mitt on your hand so there are no loose ends.
13. Lay towel across patient’s chest on top of bath blanket.
With no soap on the wash cloth, wipe one eye from inner part of the eye near the nose to the outer part. Rinse
14.
or turn cloth before washing other eye.
15. Bath the patient’s face, neck, and ears, avoiding soap on the face if the patient prefers.
Expose patient’s far arm and place towel lengthwise under it. Bath the far arm using firm strokes, wash arm
16.
and axilla, rinse and dry.
Place folded towel on bed next to patient’s hand and put basin on towel. Soak patient’s hand in basin. Wash,
17.
rinse, and dry hand.
18. Repeat actions 16 & 17 for the arm near to you.
 Spread towel across patient’s chest. Lower bath blanket to patient’s umbilical area. Wash, rinse, and dry
19. patient’s chest. Keep patient’s chest covered with towel between wash and rinse. Pay special attention to skin
folds under patient’s breasts.
20. Lower bath blanket to patient’s perineal area. Place towel over patient’s chest.
Wash, rinse, and dry patient’s abdomen. Carefully inspect and cleanse umbilical area and any abdominal folds
21.
or creases.
Return bath blanket to original position and expose the patient’s far leg. Place towel under far leg. Using firm
22.
strokes, wash, rinse, and dry patient’s leg from ankle to knee and knee to groin.
Fold towel near patient’s foot area and place basin on towel. Place patient’s foot in basin while supporting
23. patient’s ankle and heel in your hand and leg in your arm. Wash, rinse and dry paying particular attention to
area between toes.
24. Repeat action 22 and 23 for other leg and foot.
Make sure patient is covered with bath blanket. Change water at this point or earlier if necessary. Assist
25.
patient into his/ her side.
26. Assist patient to a side-lying position. Position bath blanket and towel to expose only back and buttocks.
27. Wash, rinse and dry patient’s back and buttocks area. Pay particular attention to cleansing between gluteal
folds and observe for any indication of redness or skin breakdown in the sacral area.
28. If not contraindicated, give patient a back rub as described. Back rub may also be given after perineal care.
29. Refill basin with clear water. Discard wash cloth and towel.
30. Clean patient’s perineal area or set up patient so he/she can complete perineal safe care.
31. Help patient put on clean gown and attend to personal hygiene needs.
32. Protect pillow with a towel and groom patient’s hair, as described in text.
33. Change bed linens.
34. Record any significant observation and communication on patient’s chart.

SHAMPOOING A CLIENT ON BED

Assess
• Determine routinely used shampoo products.
1. • Any scalp problems.
• Activity tolerance of the client.
Determine:
• Whether a primary care provider’s order is needed before a shampoo can be given
2. • The type of shampoo to be used.
• The best time of day for the shampoo.
Assemble Equipment
• Comb and brush
• Plastic sheet or pad
• Two bath towels
• Shampoo basin
• Washcloth or pad
3.
• Bath blanket
• Receptacle for the shampoo water
• Pitcher of water
• Bath thermometer
• Liquid or cream shampoo
• Hair dryer
Procedure
1. Introduce yourself, and verify the client’s identity. Explain to the client what you are going to do,
why it is necessary, if appropriate, and how the client can cooperate.
2. Perform hand hygiene, and observe other appropriate infection control procedures as needed.
3. Provide for client privacy.
4. Position and prepare the client appropriately.
 Assist the client to the side of the bed from which you will work.
Remove pins and ribbons from the hair, and brush and comb it to remove any tangles.
Arrange the equipment.
Put the plastic sheet or pad on the bed, under the head.
Remove the pillow from under the client’s head, and place it under the shoulders, unless there is some
underlying condition.
Tuck a bath towel around the client’s shoulders.
5. Place the shampoo basin under the head, putting a folded washcloth or pad where the client’s neck rests on
the edge of the basin. If the client is on a stretcher, the neck can rest on the edge of the sink with the
washcloth as padding.
Fanfold the top bedding down to the waist, and cover the upper part of the client with the bath blanket.
Place the receiving receptacle on a table or chair at the bedside. Put the spout of the shampoo basin over
the receptacle.
Protect the client’s eyes.
6.
Place a damp washcloth over the client’s eyes.
Shampoo the hair.
Wet the hair thoroughly with the water.
Apply shampoo to the scalp. Make a good lather with the shampoo while massaging the scalp with the
pads of your fingertips.
7. Rinse the hair briefly, and apply shampoo again.
Make a good lather, and massage the scalp as before.
Rinse the hair thoroughly this time to remove all the shampoo.
Squeeze as much water as possible out of the hair with your hands.
Dry the hair thoroughly.
Rub the client’s hair with a heavy towel.
8.
*** Dry the hair with the dryer. Set the temperature at “warm”.
*** Continually move the dryer to prevent burning the client’s scalp.
Ensure client comfort.
Assist the person confined to bed to a comfortable position.
9.
Arrange the hair using a clean brush and comb.
Document the shampoo and any assessments.

MAKING OCCUPIED BED (With patient on it)

1. Explain procedure to patient. Assess for limitations on patient’s physical activity.
2. Perform hand hygiene.
3. Assemble equipment and arrange in bedside chair.
4. Provide patient privacy.
Adjust patient’s bed accordingly. Lower side rail nearest you, leaving opposite side rail up. Place bed on flat
5.
position unless contraindicated.
6. Check bed linens and disconnect bell or any tubes from linens.
Place bath blanket, if available, over patient. Have patient hold onto bath blanket while reach under it and
7 remove top linens. Leave top sheet in place if bath blanket is not used. Fold linen that is to be reused over
the back of a clean chair.
If possible and if another person is available to assist, grasp mattress securely and shift it up to the head of
8.
the bed.
9. Assist patient to turn toward the opposite side of the bed and reposition pillow under patient’s head.
10. Loosen all bottom linens from the head and sides of the bed.
11. Fan-fold soiled linens as close to patient as possible.
12. Use clean linen and make the near side of the bed. Fan-fold clean linen as close to patient as possible.
 Raise side rail. Assist patient to roll over the folded linen in the middle of the bed toward you. Move to the
13.
other side of bed and lower side rail.
Loosen and remove all bottom linen. Place in a linen bag or hamper. Hold soiled linen away from your
14.
uniform.
Ease the clean linen from under the patient. Pull taut and secure bottom sheet under the head of the
15. mattress. Miter corners. Pull side of the sheet taut and tuck under side of the mattress. Repeat this with
draw sheet.
Assist patient to return to the center of the bed. Remove pillow and change pillowcases before replacing
16.
with open end facing the window.
Apply top linen so that it is centered and top hems are even with the head of the mattress. Have patient
17.
hold onto the top linen so bath blanket can be removed.
Secure top linens under foot of mattress and miter corners. Loosen top linens over patient’s feet by
18.
grasping them in the area of the feet and pulling gently toward the foot of the bed.
Raise side rail. Lower bed height and adjust head of the bed to a comfortable position. Reattach call light
19.
and tubes.
20. Dispose soiled linens according to agency policy.
21. Perform hand hygiene.
22. Document the procedure performed.

MAKING AN UNOCCUPIED BED (Bed without patient on it)

1. Explain the procedure to patient
2. Assemble equipment and arrange on a bedside chair.
3. Perform hand hygiene.
4. Provide patient privacy.
5. Adjust patient’s bed accordingly and lower down side rails.
Check bed linens and disconnect any tubes attached on the linens. Loosen all linens as you move around
6.
bed from head of the bed to the far side to the head of the bed to the near side.
7. Fold reusable lines and hang them over a clean chair.
Place bottom sheet with its center fold in the center of the bed and high enough to have a sufficient
8.
amount of the sheet tuck under the head of the mattress.
Place draw sheet with its center fold under the patient’s midsection. If using protective pad, place it over
9.
the draw sheet in the proper area.
Tuck bottom sheet securely under the head of the mattress on one side of the bed. Miter corners
10.
according to agency policy.
Move to the other side of the bed and pull the remainder sheet tightly and tuck under mattress. Do the
11.
same for the draw sheet.
Place top sheet on bed with its center fold in the center of the bed. Make sure hem is even with the
12. head of the mattress. Unfold and spread top sheet placing upper edge about 6 inches below over the
bed.
13. Tuck bottom part of top sheet on the near side. Miter corners.
14. Move to other side of the bed and repeat procedure.
15. Fold upper 6 inches of the top sheet down over the spread and make a cuff.
Place pillow on the bed. Open each pillowcase in the same manner as opening other linens. Gather
16. pillowcase over one hand toward closed end. Grasp pillow with hand inside the pillowcase. Keeping a
firm hold on tip of pillow, pull over onto pillow.
17. Place pillow at the head of the bed with the open end facing toward the window.
18. Pan-fold of pie-fold top linens.
 19. Secure signal device on the bed according to agency policy.
20. Adjust height of the bed accordingly.
21. Dispose soiled linen according to agency policy and perform hand hygiene.
22. Document the procedure performed.

ASSISTING WITH ORAL CARE

Preparation

1. Explain procedure to patient.

2. Perform hand hygiene. Don disposable gloves if assisting with oral care.
3. Assemble equipment on over bed table within patient’s reach.
4. Provide privacy for patient.
Lower side rail and assist patient to sitting position, if permitted, turn patient onto the side. Place towel
5.
across patient’s chest. Raise bed to a comfortable working position.
6. Encourage patient to brush own teeth or assist if necessary.
a. Moisten toothbrush and apply toothpaste to bristles.
b. Place brush at a 45 degree angle to gum line and brush from gum line to crown of each tooth.
Brush outer and inner surfaces. Brush back and forth across biting surface of each tooth.
c. Brush tongue gently with toothbrush.
d. Have patient rinse vigorously with water and spit into emesis basin. Repeat until clear. Suction
may be used as alternative for removing fluid secretions from mouth.
e. Assist patient to floss teeth, if necessary.
f. Offer mouthwash if patient prefers.
Assist patient with removal and cleansing of dentures if necessary.
a. Apply gentle pressure with 4x4 gauze to grasp and remove upper denture plate. Place it
immediately in denture cup. Lift lower denture using slight rocking motion, remove and place
denture cup.
b. If patient prefers, add denture cleanser with water in a cup and follow preparation directions or
7.
brush all areas thoroughly with toothbrush and paste. Place paper towels or washcloth in sink
while brushing.
c. Rinse thoroughly with water and return dentures to patient.
d. Offer mouthwash so patient can rinse mouth before replacing dentures.
e. Apply petroleum jelly to lips if necessary.
Remove equipment and assist patient to a position of comfort. Record any unusual bleeding or
8.
inflammation. Raise side rail and lower bed.
9. Remove disposable gloves from inside out and discard appropriately. Perform hand hygiene.
10. Document the procedure performed.

PROVIDING ORAL CARE FOR DEPENDENT CLIENT

1. Explain procedure to patient.
2. Perform hand hygiene and don disposable gloves.
3. Assemble equipment on over bed table within reach.
4. Provide for patient privacy.
Adjust bed height to a comfortable position. Lower one side rail and position patient on the side with
5. the head of the bed lowered. Place towel across patient’s chest and emesis basin in position under
chin.
 Open patient’s mouth and gently insert a padded tongue blade between back molars of necessary. If
6. teeth are present, brush carefully with toothbrush and paste. Remove dentures if present, and clean
before replacing.
Use a gauze-padded tongue blade moistened with normal saline or diluted mouth wash solution to
gently cleanse gums, mucous membranes and tongue. Use gauze-padded tongue blade moistened with
7.
mouthwash solution to rinse oral cavity. Position patient’s head to allow for return of water or use
suction apparatus to remove the water from oral cavity.
8. Moistened lips as necessary.
Remove equipment and return patient in comfortable position. Raise side rails and Perform hand
9.
hygiene.
10. Document the procedure performed. Record any unusual bleeding or inflammation noted.

NOTE: See full procedures with Rationales in your textbook,

Kozier’s Fundamentals of Nursing, Chapter 33.

PERFORMANCE TASK
1. Be able to recite and enumerate the assessment needed to be done before
performing the procedure, equipments needed, and the steps in performing the
skills/procedure.
2. Demonstrate the following procedures based on the performance checklist,
applying the principles learned.

PERFORMANCE CHECKLIST IN HYGIENE

Skills: Giving a Bed Shampoo

Preparation 1 0 Comments

Assess
• Determine routinely used shampoo products.
1.
• Any scalp problems.
• Activity tolerance of the client.
Determine:
• Whether a primary care provider’s order is needed before a
2. shampoo can be given
• The type of shampoo to be used.
• The best time of day for the shampoo.
Assemble Equipment
• Comb and brush
• Plastic sheet or pad
3. • Two bath towels
• Shampoo basin
• 2 small basins
• 2 Washcloth
 • Ear plugs or cotton balls
• Bath blanket
• Receptacle for the shampoo water
• Pitcher of water
• Bath thermometer
• Liquid or cream shampoo
• Bath soap
• Clean gown (or any clothes preferably open at the back)

Procedure 2 1 0
Introduce yourself, and verify the client’s identity. Explain to the
1.
client what you are going to do, why it is necessary, if appropriate,
and how the client can cooperate.
Perform hand hygiene, and observe other appropriate infection
2.
control procedures as needed.
3. Provide for client privacy.
Assist the client to the side of the bed from which you will work.
Remove pins and ribbons from the hair, and brush and comb it to
remove any tangles.
Put the plastic sheet or pad on the bed, under the head.
Remove the pillow from under the client’s head, and place it under the
shoulders, unless there is some underlying condition.
Tuck a bath towel around the client’s shoulders.
Place the shampoo basin under the head, putting a folded washcloth or
s pad where the client’s neck rests on the edge of the basin. If the client
is on a stretcher, the neck can rest on the edge of the sink with the
washcloth as padding.
Fanfold the top bedding down to the waist, and cover the upper part of
the client with the bath blanket.
Place the receiving receptacle on a table or chair at the bedside. Put
the spout of the shampoo basin over the receptacle.
Place a damp washcloth over the client’s eyes to protect it from
splashes.
Shampoo the hair.
Wet the hair thoroughly with the water.
Apply shampoo to the scalp. Make a good lather with the shampoo
while massaging the scalp with the pads of your fingertips.
7.
Rinse the hair briefly, and apply shampoo again.
Make a good lather, and massage the scalp as before.
Rinse the hair thoroughly this time to remove all the shampoo.
Squeeze as much water as possible out of the hair with your hands.
8. Dry the hair thoroughly.

Skills: Giving a Bed Bath

 Preparation
2 1 0
Explain procedure to patient. Assess patient’s ability to assist in bathing
1.
process and personal hygiene preferences. Check for any limitations in
physical activity.
Place necessary equipment to bedside stand or over bed table. Remove
2. compression devices (anti-embolic stockings) from lower extremities
according to agency protocol.
3. Provide client’s privacy.
4. Offer bedpan or urinal.
5. Perform hand hygiene.
6. Raise patient’s bed to your waistline.
Lower the side rails nearer to you and assist patient to the side of the bed
7.
where you will work. Have patient lie on his/her back.
Loosen top covers and remove all except top sheet. Place bath blanket over
8. patient and then remove top sheet while patient holds bath blanket in place.
If linen is to be reused, fold it over a chair. Place soiled linen in laundry bag.
9. Assist patient with oral hygiene.
Remove patient’s gown and keep bath blanket in place. If patient has an
intravenous line and is not wearing a gown with snap sleeves, remove gown
10.
from other arm first. Lower intravenous container and pass gown over tubing
and container. Rehang container and check the drip rate.
Raise side rail. Fill basin with a sufficient amount of comfortably warm water.
11. Change as necessary throughout the bath. Lower side rail closer to you when
you return to the bedside to begin the bath.
12. Fold washcloth like a mitt on your hand so there are no loose ends.
13. Lay towel across patient’s chest on top of bath blanket.
With no soap on the wash cloth, wipe one eye from inner part of the eye near
14.
the nose to the outer part. Rinse or turn cloth before washing other eye.
Bath the patient’s face, neck, and ears, avoiding soap on the face if the patient
15.
prefers.
Expose patient’s far arm and place towel lengthwise under it. Bath the far arm
16.
using firm strokes, wash arm and axilla, rinse and dry.
Place folded towel on bed next to patient’s hand and put basin on towel. Soak
17.
patient’s hand in basin. Wash, rinse, and dry hand.
18. Repeat actions 16 & 17 for the arm near to you.
Spread towel across patient’s chest. Lower bath blanket to patient’s umbilical
area. Wash, rinse, and dry patient’s chest. Keep patient’s chest covered with
19.
towel between wash and rinse. Pay special attention to skin folds under
patient’s breasts.
Lower bath blanket to patient’s perineal area. Place towel over patient’s
20.
chest.
Wash, rinse, and dry patient’s abdomen. Carefully inspect and cleanse
21.
umbilical area and any abdominal folds or creases.
Return bath blanket to original position and expose the patient’s far leg. Place
22. towel under far leg. Using firm strokes, wash, rinse, and dry patient’s leg from
ankle to knee and knee to groin.
Fold towel near patient’s foot area and place basin on towel. Place patient’s
foot in basin while supporting patient’s ankle and heel in your hand and leg in
23.
your arm. Wash, rinse and dry paying particular attention to area between
toes.
24. Repeat action 22 and 23 for other leg and foot.
Make sure patient is covered with bath blanket. Change water at this point or
25.
earlier if necessary. Assist patient into his/ her side.
Assist patient to a side-lying position. Position bath blanket and towel to
26.
expose only back and buttocks.
Wash, rinse and dry patient’s back and buttocks area. Pay particular attention
27.
to cleansing between gluteal folds and observe for any indication of redness
or skin breakdown in the sacral area.
If not contraindicated, give patient a back rub as described. Back rub may also
28.
be given after perineal care.
29. Refill basin with clear water. Discard wash cloth and towel.
Clean patient’s perineal area or set up patient so he/she can complete
30.
perineal self care.
31. Help patient put on clean gown and attend to personal hygiene needs.
32. Protect pillow with a towel and groom patient’s hair, as described in hair care.
33. Change bed linens.
34. Record any significant observation and communication on patient’s chart.

Skill: Making an Occupied Bed

Procedure 0
2 1
Explain procedure to patient. Assess for limitations on patient’s physical
1.
activity.
2. Perform hand hygiene.
3. Assemble equipment and arrange in bedside chair.
4. Provide patient privacy.
Adjust patient’s bed accordingly. Lower side rail nearest you, leaving opposite
5.
side rail up. Place bed on flat position unless contraindicated.
6. Check bed linens and disconnect bell or any tubes from linens.
Place bath blanket, if available, over patient. Have patient hold onto bath
blanket while reach under it and remove top linens. Leave top sheet in place if
7
bath blanket is not used. Fold linen that is to be reused and place on a clean
chair.
If possible and if another person is available to assist, grasp mattress securely
8.
and shift it up to the head of the bed.
Assist patient to turn toward the opposite side of the bed and reposition pillow
9.
under patient’s head.
10. Loosen all bottom linens from the head and sides of the bed.
11. Fan-fold soiled linens as close to patient as possible.
Use clean linen and make the near side of the bed. Fan-fold clean linen as close
12.
to patient as possible.
Raise side rail. Assist patient to roll over the folded linen in the middle of the
13.
bed toward you. Move to the other side of bed and lower side rail.
Loosen and remove all bottom linen. Place in a linen bag or hamper. Hold
14.
soiled linen away from your uniform.
Ease the clean linen from under the patient. Pull taut and secure bottom sheet
15. under the head of the mattress. Miter corners. Pull side of the sheet taut and
tuck under side of the mattress. Repeat this with draw sheet.
 Assist patient to return to the center of the bed. Remove pillow and change
16.
pillowcases before replacing with open end facing the window.
Apply top linen so that it is centered and top hems are even with the head of
17. the mattress. Have patient hold onto the top linen so bath blanket can be
removed.
Secure top linens under foot of mattress and miter corners. Loosen top linens
18. over patient’s feet by grasping them in the area of the feet and pulling gently
toward the foot of the bed.
Raise side rail. Lower bed height and adjust head of the bed to a comfortable
19.
position. Reattach call light and tubes.
20. Dispose soiled linens according to agency policy.
21. Perform hand hygiene.
22. Document the procedure performed.

Skills: Making an Unoccupied Bed

Procedure
2 1 0
1. Explain the procedure to patient
2. Assemble equipment and arrange on a bedside chair.
3. Perform hand hygiene.
4. Provide patient privacy.
5. Adjust patient’s bed accordingly and lower down side rails.
Check bed linens and disconnect any tubes attached on the linens. Loosen all
6. linens as you move around bed from head of the bed to the far side to the
head of the bed to the near side.
7. Fold reusable linens and hang them over a clean chair.
Place bottom sheet with its center fold in the center of the bed and high
8. enough to have a sufficient amount of the sheet tuck under the head of the
mattress.
Place draw sheet with its center fold under the patient’s midsection. If using
9.
protective pad, place it over the draw sheet in the proper area.
Tuck bottom sheet securely under the head of the mattress on one side of the
10.
bed. Miter corners according to agency policy.
Move to the other side of the bed and pull the remainder sheet tightly and tuck
11.
under mattress. Do the same for the draw sheet.
Place top sheet on bed with its center fold in the center of the bed. Make sure
12. hem is even with the head of the mattress. Unfold and spread top sheet
placing upper edge about 6 inches below over the bed.
13. Tuck bottom part of top sheet on the near side. Miter corners.
14. Move to other side of the bed and repeat procedure.
15. Fold upper 6 inches of the top sheet down over the spread and make a cuff.
Place pillow on the bed. Open each pillowcase in the same manner as opening
other linens. Gather pillowcase over one hand toward closed end. Grasp pillow
16.
with hand inside the pillowcase. Keeping a firm hold on tip of pillow, pull over
onto pillow.
 Place pillow at the head of the bed with the open end facing toward the
17.
window.
18. Fan-fold or pie-fold top linens.
19. Secure signal device on the bed according to agency policy.
20. Adjust height of the bed accordingly.
21. Dispose soiled linen according to agency policy and perform hand hygiene.
22. Document the procedure performed.

III – Assessment
• Take the quiz that will be administered.
• Graded return demonstration based on checklist.
IV - Performance
• Perform a bedbath and bedshampoo
• Make an occupied and unoccupied ned

Reference:

1. KOZIER & ERB’S FUNDAMENTALS OF NURSING:

Concepts, Process, and Practice 10th Edition, Volume 2.

Prepared By:

ROMELDA D. LUCERO, RN, MN

MAC -SCON