HYGIENE

Hygiene is the science of health and how it is maintained. Personal hygiene invol
ves self-care activities like bathing, using the toilet, maintaining overall body cleanliness,
and grooming. It is a personal practice influenced by individual and cultural values. Prop
er hygiene care includes looking after the skin, feet, nails, mouth, nose, teeth, hair, eyes
ears, and genital area, keeping it clean and well maintained.

Moreover, good hygiene is a principal barrier to numerous communicable diseas

es, which includes the faecal–oral diseases. It helps prevent infections, reduces the spr
ead of harmful bacteria and viruses, and promotes overall health and well-being (Satish
Kumar et al., 2020). It is an important practice which helps to combat the germs on the
body that could lead to bad odour and illness (Satish Kumar et al., 2020). Thus, hygiene
is the prime security to lessen the spread of pathogens in everyday’s environment.

Nurses need to assess how much help a client requires with hygiene. Some clien
ts may need assistance after urinating, defecating, vomiting, or when they become dirty
from wound drainage or excessive sweating. Additionally, cultural beliefs and practices
play a significant role in how individuals approach hygiene care.

Hygienic Care

The types of hygienic care are often described by when they occur. The following exam
ples are as follows:

● Early morning care. A hygiene provided to clients as they awaken in the mornin
g. This involves providing a urinal or bedpan the client confined to bed, washing t
he face and hands, and giving oral care, such as toothbrushing.
● Morning care. This is provided after the clients have breakfast, such as eliminati
on needs, a shower, perineal care, back massages, and oral, hair, and nail care.
● Hour of sleep or PM care. Provided to clients before they retire for the night suc
h as elimination needs, washing face and hands, giving oral care, and giving a ba
ck massage.
● As needed (prn) care. Provided as required by the client.

However, there are several factors influencing individual hygienic practices. This
variation makes being “clean” have different interpretations. This includes culture where
some place a high value on cleanliness while some do not, religion practices where peo
ple do ceremonial washings. The environment also affects the availability of facilities for
bathing, for instance, individuals who are homeless may not have warm water available.

Moreover, developmental level is one of the factors because practices vary accor
ding to the individual’s age and how they learn hygiene at home. Health and energy ma
y also affect motivation to attend hygiene especially those who are ill. Lastly, personal p
references of the clients in doing or attending personal hygienic care.
 SKIN

The skin is the largest organ of the body. It protects underlying tissues from injur
y by preventing the passage of microorganisms. It also regulates the body temperature,
transmits sensations through nerve receptors, and It produces and absorbs vitamin D in
conjunction with ultraviolet rays from the sun, which activate a vitamin D precursor pres
ent in the skin. Thus it is important to maintain its cleanliness and integrity.

General Guidelines for Skin Care

1. Nurses need to ensure that all skin care measures prevent injury and irritation be
cause intact, healthy skin is the body’s first line of defense.
2. The degree to which the skin protects the underlying tissues from injury depends
on the general health of the cells, the amount of subcutaneous tissue, and the dr
yness of the skin.
3. Moisture in contact with the skin for more than a short time can result in increase
d bacterial growth and irritation.
4. Body odors are caused by resident skin bacteria acting on body secretions.
5. Skin sensitivity to irritation and injury varies among individuals and in accordance
with their health.
6. Agents used for skin care have selective actions and purposes.

Listed Below are the Agents Commonly Used on the Skin.

a) Soap. Lowers surface tension and thus helps in cleaning.

b) Bath oil. Provides an oily film on the skin that softens and prevents chapping.
c) Chlorhexidine gluconate (CHG). A disposable cloth saturated with 2% CHG an
d skin-moisturizing substances.
d) Skin cream, lotion. Provides a film on the skin that prevents evaporation and th
erefore chapping.
e) Powder. To absorb water and prevent friction.
f) Deodorant. Diminishes body odors.
g) Antiperspirant. Reduces the amount of perspiration.

NURSING MANAGEMENT

A. Assessment

Assessment of the client’s self-care abilities determines the amount of nursing as

sistance and the type of bath (e.g., bed, tub, or shower) best suited for the client. Import
ant considerations include the client’s balance (for tub and shower), ability to sit unsupp
orted (in the tub or bed), activity tolerance, coordination, adequate muscle strength, app
ropriate joint range of motion, vision, and preferences. Cognition and motivation are als
o essential.

The functional level of clients are defined and described as follows:

● Completely Dependent - Clients are able to completely and independently do tas

ks to maintain cleanliness and healthiness.
 ● Requires Use of Equipment or Device - there is a need or required assisting devi
ces to do hygiene and other tasks.
● Semidependent - requires help from another person for assistance, supervision,
or teaching.
● Moderately Dependent – requires help from another person and equipment or d
evice
● Totally Dependent - does not participate in activity.

Moreover, presence of past or current skin problems alerts the nurse to specific n
ursing interventions or referrals the client may require. Many skin care conditions have i
mplications for hygienic care. The client may provide descriptions of these problems dur
ing the nursing health history, or the nurse may observe some during the physical exami
nation.

Common Skin Problems and Care

1. Dry Skin
● Use cleansing creams to clean the skin rather than soap or detergent, whi
ch cause drying and, in some cases, allergic reactions.
● Use bath oils, but take precautions to prevent falls caused by slippery tub
surfaces.
● Thoroughly rinse soap or detergent, if used, from the skin.
● Bathe less frequently when environmental temperature and humidity are lo
w.
● Use moisturizing or emollient creams that contain lanolin, petroleum jelly,
or cocoa butter to retain skin moisture.
● Increase fluid intake.
2. Skin Rashes
● Keep the area clean by washing it with a mild soap.
● To relieve itching, try a tepid bath or soak.
● Avoid scratching the rash to prevent inflammation, infection, and further sk
in lesions.
● Choose clothing carefully. Too much can cause perspiration and aggravat
e a rash.
3. Acne
● Wash the face frequently with soap or detergent and hot water to remove
oil and dirt.
● Avoid using oily creams, which aggravate the condition.
● Avoid using cosmetics that block the ducts of the sebaceous glands and th
e hair follicles.
● Never squeeze or pick at the lesions.

Physical Assessment

The nurse often has the opportunity to collect data about skin color, uniformity of
color, texture, turgor, temperature, intactness, and lesions when assisting with bathing a
nd other hygienic care to help identify what kind of intervention the client needs.

B. Diagnosing
 Nursing diagnosis for clients depends on the client's manifestation and specificati
on of the problem. For clients with self-care problems, the nursing diagnoses are specifi
ed as altered self-care (bathing), altered self-care (dressing), and altered self-care (toilet
ing).

C. Planning

Planning to assist a client with personal hygiene includes consideration of the clie
nt’s personal preferences, health, and limitations; the best time to give the care; and the
equipment, facilities, and personnel available. Another consideration for the nurse is to
assess the client’s comfort level with the gender of the caregiver to preserve clients dign
ity.

Moreover, the specific, detailed nursing activities provided by the nurse may inclu
de assisting dependent clients with bathing, skin care, and perineal care; providing back
massages to promote circulation; instructing clients and families about appropriate hygi
enic practices and alternative methods for dressing; and demonstrating use of assistive
equipment and adaptive activities.

Planning for Home Care

To provide for continuity of care, the nurse should assess the client’s and family’s
abilities to provide self-care and the need for referrals and home health services. In addi
tion, the nurse needs to determine the client’s learning needs

Client and Home Environment Assessment

Assessments of the client and environment should include self-care abilities for h
ygiene to evaluate client’s ability to do tasks, self-care aids required to determine needs
for tub or shower seat, facilities, and mechanical barriers.

Family Assessment

Assessments of the family should include, such as caregiver availability, skills, an

d responses to determine assistance, education needs to assess caregiver’s knowledge
in assisting client, and family role changes and coping to assess the effects of clients illn
ess on financial status, parenting, spousal roles, sexuality, and social roles.

D. Implementing

The nurse applies the general guidelines for skin care while providing one of the
various types of baths available to clients.

Bathing

It is to wash up in order to remove accumulated oil, perspiration, dead skin cells,

and bacterias found in the surface of the skin. The quantity of oil and dead skin cells ca
n multiply and manifest specially when nurses remove the cast of patients that has been
on for several weeks. The skin is crusty, flaky, and dry underneath the cast. Application
of oil for several days is essential to remove the debris.
 Frequent and overly excessive bathing, however, may disrupt the sebum's natura
l lubricating function, leading to skin dryness. This is particularly important and should b
e for older adults, as their sebum production is less than young ones.

Bathing does more than just keep the body clean. It also improves circulation and
overall well-being. Warm water helps open up blood vessels, bringing more oxygen and
nutrients to the skin, while gentle, smooth strokes during washing encourage better bloo
d flow. However, vigorous scrubbing isn’t always a good idea, especially for older adults
or people on medications like blood thinners, as their skin is more delicate and prone to
bruising. Beyond physical benefits, bathing has a big impact on mood and relaxation. S
ome people prefer a morning shower to feel refreshed and energized, while others enjo
y a soothing bath at night to unwind and improve sleep, especially after a restless night.

And for nurses, helping a patient bathe is more than just routine care. It is an opp
ortunity to check for skin issues, assess self-care abilities, and build trust. It also opens t
he door for teaching important health habits, like proper foot care for diabetics. A great o
pportunity to build trust from patients.

Categories

There are two categories of bath

A. Cleansing Baths - given for the purpose of hygiene.

Types:

1. Complete bed bath - nurses wash the entire body of the dependent client i
n bed.
2. Self-help (assisted) Bed Bath - clients in bed are able to bathe themselves,
but with assistance of nurses to wash parts hard to reach.
3. Partial Bath - washing only parts of the client that when neglected, may cau
se pain, odor, or discomfort (e.g face, hands, perineal area, back).
4. Bag Bath - 10-12 pre-packaged, no-rinse disposable washcloths, is warme
d and used for each body area and air-dried. Ideal for critical and long-term
care.
5. Towel Bath - replacing a bath blanket with warm, soapy regular towels inste
ad of washcloths, keeping the client covered. Client is then gently massage
d with the towel, best for bedridden and dementia patients.
6. Tub Bath - Allows easier washing and rinsing, with special tubs for depende
nt clients. Sponge baths are used for newborns to prevent heat loss. Also us
ed for therapeutic purposes.
7. Shower - For ambulatory clients needing minimal help. Shower chairs assis
t long-term care clients with perineal cleansing.

B. Therapeutic Baths - given for physical effects such as to soothe irritated skin or t
o treat an area.
Types:
1. Sitz Bath (Tub or Disposable Unit)- warm water to help soothe and heal the peri
neal area, common on mothers after childbirth or patients with hemorrhoids to all
eviate discomfort.
 2. Medicated Bath - medications are placed in the water in a tub half or a third full
at comfortable temperature not longer than 30 minutes, to help soothe irritation or
itchiness of skin.

Safety: Bathing at Home

Nurses suggests that client/caregiver do the following:
● Consider getting a bath seat that fits the bathtub or shower.
● Install a hand shower for use with a bath seat and shampooing.
● Use a non skid surface on the tub or shower
● Install hand bars on both sides of the tub or shower to facilitate transfers in
and out of the tub or shower.
● Carefully monitor the temperature of the bathwater.
● Apply lotion and oil after a bath, not during, because these solutions can
make a tub surface slippery.

Lifespan Considerations

Infants

● Sponge baths are suggested because daily tub baths are not considered.
● They should be immediately dried and wrapped, as their ability to regulate
body temperature has not yet been fully developed.

Children

● Encourage their participation for their development.

● Supervise children in the bathtub and do not leave them unattended.

Adolescents

● Assist them choosing deodorants/antiperspirant, for odors caused by secr

etions of sweat glands and bacteria on skin.

Older Adults

● Aging reduces the skin’s protective function, leading to fragility, dryness, a

nd decreased elasticity.
● Limit soap use and apply moisturizer immediately after bathing to help reta
in skin moisture and minimize dryness.
● Avoid excessive powder, as it can cause moisture loss and may be harmf
ul if inhaled.
● Protect older adults and children from hot water burns, as their skin is mor
e sensitive to temperature changes.

Long-Term Care Settings

1. Historical and Modern Perspective

● Bathing has always been an essential part of nursing care.
● In modern nursing, it is often viewed as a routine task and delegated to assisti
ve personnel (AP).
● The focus has shifted from a therapeutic experience to a task-based approac
h due to policy constraints and time limitations.
 2. Challenges in Bathing Procedures
● Agency policies often determine bathing frequency and methods, making the
process less personal.
● Long-term care is shifting to a client-centered approach, emphasizing comf
ort, dignity, and personal preferences over routine tasks.
3. Client-Focused Bathing Approach
● Nurses should assess:
○ Personal hygiene habits of the client.
○ Past negative experiences with bathing.
○ Physical and emotional factors like pain, fatigue, or discomfort.
● If a client resists bathing, alternatives like bag or towel baths should be con
sidered.
● The goal is to make bathing a positive experience rather than just ensuring cl
eanliness.
4. Bathing Considerations for Clients with Dementia
● Increase in Dementia incidence, including Alzheimer’s disease, affects hygien
e routines and requires a sensitive approach to preserve the dignity of clients.
● Challenges:
○ Agitation or fear during bathing.
○ Certain times of the day may make them more resistant.
● Strategies to reduce distress:
○ Identify calm periods for bathing.
○ Pause or postpone if the client becomes distressed.
○ Use a gentle tone, slow movements, and explain each step.
○ Maintain privacy and cover body parts while bathing.
○ Play familiar music to create a soothing environment.
5. Collaboration Between Nurses and Assistive Personnel (AP)
● Teamwork is essential to ensure a smooth bathing experience, especially for
clients with cognitive impairments.
● Nurses should:
○ Observe bathing challenges and suggest adjustments.
○ Provide education on dementia care and managing resistance.
○ Implement multiple interventions (e.g., reassurance, clear communication,
gentle handling).
○ Continuously evaluate the client's response and adjust approaches accord
ingly.
6. Key Takeaways
● Bathing should be an individualized, respectful, and therapeutic experience.
● Nurses must balance agency policies with client preferences to ensure comf
ort and dignity.
● Special consideration is needed for clients with dementia, using patience and
adaptive strategies.
● Collaboration between nurses and AP improves care quality and client well-b
eing.

Perineal-Genital Care

Perineal Care is an essential part of hygiene, particularly for clients requiring assistanc
e with bathing. However, both clients and nurses may find this task embarrassing, partic
ularly with clients of the opposite sex.
Providing Perineal-Genital Care
Equipment
For routine perineal care during a bed bath:
● Bath towel
● Bath blanket
● Clean gloves
● Bath basin with warm water (43°C to 46°C/110°F to 115°F)
● Soap
● Washcloth
Special perineal-genital care:
● Bath towel
● Bath blanket
● Clean gloves
● Solution bottle, pitcher, or container with warm water or prescribed solutio
n
● Bedpan to collect rinse water
● Perineal pad

Whenever possible, clients should be encouraged to clean their own genital area with m
inimal assistance. The nurse can support this by:

● Providing a moistened washcloth and soap.

● Assisting with rinsing the washcloth.
● Offering a towel for drying.

Some clients may not be familiar with medical terms for the perineal area, making expla
nations challenging. To ensure understanding and comfort, the nurse can:

● Use simple, familiar language, such as referring to the area as "private parts.”
● Allow clients to complete the task in privacy, to respect their comfort.
● Say, “I’ll give you a washcloth to finish your bath in privacy.” Most clients will und
erstand this, especially if they prefer to clean themselves.

To maintain client comfort and prevent infection, nurses should:

● Provide perineal care efficiently and professionally.

● Wear gloves during the process for hygiene and safety.

By handling perineal care with sensitivity, professionalism, and clear communication, nu

rses can ensure dignity and comfort for their clients.

FEET

The feet are essential for movement and require proper care, even when a person is be
dridden. Each foot consists of 26 bones, 107 ligaments, and 19 muscles, all working tog
ether to support standing and walking.

Developmental Variations
 ● At birth, a baby’s feet are underdeveloped, with arches supported by fatty pads,
which fully develop by ages 5 to 6.
● During childhood, ill-fitting shoes can harm foot development. Proper arch suppor
t is crucial for healthy growth.
● Feet continue growing until about age 20.
● Aging leads to wider, longer feet, mild arch flattening, and reduced heel padding.
● Cartilage deterioration may limit foot and ankle mobility.
● Older adults may require specialized foot care, particularly those with poor circula
tion and arteriosclerosis, as they are more prone to ulcers and infections.
● Limited mobility and vision issues can also hinder self-care

Safety Alert!
Clients with diabetes have a higher risk of lower extremity amputations (LEAs). Regular
foot assessments and education on proper foot care can significantly reduce this risk.

NURSING MANAGEMENT
A. Assessing
Nurses assess foot health through history-taking, physical examination, and identifying
clients at risk for foot problems.

Physical Assessment
● Assess each foot and toe for shape, size, and lesions.
● Palpate to assess tenderness, swelling, and circulation.

Assessment of the Feet

1. Inspect all skin surfaces, particularly between the toes, for cleanliness, odor, dryn
ess, inflammation, swelling, abrasions, or other lesions.
Normal Findings
● Intact skin
● Absence of swelling or inflammation
Deviations from Normal
● Excessive dryness
● Areas of inflammation or swelling (e.g. corns, calluses)
● Fissures
● Scaling and cracking of skin (e.g., athlete's foot)
● Plantar warts
2. Palpate anterior and posterior surfaces of ankles and feet for edema.
Normal Findings
● No swelling
Deviations from Normal
● Swelling or pitting edema
3. Palpate dorsalis pedis pulse on dorsal surface of foot.
Normal Findings
● Strong, regular pulses in both feet Warm skin temperature
Deviations from Normal
● Weak or absent pulses
4. Compare skin temperature of both feet.
Normal Findings
● Weak or absent pulses
Deviations from Normal
 ● Cool skin temperature in one or both feet

Nursing History
The nurse determines the client's history of client’s:
● Foot and nail care habits
● Type of footwear worn
● Self-care capabilities
● Risk factors for foot conditions
● Any foot pain or discomfort
● Perceived mobility limitations

Common Foot Problems

● Calluses – Thickened skin due to pressure from shoes, usually painless. Soften
with warm water and Epsom salts; smooth with pumice stone; apply lanolin crea
m to prevent recurrence.
● Corns – Raised, circular keratosis from friction, often on the fourth or fifth toe. Su
rgical removal may be needed. Prevent by wearing proper shoes and avoiding ov
al corn pads.
● Foot Odor – Caused by perspiration and bacteria. Prevented with regular washin
g, clean socks, and foot powders.
● Plantar Warts – Painful warts on the soles, caused by a virus. Treatment include
s freezing, curettage, or salicylic acid application.
● Fissures – Deep cracks between toes due to dryness. Treat with good hygiene,
antiseptic application, and air exposure using gauze.
● Athlete’s Foot (Tinea Pedis) – Fungal infection causing skin scaling, cracking, a
nd blisters. Prevent by keeping feet dry, wearing clean socks, and avoiding baref
oot exposure in public showers. Treat with antifungal creams or powders.
● Ingrown Toenails – Nail growing into soft tissue, causing pain. Treat with hot ant
iseptic soaks or surgical removal. Prevented by proper nail trimming.

Identifying Clients at Risk

Due to reduced peripheral circulation to the feet, clients with diabetes, peripheral vascul
ar disease, or long-term steroid use are particularly more prone to infection if skin break
age occurs. Prevention includes proper foot care guidelines.

Clinical Alert!
Diabetic clients have very dry skin. Advise them to use non-perfumed lotion, avoid lotion
between toes, and do not soak feet to prevent excessive dryness.

B. Diagnosing

A number of nursing diagnoses may apply, following are examples of common nursing
diagnoses:
● Altered self-care (foot care) related to:
a. Visual impairment
b. Impaired hand coordination.
● Potential for infection related to:
a. Altered skin integrity (e.g., ingrown toenail, corns)
b. Insufficient nail or foot care.
 C. Planning

Nurses identify interventions to help clients maintain or restore proper foot care. This inc
ludes:

● Educating clients on nail and foot care, proper footwear, and infection prevention.
● Assisting clients with self-care difficulties by scheduling foot soaking, cleaning, an
d nail trimming.
● Integrating foot care into daily routines, adjusting based on individual needs.

D. Implementing
During the procedures done, nurses have the opportunity to educate clients on foot care
practices to prevent injuries and infections.

CLIENT TEACHING: Foot Care

● Wash feet daily, ensuring thorough drying.
● Inspect feet for redness, swelling, or skin breaks.
● Check water temperature before soaking to prevent burns.
● Moisturize feet (except between toes) using lanolin-based lotion.
● Prevent foot odor by frequent washing, wearing clean socks/shoes, and using de
odorizing powders.
● File the toenails rather than cutting them to avoid skin injury. File the nails straigh
t across the ends of the toes. Seek professional care for thick or misshapen nails.
● Wear clean and well-fitting shoes and socks daily. Avoid socks with holes that ca
n cause pressure areas.
● Wear comfortable, well-fitting shoes that neither restrict the foot nor rub on any ar
ea. Check worn shoes for rough spots in the lining. Break in new shoes gradually
to prevent blisters.
● Avoid walking barefoot to prevent injuries and infections, especially in public area
s.
● Exercise feet regularly (pointing toes up/down, rotating feet) to improve circulatio
n.
● Avoid crossing legs or wearing tight garments that reduce circulation.
● Keep feet warm using socks and blankets instead of heating pads or hot water b
ottles.
● Treat cuts immediately with antiseptic and notify a healthcare provider.
● Avoid self-treating corns or calluses and seek professional care.
● Report any abnormalities (sores, pain, drainage, temperature or color changes) t
o a healthcare provider.

NAILS
Nails are present at birth and grow throughout life, changing little until old age. In older a
dults, they become tougher, more brittle, thicker, and slower-growing, often developing r
idges and grooves.

NURSING MANAGEMENT
A. Assessing
 Nurses evaluate a client’s nail care habits, self-care abilities, and any related pro
blems. A physical assessment includes checking nail shape, texture, color, and s
urrounding tissues.

B. Diagnosing
Common nursing diagnoses related to nail care issues and contributing factors follow:
● Altered self-care (nail care) related to:
a. Impaired vision
b. Cognitive impairment.
● Potential for infection around the nail bed related to:
a. Impaired skin integrity of cuticles
b. Altered peripheral circulation.

C. Planning
The nurse identifies measures to help clients maintain healthy nails, including schedulin
g regular nail care.
D. Implementing
To provide proper nail care, it requires:
● Nail clippers, file, cuticle stick, hand lotion, and warm water for soaking (if nails ar
e thick/hard).
● Trimming or filing nails straight across to prevent ingrown nails. Avoid digging int
o the corners.
● Filing instead of cutting for clients with diabetes or circulatory issues to prevent in
jury.
● Gently pushing back cuticles without damaging them.
● Reporting any abnormalities like infected cuticles or inflammation.

E. Evaluating
Desired outcomes for nail hygiene includes the client being able to:
● Demonstrate clean, short nails with smooth edges and healthy cuticles.
● Identify factors affecting nail health and preventive measures for the specific nail
problem.
● Perform proper nail care independently.
● Exhibit pink nail beds with quick color return after the blanch test.

MOUTH
Proper oral hygiene is crucial for keeping teeth and gums healthy. This involves regu
lar brushing and flossing. By practicing proper oral care, many dental problems can be a
voided before they develop. Additionally, oral health is closely connected to overall well-
being, making it an essential part of daily self-care (Professional, 2025).

Teeth have three parts:

● Crown - The visible exposed part outside the gum, covered with enamel.
● Root - Embedded in the jaw, covered by cementum.
● Pulp Cavity - center of the tooth, contains blood vessels and nerves.

Developmental Variations
 ● Infants (5–8 months) - First teeth appear; prolonged bottle-feeding with milk/juice
can cause cavities, especially when sleeping (Ball, Bindler, Cowen, & Shaw, 201
7).
● Children (by age 2) - Have all 20 temporary teeth; begin losing deciduous teeth
around age 6–7, replaced by the 33 permanent teeth.
● Adults (by age 25) - most people have all of their permanent teeth.
● Pregnancy - Increased hormones lead to gum swelling, redness, and bleeding.
● Aging:
○ Teeth yellow as enamel thins.
○ Gum recession and dry mouth are common.
○ Gum disease is a leading cause of tooth loss, not cavities.
○ Lack of fluoride and preventive care increases dental issues.
○ In addition, coffee drinking and cigarette smoking can stain the teeth.

NURSING MANAGEMENT
A. Assessing
Assessment of the client's mouth and hygiene practices includes:
● Nursing history – Oral hygiene habits, self-care ability, dental visits, and past issu
es.
● Physical assessment of mouth – checking for plaque, cavities, gingivitis, and peri
odontal disease.
● Identification of clients at risk for developing oral problems.

Nursing History
The nurse assesses the client’s oral hygiene by gathering information on:
● Oral hygiene habits - Frequency of brushing, flossing, and dental visits and incor
porate it in the care plan.
● Self-care abilities - Any physical or cognitive limitations affecting oral care.
● Past and current oral health issues - Identifies learning needs, required interventi
ons, or referrals

Clients with impaired coordination, cognitive decline, low energy, or treatment restriction
s may need assistance in maintaining oral hygiene.

Physical Assessment
The two most common oral health problems are:
● Dental Caries - Tooth decay caused by plaque —a soft, invisible film of bacteria,
saliva, and food particles that adhere to tooth surfaces. If untreated, plaque hard
ens into tartar, leading to cavities.
● Periodontal Disease - Gum disease resulting from tartar buildup, leading to rece
ding gum lines, formation of pockets between teeth and gums, and eventual toot
h loss, which can progress in severity:
○ Gingivitis - Inflammation of the gums, causing redness, swelling, and ble
eding.
○ Periodontitis - Pyorrhea (Severe Periodontitis) - Pus formation around t
he teeth, indicating severe infection and potential bone loss.

Identifying Clients at Risk

Certain clients are prone to oral problems because of an inability to maintain oral
hygiene. Among these are clients with:
1. Health Conditions
 ● Elderly individuals - More susceptible due to cognitive, visual, or physical im
pairments (Lee et al., 2016).
● Seriously ill, Comatose, Depressed patients or Critically ill patients – Oft
en lack the ability or motivation for oral care (Robinson et al., 2018).
● Stroke patients – Higher risk of aspiration pneumonia due to pathogenic oral
bacteria.
● Patients with nasogastric tubes or oxygen therapy – Increased risk of dry
mouth, especially in mouth breathers.
● Post-surgical oral or jaw patients – Require meticulous hygiene to prevent i
nfections.
2. Lifestyle or Socioeconomic Risks
● Lack of knowledge,
● Poor nutrition
● Financial barriers - limited access to dental care increases risk.
● family history of periodontal disease
● High sugar and salt intake – leads to enamel erosion.
● Dehydration, smoking, and alcohol use – Contribute to dry mouth and poor
oral health.
3. Medication and Radiation Therapy Risks
● Diuretics, tranquilizers (e.g., diazepam), and excessive laxative use - cau
se dry mouth.
● Chemotherapy drugs – Lead to oral mucositis (inflammation of mucous me
mbranes).
● Phenytoin (Dilantin) – Can cause gingival hyperplasia (overgrowth of gums).
● Head and neck radiation – Can cause permanent salivary gland damage, le
ading to chronic dry mouth.

Clinical Alert!
Clients in long-term care settings are at high risk for oral health problems. Nurses must
assess oral health and educate caregivers on maintaining proper hygiene to prevent co
mplications.

B. Diagnosing

Nursing diagnosis for oral health issues include:

● Altered Oral Mucous Membranes - causes may include poor hygiene, infection
s, mouth breathing, oxygen therapy, decreased salivation, extreme temperatures,
mechanical factors (e.g., broken teeth, ill-fitting dentures), autoimmune diseases,
or physical injuries.
○ Symptoms include: dry mouth (xerostomia), coated tongue, halitosis, gingi
val hyperplasia, oral pain, and ulcers.
● Lack of Knowledge – Clients may not be aware of proper oral hygiene practices
and their importance in preventing dental and systemic diseases.

C. Planning

Nurses, along with the client and family when applicable, set goals to improve oral healt
h. Interventions and activities include:

● Monitoring for dryness, inflammation (glossitis, stomatitis), and other oral issues.
 ● Assisting dependent clients with oral care.
● Providing specialized care for unconscious or debilitated clients and those with or
al lesions.
● Teaching clients on proper oral hygiene and its role in preventing dental problem
s.
● Reinforcing oral care routines before discharge.

D. Implementing

Oral hygiene is a fundamental nursing responsibility but is often overlooked by primary c

are providers and nurses due to low prioritization, lack of knowledge, inadequate suppli
es, or time constraints (Sheffler, 2018). Nurses play a key role by:

● Encouraging daily gum stimulation, brushing, flossing, and rinsing to remove bact
eria and stimulate saliva.
● Assisting clients in maintaining oral hygiene, especially those who are unable to
do so independently.
● Identifying issues requiring dental or surgical intervention and facilitating referrals.

Promoting Oral Health Throughout the Lifespan

A major role of the nurse in promoting oral health is to teach clients about specific oral h
ygienic measures.

Infants and Toddlers

● Begin dental hygiene when the first tooth erupts, cleaning after each feeding with
a wet washcloth or gauze.
● Prevent dental caries by limiting sweets and avoiding prolonged bottle use during
naps/bedtime.
● At 18 months, introduce brushing with a soft toothbrush and fluoridated toothpast
e later.
● Provide fluoride supplements if water is not fluoridated.
● Schedule first dental visit by 2-3 years old or earlier for an inspection visit. Seek p
rofessional help for any problems.

Preschoolers and School-Age Children

● Maintain deciduous teeth to prevent misalignment of permanent teeth.

● Continue fluoride use to prevent cavities.
● Teach children to brush after meals, limit sugary foods, and floss daily.
● Ensure regular dental checkups during permanent tooth development.

Adolescents and Adults

● Reinforce proper diet and oral care habits.

● School nurses should educate on risks of oral piercings.

CLIENT TEACHING: Measures to Prevent Tooth Decay

● Brushing after meals and at bedtime.

● Flossing daily.
 ● Intake of nutrient-rich foods (calcium, phosphorus, vitamins A, C, and D; a
nd fluoride)
● Limiting sugary snacks and drinks.
● Have topical fluoride applications as prescribed by the dentist
● Having dental checkups every 6 months.

Older Adults

● Tooth loss (edentulism) is declining, but older adults remain at high risk for cavi
ties and periodontal disease.
● Self-care deficits and limited dental visits increase risk, especially in nursing hom
e residents and those with dementia.
● Poor oral hygiene in frail adults can lead to serious illnesses like pneumonia.
● Nurses play a key role by:
● Conducting regular oral assessments.
● Educating caregivers on proper oral care.
● Ensuring availability of oral hygiene supplies.
● Prioritizing oral care as part of routine nursing care.

LIFESPAN CONSIDERATIONS: Oral Hygiene

INFANTS

● Start oral hygiene when the first tooth appears.

● Clean after feedings with a wet washcloth or gauze.

CHILDREN

● At 18 months, begin brushing with a soft toothbrush and introduce fluoride toothp
aste later.
● Limit sugary snacks to prevent cavities.

OLDER ADULTS

● Oral care may be challenging due to dexterity issues or dementia.

● Long-term care facilities often provide regular dental visits.
● Dry mouth increases risk of tooth decay—advise discussing it with a dentist.
● Receding gums expose tooth roots, making them more prone to decay.

Brushing and Flossing the Teeth

● Brushing removes food particles, prevents tooth decay, and stimulates gum circul
ation.
● The sulcular technique helps clean under the gum line.
● Fluoride toothpaste is recommended for antibacterial protection.

Caring for Artificial Dentures

● Types: Complete dentures (full set), partial dentures (bridge: fixed or removable).
● Dentures should be worn regularly to prevent gum shrinkage and maintain proper
chewing function.
● Clean daily with a toothbrush or denture cleaner; rinse before reinserting.
● Handle dentures carefully to prevent loss or damage.
Assisting Clients with Oral Care

● Wear gloves to prevent infection. Use a curved basin under the client's chin and t
owel for protection.
● Foam swabs help remove debris but do not effectively remove plaque or bacteria.
● Tooth brushing is more effective in preventing ventilator-acquired pneumonia tha
n foam swabs.
● Most people prefer privacy when they remove their artificial teeth to clean them.
Special care should be taken so as not to lose the client's dentures.

Clients with Special Oral Hygiene Needs

● Unconscious or debilitated clients require frequent oral care (every 2-8 hours)
due to dry mouth (xerostomia), which increases the risk of tooth decay and infe
ctions.
● Saliva has antiviral, antibacterial, and antifungal properties, and reduced sali
va production can lead to inflammation and infection.

Other causes of Dry Mouth (Xerostomia)

● Medications: Antihistamines, antidepressants, antihypertensives.

● Medical conditions: Oxygen therapy, tachypnea, NPO status (unable to take flui
ds by mouth).

Oral Care Techniques

● Use a soft-bristled toothbrush for thorough plaque removal.

● For dependent clients: A suction toothbrush may be necessary.
● If a toothbrush cannot be used:
○ Use an oral swab or a gauze-wrapped, gloved finger soaked in saline to cl
ean teeth, tongue, and oral mucosa.
○ A foam swab can provide gentle cleaning but is not as effective for plaque
removal.

Avoid:

● Lemon-glycerin swabs – Can dry and irritate the oral mucosa.

● Alcohol-based mouthwashes – Can cause irritation and dryness.
● Mineral oil as a lip moisturizer – Risk of aspiration, leading to lipid pneumonia.

Use:

● Water-soluble moisturizers – Hydrates lips and oral tissues.

● Saliva substitutes – Helps maintain moisture in the mouth.

E. Evaluating

The nurse assesses the oral mucosa, lips, tongue, and teeth to determine if desired o
utcomes were achieved.
If outcomes are not met, the nurse and client need to explore the reasons before modify
ing the care plan. It should be modified by considering:

● Client's functional abilities (Was it overestimated?)

● Hand coordination or cognitive function (Has it affected self-care?)
● Changes in condition (Has it worsened?)
● Energy level or motivation (Was there a decline affecting oral care?)

HAIR

Hair appearance reflects self-concept, cultural identity, and health. Poor grooming due t
o illness can cause discomfort, odor, and irritation. Hair texture changes may indicate h
ealth issues (e.g., dryness in hypothyroidism).

Developmental Variations
● Newborns - May have lanugo (fine body hair), which disappears over time. Scal
p hair grows within the first year.
● Adolescents - Pubic hair appears first, followed by axillary and facial hair (boys).
Increased sebaceous activity makes hair oilier.
● Older Adults - Hair becomes thinner, drier, and slower-growing. Men may experi
ence baldness, while women may develop facial hair. Axillary and pubic hair bec
ome sparser, but eyebrows grow coarser.

NURSING MANAGEMENT
A. Assessing
Nurses assess hair care practices, self-care abilities, and potential problems through a
nursing health history and physical assessment.

Nursing History
During the nursing history the nurse elicits data about usual hair care, history of scalp is
sues, and conditions affecting hair (e.g., chemotherapy causes alopecia; hypothyroid
ism causes dry, brittle hair).

Physical Assessment
Physical assessment of the hair includes problems like dandruff, hair loss, ticks, pedicul
osis, scabies, and hirsutism.

Dandruff
Causes scalp scaling and itching, sometimes spreading to eyebrows and ears. Mana
ged with antidandruff shampoo; severe cases may require medical advice.

Hair Loss
Hair loss and growth are continual processes. Some permanent thinning of hair normall
y occurs with aging. Hereditary baldness (men) has limited treatment (e.g., hairpieces,
transplants, medications with uncertain outcomes).

Ticks
Small gray-brown blood-sucking parasites that transmit diseases (e.g., Lyme disease, R
ocky Mountain spotted fever).
 Removal:
● Use tweezers or gloved fingers, pulling straight out without twisting or squ
eezing.
● Clean area with antibacterial soap and save the tick in rubbing alcohol for i
dentification.
● Avoid ineffective/dangerous methods (e.g., heat, petroleum jelly, gasoline).

Pediculosis (Lice)
Lice are parasitic insects that infest mammals. Infestation with lice is called pediculosis
Due to direct contact or infested clothing/bedding and causes intense itching and red b
umps at hairlines, behind ears, and on affected areas.

Types of Lice:

● Head Lice (Pediculus capitis) – Found on the scalp, laying eggs (nits) that resem
ble dandruff.
● Body Lice (Pediculus corporis) – Cling to clothing rather than the body, sucking
blood and causing scratches, skin irritation, and hemorrhagic spots.
● Pubic Lice (Pediculus pubis or "crab lice") – Found in pubic hair, recognizable b
y red legs.

To Treat and Prevent:

● Over-the-counter permethrin (Nix) and pyrethrins (Rid) as first-line treatment
● If it does not work, use prescription medications like malathion (Ovide), benzyl al
cohol (Ulesfia), etc.
● Home remedies (e.g., olive oil, mayonnaise, tea tree oil) lack scientific evidence.
● Nit (egg) removal is essential, use fine-toothed nit combs.
● Prevention: Wash hair care items and bedding in hot water to kill lice.

Scabies
Scabies is a contagious skin infestation by the itch mite, which burrow into the upper sk
in layers.
Characteristics:
● Pimple- like rash are commonly observed between the fingers, wrists and elbows,
beneath breast tissue, and in the groin area.
● Intense itching that is more pronounced at night
● Secondary lesions caused by scratching: vesicles, papules, pustules, excoriation
s, and crusts.
To Treat and Prevent:
● Thorough body cleansing with soap and water to remove scales and debris.
● Topical scabicide cream application.
● Wash all bed linens and clothing in very hot or boiling water to prevent reinfestati
on.

Hirsutism
The growth of excessive body hair. The acceptance of body hair in the axillae and on th
e legs is often dictated by culture.
● Acceptance of body hair varies—some cultures expect for well-groomed wome
n to remove leg/axillae hair, while others do not.
 ● Excessive body hair may be due to hormonal changes (e.g., menopause, endo
crine disorders).
● Heredity is also thought to influence hair growth patterns.

B. Diagnosing
Common nursing diagnoses related to hair hygiene and scalp conditions:
● Altered skin integrity related to:
a. Pruritus secondary to scabies
b. Pruritus secondary to head lice
c. Insect bite.
● Potential for infection related to:
a. Scalp laceration
b. Insect bite.
● Altered body image related to alopecia.

C. Planning
In planning care, the nurse, client and family set outcomes for each nursing diagnosis. I
nstruct the client and family on alternative methods for hair care including facilitating the
assistance of a barber or beautician, as necessary. Hair care planning considers:

● Personal preferences and cultural practices.

● Health status and energy levels.
● Time, equipment, and personnel availability.

D. Implementing
Hair needs to be brushed or combed and washed, as needed, to keep it clean. Nurses
may need to provide hair care for clients who cannot meet their own self-care needs.

Brushing and Combing Hair

Stimulates blood circulation, distributes natural oils, and helps with styling.

● Curly or textured hair:

○ Brushing can cause breakage; some prefer using fingers to comb.
○ Dry scalp and hair require less frequent shampooing to avoid damage.
● Long hair:
○ Can become matted in bedridden clients.
○ Braiding can prevent tangling and maintain neatness.
● Dreadlocks or braids:
○ Should not be unbraided without client’s permission.
○ Some clients apply oil between braids to prevent dryness.

Clinical Alert!
Excessively matted or tangled hair may be infested with lice.

Shampooing the Hair

Hair should be washed as often as needed to keep it clean.

Methods:

● In the shower (for well enough clients)

 ● Shampoo while sitting in front of Sink
● Giving shampoo on a Stretcher wheeled to Sink (for clients who can be moved).
● Bedside shampoo with water (for immobile clients).
● Head bath placed over hair (pre-moistened cap) – an alternative in some facilities.

Special hair care considerations:

● Using conditioner instead of shampoo helps retain moisture in dry or curly hair.
● Dry shampoos can remove oil and odor but may dry out the scalp.
● Medicated shampoos are necessary for lice treatment.
● Water temperature should be 40.5°C (105°F) to avoid discomfort or injury.

LIFESPAN CONSIDERATIONS: Hair Care

INFANTS
● Daily shampooing to prevent seborrhea.
CHILDREN
● Monitor for head lice (pediculosis).
OLDER ADULTS
● Ensure adequate warmth to prevent chilling during shampooing.

Beard and Mustache Care

Beards and mustaches also require daily care.
● Regular cleaning to remove food particles and maintain hygiene.
● Clients may need periodic trimming for a well-groomed appearance.
● Shaving is often performed after a bath when the skin is softer. If a client is taking
an anticoagulant (e.g., Coumadin, heparin), an electric shaver should be used.

Steps to using Safety Razor (Facial Hair)

1. Wear gloves to prevent contact with possible facial nicks.
2. Apply shaving cream or soap with water to soften the bristles and make skin mor
e flexible.
3. Hold the skin taut, particularly around creases, to prevent cuts.
4. Place the shaver at 45° angle to the skin, and shave in short, firm strokes in the d
irection of hair growth.
5. Wipe face with a wet washcloth to remove any remaining shaving cream and Hai
r.
6. Dry the face thoroughly, then apply aftershave lotion or powder if preferred.
7. Pat on the lotion with the fingers and avoid rubbing the face, to prevent irritation.

Note: Check agency policy as some do not allow safety razors because of the risk of i
mpaired skin integrity from cutting the skin. Only electric razors can be used to shav
e clients with bleeding tendencies. Check the electric razor for safety aspects.

Clinical Alert!
A beard or mustache should not be shaved off without the client's consent.

E. Evaluating
Using data collected during care, nurses assess whether the desired hair care outcome
s have been met using data collected during care. Measurable or observable client outc
omes include the client being able to:
 ● Perform hair grooming with assistance (specify).
● Hair looks clean, well-groomed, and resilient, with a healthy sheen.
● Reduce or get rid of scalp lesions or infestations.
● Accurately describe factors, interventions, and preventive measures for a specific
hair problem (e.g., dandruff).

EYES

Under normal conditions, the eyes do not require special hygiene because lacrim
al fluid continuously cleanses them, and the eyelids and eyelashes help prevent foreign
particles from entering. However, special care is necessary for unconscious patients an
d those recovering from eye surgery or experiencing eye injuries, irritations, or infection
s. Unconscious patients may lack the blink reflex, leading to the buildup of excessive dr
ainage along the eyelid margins. Similarly, individuals with eye trauma or infections ofte
n experience increased discharge or drainage. Any secretions on the eyelashes should
be cleaned before they dry and form crusts. Additionally, patients who use eyeglasses o
r contact lenses may need guidance and care from a nurse.

Eye Care

Dried secretions that have accumulated on the lashes need to be softened and w
iped away.

1. Soften dried secretions by placing a sterile cotton ball moistened with sterile wate
r or normal saline over the lid margins.
2. Wipe the loosened secretions from the inner canthus of the eye to the outer cant
hus to prevent the particles and fluid from draining into the lacrimal sac and nasol
acrimal duct.
3. For an unconscious client who lacks a blink reflex, drying and irritation of the cor
nea must be prevented.

Eyeglass Care

Glass lenses can be cleaned with warm water and dried with a soft tissue that wil
l not scratch the lenses. Plastic lenses are easily scratched and may require special cle
aning solutions and drying tissues. When not being worn, all glasses should be placed i
n an appropriately labeled case and stored in the client’s bedside table drawer

Contact Lens Care

Contact lenses, thin curved disks of hard or soft plastic, fit on the cornea of the e
ye directly over the pupil. Most clients normally care for their own contact lenses. Each l
ens manufacturer provides detailed cleaning instructions. Depending on the type of lens
and cleaning method used, warm tap water, normal saline, or special rinsing or soaking
solutions may be used.

All users should have a special container for their lenses. Some contain a solutio
n so that the lenses are stored wet; in others, the lenses are dry. Each lens container ha
s a slot or cup with a label indicating whether it is for the right or left lens. It is essential t
he correct lens be stored in the appropriate slot so that it will be placed in the correct ey
e.
General Eye Care

Many clients may need to learn specific information about care of the eyes. Som
e examples follow:

● Avoid home remedies for eye problems. Eye irritations or injuries at any age sho
uld be treated medically and immediately.
● If dirt or dust gets into the eyes, clean them copiously with clean, tepid water as a
n emergency treatment.
● Take measures to guard against eyestrain and to protect vision, such as maintain
ing adequate lighting for reading and obtaining shatterproof lenses for glasses.
● Schedule regular eye examinations, particularly after age 40, to detect problems
such as cataracts and glaucoma.

Ears

Normal ears require minimal hygiene. Clients who have excessive cerumen or ea
rwax and dependent clients who have hearing aids may require assistance from the nur
se. Hearing aids are usually removed before surgery.

Cleaning the Ears

● The auricles of the ear are cleaned during the bed bath.
● The nurse or client must remove excessive cerumen that is visible or that causes
discomfort or hearing difficulty.
● Visible cerumen may be loosened and removed by retracting the auricle up and b
ack. If this measure is ineffective, the use of a ceruminolytic (wax-softening agent
s used to soften the cerumen) or irrigation may be necessary.
● Ear irrigations have the potential to cause discomfort or even injury, thus the nurs
e must have competence in aural irrigation prior to performing the procedure.

Clients who use hearing aids are more prone to cerumen (earwax) impaction for two
main reasons:

1. The hearing aid, being a foreign object, stimulates increased cerumen production

2. The presence of hearing aids interferes with the ear’s natural process of removin
g wax.

Nurses should advise clients to avoid using bobby pins, toothpicks, or cotton-t
ipped applicators to clean their ears. Bobby pins and toothpicks can damage the ear c
anal and may even rupture the tympanic membrane (eardrum), while cotton-tipped ap
plicators can push the wax deeper into the ear canal, causing further blockage.

Care for Hearing Aids

A hearing aid is a battery-powered, sound-amplifying device used by people with

hearing impairments. It consists of a microphone that picks up sound and converts it to
electric energy, an amplifier that magnifies the electric energy electronically, a receiver t
hat converts the amplified energy back to sound energy, and an earmold that directs the
sound into the ear. There are several types of hearing aids:
 1. Behind-the-ear (BTE) open fit. Barely visible with a clear tube that runs down i
nto the ear canal. It does not occlude the ear canal.
2. Behind-the-ear (BTE) with earmolds. Widely used type because it fits snugly b
ehind the ear.
3. In-the-ear (ITE) hearing aid. It is more visible than other types but has more roo
m for features such as volume control.
4. In-the-canal (ITC) hearing aid. It fits completely inside the ear canal. It looks like
the ITE hearing aid except a smaller portion of the hearing aid shows in the outer
ear. However, it is not suitable for clients with progressive hearing loss.
5. Completely-in-the-canal (CIC) aid. Almost invisible to an observer, the CIC aid
has to be custom designed to fit the individual’s ear.

For correct functioning, hearing aids require appropriate handling during insertio
n and removal, regular cleaning of the earmold, and replacement of dead batteries. With
proper care, hearing aids generally last 5 to 10 years. Earmolds generally need readjust
ment every 2 to 3 years.

Patient-Centered Care

People who need a hearing aid may not wear one because they view it as a stig
ma of old age. It is important for the client who just purchased a hearing aid to know that
it often takes weeks or even months to adjust to it. At first, the sounds may seem shrill a
s they start hearing high frequency sounds that had been forgotten. Remind them that it
is a hearing aid, not a hearing cure. Encourage them to not give up. The client needs to
adjust to the hearing aid gradually by increasing the amount of time each day until the ai
d can be worn for a full day.

Nose

Nurses usually need not provide special care for the nose, because clients can or
dinarily clear nasal secretions by blowing gently into a soft tissue. When the external nar
es are encrusted with dried secretions, they should be cleaned with a cotton-tipped appl
icator or moistened with saline or water. The applicator should not be inserted beyond t
he length of the cotton tip; inserting it further may cause injury to the mucosa

SUPPORTING HYGIENIC ENVIRONMENT

Since clients are often confined to bed for extended periods when ill, the bed bec
omes a significant part of their daily life. A clean, safe, and comfortable bed promotes b
etter rest, sleep, and overall well-being. From a holistic viewpoint, bed making is seen a
s creating a healing environment. When done with care and attention to support the clie
nt’s recovery, the space can positively influence the healing process.

Environment
In Florence Nightingale’s book Notes on Nursing, she discussed many concepts i
ncluding ventilation and warming, light, cleanliness of rooms, noise, and beds and beddi
ng. These concepts are just as important today and the nurse is often an influencing fac
tor (e.g., dimming lights, controlling noise, providing a clean bed). When providing a co
mfortable environment, it is important to consider the client’s age, severity of illness, and
level of activity.
Room Temperature
A room temperature between 20°C and 23°C (68°F and 74°F) is comfortable for
most clients. People who are very young, very old, or acutely ill frequently need a room t
emperature higher than normal.

Ventilation
Proper ventilation is essential for removing unpleasant odors and stale air. Odors
from sources like urine, draining wounds, or vomit can be unpleasant for others. While r
oom deodorizers can help mask these smells, maintaining good hygiene is the most eff
ective way to prevent unpleasant body and breath odors. Additionally, hospitals enforce
a no-smoking policy in patient rooms and throughout the entire facility.

Noise
Hospital environments can be quite noisy, and special care needs to be taken to
reduce noise in the hallways and nursing care units. Environmental distractions such as
environmental noises and staff communication noise are particularly troublesome for ho
spitalized clients.
For example, increased noise has been linked to stress reaction, sleep disturban
ce, and increased perception of pain. Environmental noises include the sound of paging
systems, telephones, and call lights; doors closing; elevator chimes; industrial floor clea
ners; and carts being wheeled through corridors. It is important for nurses to increase t
heir awareness of noise on their units and intervene to find solutions.

Hospital Beds

The frame of a hospital bed is divided into three sections.This permits the head and the
foot to be elevated separately. Most hospital beds have “high” and “low” positions that c
an be adjusted either mechanically or electrically by a button or lever. The high position
permits the nurse to reach the client without undue stretching or stooping. The low positi
on allows the client to step easily to the floor.

Commonly Used Bed Position

1. Flat - Mattress is completely horizontal.

Used when a client is sleeping in a variety of bed positions, such as back-lying, si
de-lying, and prone (face down).
2. Fowler's position - Semi-sitting position in which the head of bed is raised to an
angle between 45° and 60°, typically at 45°. Knees may be flexed or horizontal.
Convenient for eating, reading, visiting, watching TV
3. Semi Fowler’s Position - Head of bed is raised between 15° and 45°, typically a
t 30°. To promote lung expansion.
4. Trendelenburg’s position - Head of bed is lowered and the foot raised in a stra
ight incline. To promote venous circulation in certain clients.
5. Reverse Trendelenburg’s position - Head of bed raised and the foot lowered.
Straight tilt in direction opposite to Trendelen burg’s position. To promote stomac
h emptying and prevent esophageal reflux in clients with hiatal hernia.

Mattresses
Mattresses are usually covered with a water-repellent material that resists soiling
and can be cleaned easily. Most mattresses have handles on the sides called lugs by w
hich the mattress can be moved. Many special mattresses are also used in hospitals to
relieve pressure on the body’s bony prominences, such as the heels. They are particula
rly helpful for clients confined to bed for a long time.
In making beds, nurses need to be able to prepare hospital beds in different way
s for specific purposes. In most instances, beds are made after the client receives hygie
nic care and when beds are unoccupied. This helps reduce the accumulation of dust, all
ergens, and bacteria by ensuring that bedding is smooth and less likely to harbor these
contaminants (Okorobie, 2024). At times, however, nurses need to make an occupied b
ed or prepare a bed for a client who is having surgery. Regardless of what type of bed
equipment is available, whether the bed is occupied or unoccupied, or the purpose for w
hich the bed is being prepared, certain practice guidelines pertain to all bed making.

Conclusion
Caring for the body is not only about eating right or exercising regularly, not a sin
gle thing, but an interconnected system of routines that keeps people healthy. Hygiene i
s an essential aspect beyond preventing the spread of bacteria; it’s about overall self-m
aintenance. From bathing to remove dirt, trimming hair and nails to the right length, brus
hing teeth after every meal, and ensuring every body part is well-maintained, hygiene is
a daily practice to look and feel alive.
In the field of nursing, hygiene takes on a deeper meaning. It’s no longer just abo
ut personal business, but a professional responsibility to continue to nurture patient’s co
mfort, dignity, and self preservation. All of this contributes to maintaining their strength a
nd hope towards their conditions. Hygiene becomes a source of strength for those unabl
e to care for themselves, keeping their sense of self. It is a simple yet powerful act that i
nfluences the lives of those struggling to continue. In the end, hygiene is more than just
a habit or routine, but a foundation of health, self-respect, and genuine, compassionate
care.