Hygiene is the science of health and its maintenance.

Personal hygiene is the self-care by

which individuals attend to such functions as bathing, toileting, general body hygiene, and
grooming.

After completing this chapter, you will be able to:

1.​ Describe hygienic care that nurses provide to clients.
2.​ Identify factors influencing personal hygiene.
3.​ Identify normal and abnormal assessment findings while providing hygiene care.
4.​ Apply the nursing process to common problems related to hygienic care of the:
• Skin
• Feet
• Nails
• Mouth
• Hair
• Eyes
• Ears.
5.​ Identify the purposes of bathing.
6.​ Describe various types of baths.

Hygienic Care

early morning care is provided to clients as they awaken in the morning.

Morning care is often provided after clients have break-fast although it may be provided before
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 the client. For example, a client who is
diaphoretic (sweating profusely).

Assessing
Assessment of the client's skin and hygienic practices includes
(a) a nursing health history to determine the
-​ client's skin care practices
-​ self-care abilities
-​ and past or current skin problems; and
(b) physical assessment of the skin.

Diagnosing
Examples of nursing diagnoses for clients with
-​ self-care problems need to specify the problem,
-​ such as bathing, feeding, toileting, or dressing.

Planning
In planning care, the nurse and, if appropriate, the client and family set outcomes for
each nursing diagnosis.
-​ The nurse then performs nursing interventions and activities to achieve the client
outcomes.
-​ to perform self care independently
-​ Plan for home self care ability
-​ Needs for referrals and home care service

Evaluating
Using data collected during care, the nurse judges whether desired outcomes have been
achieved. If the outcomes have not been achieved, the nurse explores reasons why.
For example:
• Did the nurse overestimate the client's functional abilities (physical, mental, emotional) for
self-care?
• Were provided instructions clear?
• Were appropriate assistive devices or supplies available to the client?
• Did the client's condition change?
• Were required analgesics provided before hygienic care?
• What currently prescribed medications and therapies could affect the client's abilities or tissue
integrity?
• Is the client's fluid and food intake adequate or appropriate to maintain skin and mucous
membrane moisture and integrity?

Notes ko kay maam-

Evaluation
-​ functional ability for self care
-​ Clients status
-​ Needs for analgesics
-​ Tissue integrity

Skin

The skin, the body's largest organ, serves five major functions:

1.​ Protects underlying tissues by preventing microorganism passage, acting as the first
line of defense. Intact, healthy skin is the body's first line of defense.
2.​ Regulates body temperature.
3.​ Secretes sebum, which softens and lubricates hair and skin, prevents brittleness, and
reduces water loss in low humidity.
4.​ Transmits sensations via nerve receptors sensitive to pain, temperature, touch, and
pressure.
5.​ Produces and absorbs vitamin D with UV rays, activating a precursor in the skin.

Implementing
●​ Moisture in contact with the skin for more than a short time can result in increased
bacterial growth and irri-tation.
●​ 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 dryness of the
skin.
●​ Intact, healthy skin is the body's first line of defense.
●​ Body odors are caused by resident skin bacteria acting on body secretions.
●​ Skin sensitivity to irritation and injury varies among individuals and in accordance with
their health.
●​ Agents used for skin care have selective actions and purposes.

Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
-​ Excessive bathing, however, can interfere with the intended lubricating effect of the
sebum, causing dryness of the skin.

Cleansing baths are given chiefly for hygiene purposes and include these types:

• Complete bed bath. The nurse washes the entire body of a dependent client in bed.

• Self-help (assisted) bed bath. Clients confined to bed are able to bathe themselves with help
from the nurse for washing the back and perhaps the feet.
• Partial bath. Only the parts of the client's body that might cause discomfort or odor, if
neglected, are washed: the face, hands, axillae, perineal area, and back.

• Bag bath. This bath is a commercially prepared product that contains 10 to 12 presoaked
disposable washcloths that contain no-rinse cleanser solution.

• Towel bath. This bath is similar to a bag bath but uses regular towels. It is useful for clients
who are bedridden and clients with dementia.

•Tub bath. Tub baths are often preferred to bed baths because it is easier to wash and rinse in
a tub. Tubs are also used for therapeutic baths.

•Shower. Many ambulatory clients are able to use shower facilities and require only minimal
assistance from the nurse. Clients in long-term care settings are often given showers with the
aid of a shower chair.

Therapeutic baths are given for physical effects, such as to soothe irritated skin or to treat an
area (e.g., the perineum).
-​ sitz bath, the client sits in warm water to help soothe and heal the perineum. For
example, mothers after childbirth
-​ medicated therapeutic bath is generally taken in a tub one-third or one-half full with water
at a comfortable temperature. Medications may be placed in the water

Factor Variables

Culture Some cultures emphasize cleanliness more

than others. Bathing frequency varies (daily
vs. weekly). Some cultures value privacy,
while others practice communal bathing.
Body odor may be offensive or accepted.

Religion Some religions require ceremonial washings

as part of spiritual practices.

Environment Financial limitations can impact access to

bathing facilities and hygiene products (e.g.,
homeless individuals may lack warm water,
soap, or deodorants).

Developmental Level Hygiene practices are learned at home.

Young children need guidance, while
preschoolers can perform most hygiene tasks
independently with encouragement.

Health and Energy Illness and low energy levels can reduce a
person's ability to maintain hygiene.
Neuromuscular impairments may prevent
independent hygienic care.
Personal Preferences Some individuals prefer showers over baths.
Bathing time varies (morning vs. evening).

Functional Completely Requires Semidepend Moderately Totally

Level Independent Use of ent (+2) Dependent Dependent
(0) Equipment Requires (+3) (+4) Does
or Device Help from Requires Not
(+1) Another Help from Participate
Person for Another in Activity
Assistance, Person and
Supervision, Equipment
or Teaching or Device

Bathing Nurse Nurse Client needs

provides all supplies all complete
equipment; equipment; bath; cannot
positions positions assist at all.
client in bed client;
or bathroom. washes back,
Client legs,
completes perineum,
bath, except and all other
for back and parts, as
feet. needed.
Client can
assist.

Oral Nurse Nurse Nurse

Hygiene provides prepares completes
equipment; brush, rinses entire
client does mouth, procedure.
task. positions
client.

Dressing/Gr Nurse Nurse combs Client needs

ooming gathers items client's hair, to be dressed
for client; assists with and cannot
may button, dressing, assist the
zip, or tie buttons and nurse; nurse
clothing. zips clothing, combs
Client ties shoes. client’s hair.
dresses self.

Toileting Client can Nurse Client is

walk to provides incontinent;
bathroom or bedpan, nurse places
commode positions client on
with client on or bedpan or
assistance; off bedpan, commode.
nurse helps places client
with clothing. on commode.
 Problem & Appearance Nursing Implications

Abrasion 1. Prone to infection; therefore, wound should

Superficial layers of the skin are scraped or be kept clean and dry.
rubbed away. Area is reddened and may 2. Do not wear rings or jewelry when
have localized bleeding or serous weeping. providing care to avoid causing abrasions to
clients.
3. Lift, do not pull, a client across a bed.
4. Use two or more people for assistance.

Excessive Dryness 1. Prone to infection if the skin cracks;

Skin can appear flaky and rough. therefore, provide alcohol-free lotions to
moisturize the skin and prevent cracking.
2. Bathe client less frequently; use no soap,
or use non-irritating soap and limit its use.
Rinse skin thoroughly because soap can be
irritating and drying.
3. Encourage increased fluid intake if health
permits to prevent dehydration.

Ammonia Dermatitis (Diaper Rash) 1. Keep skin dry and clean by applying
Caused by skin bacteria reacting with urea in protective ointments containing zinc oxide to
the urine. The skin becomes reddened and is areas at risk (e.g., buttocks and perineum).
sore. 2. Boil an infant's diapers or wash them with
an antibacterial detergent to prevent infection.
Rinse diapers well because detergent is
irritating to an infant's skin.

Acne 1. Keep the skin clean to prevent secondary

Inflammatory condition with papules and infection.
pustules. 2. Treatment varies widely.

Erythema 1. Wash area carefully to remove excess

Redness associated with a variety of microorganisms.
conditions, such as rashes, exposure to sun, 2. Apply antiseptic spray or lotion to prevent
elevated body temperature. itching, promote healing, and prevent skin
breakdown.

Hirsutism 1. Remove unwanted hair by using

Excessive hair on the body and face, depilatories, shaving, electrolysis, or
particularly in women. tweezing.
2. Enhance client's self-concept.

General Guidelines for Bathing People with Dementia

●​ Focus on the person rather than the task.

○​ Cover! Keep the person covered as much as possible to keep warm.
○​ Time the bath to fit the person’s history, preferences, and mood.
○​ Move slowly and let the person know when you are going to move them. Or, ask
the client to move his or her own arm or leg.
○​ Evaluate to determine if the person needs pain control before the bath.
 ○​ Use a gentle touch. Use soft cloths. Pat dry rather than rubbing.
●​ Be flexible. Adapt your approach to meet the needs of the person.
○​ Consider adapting your methods (e.g., distracting the person with singing while
bathing), the environment (e.g., correct size of shower chair, reducing noise,
playing music), or the procedure (e.g., consistently assigning the same caregiver,
inviting family to help).
○​ Encourage flexibility in scheduling of bath based on the individual’s preference.
●​ Use persuasion, not coercion.
○​ Give choices and respond to individual requests.
●​ Help the person feel in control.
○​ Use a supportive, calm approach and praise the person often.
●​ Be prepared.
○​ Gather everything that you will need for the bath (e.g., towels, washcloths,
clothes) before approaching the person.
●​ Stop when a person becomes distressed. It is not normal to have cries, screams, or
protests from the person.
○​ Stop what you are doing and assess for causes of the distress.
○​ Adjust your approach.
○​ Shorten or stop the bath.
○​ Try to end on a positive note.
○​ Reapproach later to wash critical areas if necessary.
●​ Ask for help.
○​ Talk with others, including the family, about different ways to help make the bath
more comfortable for the person.