Ch. 27: Hygiene

Introduction to Hygiene in Patient Care

•Hygiene = practices that promote & preserve health
•Hospitalized patients may depend on nurses for basic care
•Includes bathing, oral care, perineal care, foot care, shaving
•Influenced by habits, culture, ethnicity, age
•Hygiene care provides assessment opportunities

Structure & Function: Skin, Hair, and Nails

•Skin, nails, hair, sweat & sebaceous glands → integumentary system
•Skin = 20% of body weight; barrier to external environment → 1st line of defense
•Sweat glands: activated by heat, stress → can cause odor
•Sebaceous glands: produce sebum to soften hair & skin
•Nails: protection; composed of keratin

Hair Growth & Alopecia

•Hair grows from follicles in the dermis
•Normal cycle: growth → rest → shedding
•Alopecia = hair loss
•Causes: hereditary, illness, medications (chemo), stress

Oral Cavity: Structure & Function

•Mucous membranes line body cavities
•Salivary glands produce saliva for moisture & digestion
•Teeth perform mechanical digestion
•Healthy gingivae support teeth

Decreased Sensation & Safety Concerns (in exam)

Peripheral neuropathy reduces sensation
•Risk: burns from hot water
•Nurse must check bathwater temperature
•Monitor for injuries patient can’t feel

Pediculosis (lice)

•Caused by Pediculus humanus capitis
•Spread by contact with infested items
•Symptoms: itching, redness
•Risk for secondary infections
•Requires treatment & contact precautions

Nail Problems

•Fungal, bacterial, viral infections
•Can cause discoloration & thickening
•Poor circulation → delayed healing
•May require PCP order or podiatry

Assessment in Hygiene Care

Hygiene care = opportunity to assess physical and cognitive status
• Evaluate:
• Cognitive functioning
• Mobility & ROM
• Skin integrity
• Hygiene practices
• Good hygiene → direct impact on integumentary health
• Use subjective + objective data to guide individualized care

Assessing Skin, Hair, Nails, Oral Cavity

•Ask about dryness, rashes, sores
•Observe exposed skin + odors
•During bath: inspect color, warmth, texture, integrity
•Review hair, nails, oral mucosa condition
•Calculate Braden score

Assessing Self-Care Abilities

• Evaluate ability to perform ADLs

• Identify deficits or support needs

• Consider discharge planning + referrals

Planning

•Prioritize diagnoses
•Goals must be realistic and individualized
•Consider abilities, family, resources, length of stay

Implementation & Evaluation

Hygiene = fundamental nursing care
•Promote comfort, safety, infection prevention
•Evaluate continually

Safe Practice Alert

• This is crucial. Reddened areas are early signs of pressure injury.
  Massaging them can worsen tissue damage. I avoid pressure,
  assess carefully, and adjust care to protect the skin.

Hand & Foot Care

• Inspect for sores, dryness, ulcers

• No soaking feet for neuropathy

• Diabetic foot precautions

• Document finding

Pediculosis (Head Lice) Care

Use pediculicidal shampoos with caution
•Toxic potential + CNS side effects
•Contraindicated for seizure history, pregnancy, young children
•PPE required
•Fine-tooth comb before & after treatment
•Document scalp assessment + tolerance

Oral Care Overview

•Removes plaque + bacteria
•Reduces tooth decay + halitosis
•Brushing, flossing, rinsing
•Denture cleaning if applicable
•Elevate HOB for dependent patients

Patients With Special Oral Care Needs

•NPO or oxygen therapy → dry mucosa
•Oral care every 2 hours
•Use toothbrush or moistened toothette
•Unconscious patients = aspiration risk
•Modified technique required

Prosthetic Eye Care

•Prosthetic eyes may be removable or permanent
•Many patients perform their own care
•If assisting:
•Pull down lower lid
•Apply pressure to lower edge to break suction
•Clean prosthesis and socket with saline

Nose Care

•Remove secretions for patients unable to blow nose
•Suction for moist secretions
•Moistened applicator for dried mucus
•Never insert applicator beyond cotton tip
•Saline spray or lubricant if dry
•Humidify oxygen if nasal dryness occurs
•Clean crusting around NG tubes daily

Ear Care

•Routine cleaning with washcloth and soap
•PCP may order oil drops for cerumen
•Do NOT use cotton-tipped applicators
•Irrigation may be used if ordered