Hygiene and Self Care - Objectives

Discuss important subjective and objective areas of assessment when identifying self-care deficits and individualizing a plan for self-care​

Normal Pattern Identification

Risk Identification

Dysfunction Identification

Normal Pattern Identification 

• How do you manage bathing or hygiene (dressing, eating, and toileting)? Are you satisfied with your ability to bathe (dress, eat, and toilet)?

• Describe any factors that interfere with bathing (dressing, eating, and toileting)?

• What are your expectations about performing self-care?

• Do you foresee any problems with your ability to care for yourself?

Risk Identification

• Pain

• Immobility or limited use of an extremity

• Neuromuscular impairment

• Altered level of consciousness, such as confusion or decreased alertness

• Decreased visual acuity or other sensory deficits

• Inability to control bowel or bladder function

• Decreased energy levels or fatigue

• Socioeconomic factors

• Dysfunction Identification 

• Evidence of an inability to manage self-care (e.g., poor grooming, body odor, skin lesions, poor nutrition)

• Ability to process sensory input by hearing, sight, smell, and touch

• Evidence of weakness, cognitive deficits, immobility or spasticity, or lethargy

• Manual dexterity

• Use of sensory or mechanical aids (e.g., glasses or contact lenses, dentures, hearing aid, cane or walker, condom catheter, raised toilet seat, special eating utensils)

• Bathing 

• Wash Hands

• Gloves? (No gloves in figure)

• Close door, prepare room (bathmat on floor or towel), transport, occupied

• Cover patient with towel while water warms 

• Fill tub halfway with warm or adjust shower 

• Test temperature 

• Help into shower

• Handheld shower to wet 

• Soap and washcloth with long, firm strokes 

• Help out

• Dress and groom 

• Hand hygiene 

• Document  

• Bed Bathing 

• Bed in high position 

• Remove linen 

• Bath blanket on patient 

• Heat cloths 

• Wash with long firm strokes 

• Get between toes and bottom

Perineal

• Female

  • Cleanse upper inner thigh 

  • Labia majora 

  • Folds between majora and minora 

  • Cleanse away from pubic area toward anus in one stroke, repeat

• Male 

  • Upper inner thigh, penis, scrotum, maybe foreskin retract

  • Cleanse tip of penis from urethra meatus outward in a circular motion 

  • Cleanse penile shaft from tip downward towards scrotum 

• Foot/Hand 

• Privacy, gloves, chair maybe 

• Fill washbasin with warm (94-98) water

• Call light in reach, soak for ten minutes 

• Dry one, soak other 

• Clean under nails with stick or cotton (thick/yellow = fungus, wear gloves)

• Cut nails straight across and shape, start with thumb (diabetes = file down)

• Push back cuticle

• Rinse in warm water, dry including between digits 

• Lotion 

Toileting

• Condom Catheter (over shaft of penis)

• Female External Catheter

  • Between labia, wicks away 

• Bedpans- high up and low rim 

• Bed Making - occupied 

• Assemble equipment on bedside table 

• Lock rails on opposite side 

• Losen linen from foot, remove and place over to chair

  • Fanfold soiled 

  • tuck under patient 

• Cover patient with blanket 

• Flat bottom sheet fanfold toward center of bed 

• Draw under soiled liniens 

• Patient roll to other side 

• Help patient to center of bed 

• Top sheet over patient to knees, then remove second one 

• Tuck with triangle under mattress

• Change pillowcase with no shaking

Eyes

• Note if edematous, crusted, inflamed, tearing excessivley 

• Examine sclera color 

• Clean secretions with washcloth or sterile gauze pads soaked in sterile water or saline 

  • Contact lenses 

    • Glasses cleaned daily 

    • Secretions and foreign matter accumulate below lenses 

    • Based on manufacturer 

Ears

• Check the ear for inflamed tissue, drainage, discomfort 

• Clean auricles with washcloth covered finger 

• Excessive cerumen removed with the twisted end of a clean washclooth pulling down auricle 

• Irrigate if necessary 

  • Hearing Aids  

    • Inspect to ensure tubing and mold are in tact 

Teeth

• Perform brushing or flossing, encourage regular

• Sit patient up 

• Towel under chin 

• Moisten brush and apply toothpaste 

• Pull up gum 45 degrees

• Back and forth strokes from gumline to tooth crown 

• Rinse and spit 

• 18in of dental floss

• Up and down between teeth 

• Unconscious = do sideways, use suction 

  • Dentures

    • Pull out with gauze from center teeth by gently rocking 

    • Place towel in the sink and hold firmly 

    • Brush like regular teeth

• List beneficial patient teaching for each of the 4 areas of self-care (bathing, feeding, toileting, dressing)​

• The patient should exhibit increased independence in bathing, grooming, feeding, and toileting. 

• state any limitations and accept necessary assistance. 

• demonstrate a positive self-image and satisfaction with accomplishments in self-care

• use adaptive devices to facilitate self-care without injury.