Hygiene
Hygiene
Objectives of the Chapter
After completing the chapter, students will be able to:
Identify factors affecting personal hygiene.
Assess the adequacy of hygiene practices and self-care behaviors using appropriate interview and physical assessment skills.
Assess the condition of the patient’s skin, oral cavity, hair, and nails utilizing interview and physical assessment skills.
Formulate diagnoses/patient problems related to hygiene amenable to nursing intervention.
Demonstrate techniques for assisting patients with hygiene measures, including those used when administering various types of baths.
Describe agents commonly used on the skin and scalp, including precautions associated with their use.
Plan, implement, and evaluate nursing care related to diagnoses/patient problems involving alterations in hygiene.
Factors Affecting Personal Hygiene
Personal Hygiene Importance:
Promotes physiological and psychological well-being.
Hygiene practices include bathing and care of various body areas:
Skin
Oral cavity
Eyes
Ears
Nose
Hair
Nails
Feet
Perineal and vaginal areas
Cultural Factors:
Habits, typical bathing practices, and behaviors vary across cultures.
Socioeconomic Class:
Financial constraints can lead to inadequate hygiene maintenance (e.g., lack of toiletries).
Spiritual Practices:
May involve ritual baths, prayers, or specific eating habits.
Developmental Level:
Hygiene practices such as frequency of brushing teeth or shampooing hair are learned in childhood.
Health State:
Surgery or injury can impair a person’s ability to maintain hygiene practices.
Personal Preferences:
Individual choices (e.g., frequency of tooth brushing, preference for showers vs. baths).
Factors to Consider When Examining Skin
Key Assessment Factors:
Cleanliness
Color
Temperature
Turgor
Moisture
Sensation
Vascularity
Evidence of lesions
Guidelines for Assessing the Skin
Employ the nursing process to identify impairments, risks, and to create plans for hygiene care.
Always incorporate skin assessment during evaluations of other body systems.
Use adequate lighting, preferably daylight, for accurate evaluation.
Compare bilateral body parts to assess for symmetry.
Use standard clinical terminology when reporting and recording findings.
Direct skin assessments based on information obtained from nursing history.
Identify variables known to provoke skin issues.
At Risk for Skin Alteration
Lifestyle Factors
Changes in Health State
Illness:
Immobile patients may suffer from malnutrition or impaired hygiene.
Diagnostic Measures:
Tools such as the Braden Scale to assess risk.
Therapeutic Measures:
Other Factors affecting skin integrity.
Focus of Self-Care Deficit Diagnoses
Evaluated areas include:
Feeding
Bathing and hygiene
Dressing and grooming
Toileting
Care Routines
Early Morning Care:
Assist patient with toileting.
Provide comfort measures, wash face and hands, and oral care.
Morning Care (A.M. Care):
Performed after breakfast, includes:
Toileting
Oral care
Bathing
Back massage
Special skin measures
Hair care and application of cosmetics
Additionally includes dressing, positioning for comfort, changing bed linens, and tidying up bedside.
Afternoon Care (PM Care):
Post-lunch comfort measures include:
Assistance with toileting, handwashing, and oral care.
Straightening bed linens.
Supporting patient mobility and repositioning.
Hour of Sleep Care (HS Care):
Assistance with toileting, washing, and oral care before bedtime.
Offer back massage and change soiled linens.
Ensure comfort and accessibility of required items (e.g., call light).
As Needed Care (PRN Care):
Identify individual hygiene measures as needed.
Change clothing and bed linens for diaphoretic patients; provide oral care every two hours if required.
Reasons for Providing Back Massage
Physiological Benefits:
Acts as a general body conditioner, relieving muscle tension and promoting relaxation.
Improves circulation, potentially decreasing pain, distress, and anxiety while improving sleep quality.
Observational Benefits:
Provides opportunity to assess skin for any breakdown.
Communication Benefits:
Offers a means of non-verbal communication through touch.
Purposes of Bathing
Physical and Psychological Benefits:
Cleanses the skin
Acts as a skin conditioner
Promotes relaxation
Enhances circulation
Offers musculoskeletal exercise
Stimulates rate and depth of respirations
Promotes comfort through muscle relaxation and skin stimulation.
Provides sensory input and enhances self-image.
Strengthens nurse-patient relationship.
Providing a Bed Bath
Preparation Steps:
Gather bathing articles on overbed table or bedside stand.
Ensure patient privacy, remove top linens, and replace with bath blanket.
Set up cosmetics conveniently.
For patients unable to fully bathe themselves, provide appropriate assistance.
Physical Assessment of Oral Cavity
Assessment Areas:
Evaluate for oral problems such as:
Dental caries
Periodontal disease
Other oral issues
Identify actual or potential oral problems nurses can address.
Formulate nursing measures and execute the care plan.
Assessment of the Oral Cavity
Evaluation Components:
Lips
Buccal mucosa
Color and surface of gums
Teeth
Tongue
Hard and soft palates
Oropharynx
Administering Oral Hygiene
Components Include:
Moistening the mouth
Cleaning the mouth
Caring for dentures
Tooth brushing and flossing
Using mouthwashes
Care of Eyes
Procedure Guidelines:
Clean from inner to outer canthus with a wet, warm cloth, cotton ball, or compress.
If the blink reflex is absent, apply artificial tear solution or normal saline every four hours.
Maintain care for eyeglasses, contact lenses, or artificial eyes if applicable.
Ear and Nose Care
Washing Procedures:
Clean external ear using a washcloth-covered finger without using cotton-tipped swabs.
Provide education on hearing aid care when necessary.
Instruct patient to blow nose if both nares are clear.
For crusted secretions, apply warm, moist compress for removal.
Providing Hair Care
Care Guidelines:
Understanding patient’s usual hair and scalp care practices is essential.
Note any past issues with hair/scalp (e.g., dandruff, loss, or baldness).
Manage infestations (e.g., pediculosis, ticks).
Groom and shampoo hair effectively.
Assistance may be required for beard and mustache care or unwanted hair removal.
Head Lice
Understanding Pediculosis:
Lice can be transmitted through direct contact with infested areas or indirectly via clothing, linens, brushes, or combs.
Nail and Foot Care
Assessment Components:
Examine nails for color, shape, intactness, cleanness, and tenderness.
Inquire about a history of nail or foot issues.
Soak nails and feet, provide cleaning and trimming assistance (if appropriate).
Massage feet to enhance relaxation and comfort.
Special care for diabetic foot if necessary.
Perineal Care Useful Tips
Conduct Assessment:
Assess for perineal or vaginal issues and related treatments.
Perform a thorough physical assessment of male and female genitalia.
Ensure care is performed in a straightforward and respectful manner, following protocol.
Cleanse the vaginal and male genitalia with plain soap and water.
Ensuring Bedside Safety
Safety Considerations:
Ensure bed is in lowest position for safety.
Check that bed position is safe for the patient.
Confirm functionality and safety of bed controls (e.g., electrically safe).
Raise side rails when indicated.
Lock wheels or casters of the bed as needed.
Patient Outcome Achievement
Assessment Goals:
Determine the level of patient participation in the hygiene program.
Identify any elimination of, reduction in, or compensation for factors that hinder independent hygiene execution.
Monitor changes related to specific skin problems and patient management of prescribed treatments.