Hygiene is the science of health
and its maintenance. Personal
hygiene is the self-care by which
people attend to such functions as
bathing, toileting, general body
hygiene, and grooming.
HYGIENIC CARE
Nurses commonly use the following terms to describe
types of hygienic care.
Early morning care is provided to clients as they
awaken in the morning. This care consists of
providing a urinal or bedpan to the client confined to
bed, washing the face and hands, and giving oral care.
Morning care is often provided after clients have
breakfast, although it may be provided before
breakfast. It usually includes providing for
elimination needs, a bath or shower, perineal care,
back massages, and oral, nail, and hair care. Making
the client’s bed is part of morning care.
Hour of sleep or PM care is provided to
clients before they retire for the night. It
usually involves providing for elimination
needs, washing face and hands, giving oral
care, and giving a back massage.
As-needed (prn) care is provided as required
by the client. For example, a client who is
diaphoretic (sweating profusely) may need
more frequent bathing and a change of
clothes and linen.
HYGIENE
Purpose of Bathing
Cleansing the skin
Removes perspiration, bacteria, which
minimizes skin irritation and reduces
chance of infection
Stimulation of circulation
Warm water and gentle strokes from
distal to proximal increase circulation
and promote venous return
Improve self-image
Promotes feeling of being refreshed,
relaxed
Purpose of Bathing
Reduction of body odors
Especially in axillae and pubic areas
Promotion of Range of Motion
Movement of extremities while
bathing
Nurse’s Advantage
Provides opportunity to develop a
meaningful nurse-patient relationship
Provides opportunity for assessment of
the patient including condition of
patient, psychosocial and learning
needs.
Before You Begin Bathing
It is the Nurses Role to:
Assess Your Patient
Factors Affecting
Personal Hygiene
1. Cultural / Religious
2. Developmental Stage
3. Mobility
4. Emotional
5. Physical Illness
6. Personal Preference
Critical Thinking
Situation:
The Nurse enters Mrs. G’s room to do a
complete bed bath and she says “I do
not want my bath now, I just want to
rest”.
What should the nurse do now?
Critical Thinking
Situation:
The nurse enters Mr. C’s room to do
a complete bed bath and he says “I
do not want my bath now, I just want
to rest”. You notice that his bed is
wet and he was incontinent of urine.
Now what should the nurse do?
Types of Baths
Cleansing Baths
Used to clean the patient
Cleansing Baths
Complete Bed Bath
Nurse baths entire body of dependent
patient in bed
Self-Help Bath
Patients confined to bed are able to bathe
themselves with some help
Partial Bath
Parts of the body are washed by the patient
and some by the nurse
Cleansing Baths
Tub Bath
Much easier for
bathing and rinsing
than in a bed
Varies in style
types of baths
Shower
Used by ambulatory
patients who require
only minimal assistance
Can be used with a
shower chair
Types of Baths
Therapeutic Baths
Bath used for treatment
Usually requires a doctor’s
order
Therapeutic Baths
Medicated solutions may be used in
bathing
Range from warm water baths,
cool water baths, cornstarch,
oatmeal, Aveno, alcohol
Back Rub
May be performed after drying off
the back during the bath.
Position of Patient: Prone or side-lying
Expose only the back, shoulders, upper arms.
Cover remainder of body
Lay towel alongside back
Warm lotion in your hands—still explain that
it may be cool and wet.
TYPES OF BACK RUB
[Link]- a form of massage involving a
circular stroking movement with the palm of
the hand.
[Link]- a massage technique that
involves kneading the body.
[Link]- rapid and repeated striking
of the body as a technique in massage.
Back Rub
Start in the sacral area, moving up the back.
Massage in a circular motion over the
scapula.
Move upward to shoulders, massage over the
scapula
Continue in one smooth stroke to upper arms
and laterally along side of back down to iliac
crests.
Do NOT allow your hands to leave the
patient’s skin
End by telling your patient that you are
finished
Guidelines for Bathing
1. Provide Privacy
2. Maintain Safety
3. Maintain warmth
4. Promote the patient’s independence
as much as possible
Part A: Perineal Care
Hygienic measures
related to the
care of the genitalia.
Perineal Care
Can be embarrassing for the nurse and
the patient.
Should not be overlooked because of
embarrassment.
If the patient can do it themselves—let
them.
Hand them the washcloth and ask if
they would like to “finish their bath.”
Perineal Care
Those patients who may need the
nurses assistance:
Vaginal or urethral discharge
Skin irritation
Catheter
Surgical dressings
Incontinent of urine or feces
Perineal Care Procedure
Normal conditions, Discharge, Menses
Women
Wipe labia majora (outer) from front to back in
downward motion using clean surface of wash cloth for
each swipe.
Wipe labia minora (inner) from front to back in
downward motion using clean surface of wash cloth for
each swipe
Wipe down the center of the meatus from front to
back. If catheter in place, clean around catheter in
circular fashion, using clean surface of wash cloth for
each swipe.
Wash inner thighs from proximal to distal
Cont. Female Perineal Care
Rinse with warm to tepid water using pour from peri-
bottle if available.
Pat dry using clean towel in same order as wash
Remove bedpan if one is used
Verbalize turning patient on side to wash anal area
from front to back and dry
Perineal Care - Male
Retract foreskin of penis if uncircumcised
Wash around the urinary meatus in a circular motion, using
clean surface of washcloth for each stroke and around the
head of penis in circular motion
Wash down shaft of penis toward the thighs changing
washcloth position with each stroke
Wash scrotum – front to back
Wash inner thighs
continued
Cont. Perineal Care - Male
Rinse with clean wash cloth or peri-bottle using warm
water in same sequence as the wash
Dry with clean towel in the same sequence
Replace foreskin, as appropriate
Turn patient on side to wash anus from front to back
and dry
Perineal Care with Catheter
Follow similar
procedure in the male
patient.
Start at the urethra
opening and clean
outward.
Part C: Oral Hygiene
Maintains the healthy state of the mouth
Cleanses teeth of food particles, plaque, and
bacteria
Massages the gums
Relieves discomfort from unpleasant odors and
tastes.
Refreshes the mouth and gives a sense of
well-being and thus can stimulate appetite.
Assessment: Oral Hygiene
a. Frequency
Depends on the condition of the patient’s mouth.
Some patient’s with dry mouth or lips need care
every 2 hours.
Usually done twice a day or after each meal
b. Assistance Needed
Does the patient need assistance to do oral care
*The nurse can help patients maintain good oral
hygiene by:
1. Teaching them correct techniques
2. Actually performing for weakened or disabled
patients.
Oral Hygiene
Assessment
c. Abnormalities
Loose or missing teeth
Swelling and bleeding of gums
Unusual mouth odor
Pain or stinging in mouth structures
Brushing
Major concerns are:
Thoroughness in cleansing
Maintaining the condition of the oral
mucosa.
Procedure for Conscious Patient:
Upright position
Brushing: Unconscious Patient
See performance checklist in syllabus
Safety is of utmost importance
Prevent aspiration
1. Positioning—lateral position with head turned to
the side or side-lying. Position back of head on a
pillow so that the face tips forward and fluid/
secretions will flow out of the mouth, not back
into the throat.
2. Place a bulb syringe or suction machine with
suction equipment nearby.
Oral Hygiene: Unconscious Patient
Keeping the mouth open
1. Use a padded tongue blade to open the
patients mouth and separate the upper and
lower teeth
[Link] place your hand in the patient’s
mouth or open with your fingers. Oral
stimulation often causes the biting –down
reflex and serious injuries can occur.
Denture Care
Clean dentures as frequently as natural teeth
Dentures are the patient’s personal property
and should be handled with care because they
can be easily broken.
Care:
Remove before going to bed – allows gums
to rest and prevents buildup of bacteria.
Store in a labeled container covered with
water or denture cleaner if available
Denture Care
Tips to remember:
Use gauze squares or washcloth
to grasp front of dentures to
prevent from slipping
Place wash cloth or paper towel in
sink to line it while you are
cleaning the dentures
Work close to the bottom of the
sink in case you drop them.
Use tepid water
Part D: Hair Care
A person’s appearance and
feeling of well-being often
depends on the way their
hair looks and feels
Major Goals in Hair Care
Stimulate Circulation
Prevents Matting
Brushing and Combing
Keeps hair clean and distributes oil evenly
along the hair shaft
Combing styles hair and prevents from
tangling
Assessment while brushing
Scalp lesions, abrasions
Dandruff
Parasitic infestations
Quality of hair
Appearance
Hair Care: Shampooing
Depends on:
Personal preference of the patient, does not have
to occur every day with hygiene
Condition of the hair
Ways to Shampoo
If patient can get up and into a shower or sink,
use a hand held nozzle
If patient can not get up, place on stretcher and
roll to a shower area
If patient is unable to be moved, may shampoo in
the bed
“Shampoo in a Bag” or dry shampoos are available
Part E: Shaving
Improves self-esteem and emotional
needs of the patient
Usually done after the bath or shampoo
Assessment:
Skin for elevated moles, warts,
Rashes, patchy skin lesions, or
pustules
Shaving
Provide Safety
When using a razor blade, the
skin must be softened to
prevent pulling, scraping, or
cutting
Place a warm wash cloth over
area and then apply some gel,
cream, foam.
Hold the razor at a 450 angle
Pull the skin taut
Shave in the direction of hair
growth
Shaving
Safety Precautions
Electric razors must be used in
patients who are at risk for
bleeding, confused, or
depressed
Part F: Foot and Nail Care
Usually part of the bath
Purpose:
Eliminate sources of infection and
decrease odors
Assessment:
Color, shape length, texture of nails
Condition of skin around nails and between
toes and fingers – swollen, inflamed,
callused, lesions, temperature
Foot and Nail Care
Soak the hand or foot to
soften the cuticles
Thoroughly cleanse and dry
Trim the nails ONLY if you
have permission or it is
allowed at that institution.
Most institutions do not
allow nurses to trim the
nails.
Foot and Nail Care
Teach patient and family that nails should be
cut – straight across. May need to get a
referral if no one available to cut nails.
Show close attention to the feet and nails of
the diabetic patient and the elderly
** If feet and nails are in bad condition–
notify doctor so a consult can be ordered
with a podiatrist
Part G: Ear Care
Usually requires minimal care
Cleanse the external auricle with
washcloth when bathing
Avoid insertion of objects into the ear
Hearing Aids
a. Check that the device is functioning correctly and clean any
body oils or cerumen from the hearing aid
b. Make sure the hearing aid is off and volume is down before
insertion
c. Insert hearing aid in ear by pulling earlobe downward while
pressing the hearing aid inward
d. Turn on and adjust volume
e. Ask the patient if comfortable and can they hear!
Part G: Eye Care
Assessment:
Abnormal lesions
Discharge
Tearing
Presence of any infection
Use of Visual Aids (contacts, glasses)
Ask when patient needs to use these
devices
Eye Care
Wash around the eyes with a warm moist
washcloth with warm water—NO SOAP!
Clean from the inner canthus to the outer
canthus of the eye. Pay special attention to
the inner canthus.
Provide special care for the eyes of
unconscious patients.
May need to tape the eye lids shut if
unable to blink and protect own eyes
Part H: Elimination Care
Optimum elimination occurs
when the patient can use a
toilet and eliminate in
private.
Elimination Hygiene
There are various circumstances when a
patient will have to use a bedpan or
urinal for elimination
Elimination Hygiene
Assist patient’s in a respectful way
Assist to be comfortable especially
when using a bed pan
Provide privacy
Do not hurry
Elimination Hygiene
Types of Devices
Bedside commode
Urinal
Bedpan
Regular
Orthopedic / fracture
Elimination Hygiene
Procedure for Using Bedpan / Urinal
1. Bring to the bedside
2. Warm the bedpan if it is metal
3. Place bed in appropriate position
4. Fold the top linen back to allow for
placement of bedpan or urinal
5. Have patient assist by bending knees
and lifting up, place hand under lower
back and slip into place.
or
Use of Bedpan
6. Turn to the side
and roll back onto
the bedpan
7. Check placement
Bedpan - when the buttocks rest on the
rounded edge of the pan
Urinal – penis is inside, urinal rests on the
bed
Procedure for using bedpan / urinal
8. Raise head of bed to upright sitting
position
9. Place call light and toilet within reach.
Leave the patient if safe to do so,
with side rails up
10. Removal
• Same manner as offered; hold
steady
• Cover the pan
THANK Y O U…….
