Shurouq Qadose 12/3/2008. Personal hygiene is the self-care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming. Hygiene is a highly personal matter determined by individual values and practices. Factors influencing individual hygienic practices:
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Personal hygiene is the self-care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming. Hygiene is a highly personal matter determined by individual values and practices.
The skin is the largest organ of the body. It serves five major functions:
Assessment of the client’s skin and hygienic practices includes:
(a) A nursing history to determine the client’s skin care practices, self-care abilities, and past or current skin problems
(b) Physical assessment of the skin
(c) Identification of clients at risk for developing skin impairments
Assessment of the client’s self-care abilities determines the amount of nursing assistance and the type of bath best suited for the client. Important considerations include the client’s balance, activity tolerance, coordination, adequate muscle strength, and appropriate joint range of motion, vision, and the client’s preference. Cognition and motivation are also essential.
Physical Assessment of the skin, which involves inspection and palpation.
Self- care Deficit diagnoses are used for clients who have problems performing hygiene care.
Self- care Deficit: Bathing / Hygiene
Self- care Deficit: Dressing/Grooming
Self- care Deficit: Toileting
The nurse and, if appropriate, the client and /or family set outcomes for each nursing diagnosis.
The nurse applies the general guidelines for skin care while providing one of the various types of baths available to clients.
Bathing removes accumulated oil, perspiration, dead skin cells and some bacteria.
Two categories of baths are given to clients: cleaning and therapeutic. Cleaning baths are given chiefly for hygiene purposes and include these types:
Therapeutic bath bathsare given for physical effects, such as to soothe irritated skin or to treat an area such as perineum. Medication may be placed in the water.
Perineal-Genital Care, Perineal-genital care is also referred to as perineal care or pericare.
The feet are essential for ambulation and merit attention even when people are confined to bed.
Assessing it includes the following
Nursing Health History
The nurse determines the client's history of (a) normal nail and foot practices, (b) type of foot wear worn, (c) self-care abilities, (d) presence of risk factors for foot problems, (e) any foot discomfort, and (f) any perceived problems with foot mobility.
Each foot and toe is inspected for shape, size, and presence of lesions and is palpated to assess areas of tenderness, edema, and circulatory status. Normally, the toes are straight and flat. Common foot problems include:-
A callus is a thickened portion of epidermis, a mass of keratotic material. Most calluses are painless and flat and are found on the bottom or side of the foot over a bony prominence, usually caused by pressure from shoes.
Unpleasant odors occur as a result of perspiration and its interaction of microorganisms.
Fissuresor deep grooves frequently occur between the toes as a result of dryness and cracking of the skin.
Ingrown toenail, the growing inward of the nail into the soft tissues around it, most often results from improper nail trimming.
Because of reduced peripheral circulation to the feet, clients with diabetes or peripheral vascular disease are particularly prone to infection if skin breakage occurs.
The most common diagnostic labels with possible related factors are as follows:
*Self care deficit: Hygiene (foot care) R/T
- Visual impairment
- Impaired hand coordination
* Risk for impaired skin integrity R/T
- Poorly fitting shoes
- Impaired skin integrity (trauma, corn)
- Deficient nail or foot care
* Deficient knowledge (diabetic foot care) R/T
- Lack of teaching/learning activities about diabetic foot care
- Newly established medical diagnosis (diabetes)
Planning involves (a) identifying nursing interventions that will help the client maintain or restore healthy foot care practices and (b) establishing desired outcomes for each client.
In Skill lab we explain how to provide foot care.
During the nursing health history, the nurse explores the client’s usual nail care practices, self – care abilities, and any problems associated with them. Physical assessment involves inspection of the nails (shape and texture, nail bed color, and tissues surrounding the nails).
Nursing diagnosing related to nail care and nail problems include:-
*Self care Deficit: Grooming related to impaired vision
*Risk for infection around the nail bed related to
- Impaired skin integrity of cuticles
- Altered peripheral circulation
The nurse identifies measures that will assist the client to develop or maintain healthy nail care practices.
In Skill lab we explain how to provide foot care.
Examples of desired outcomes for nail hygiene include the client being able to:
Demonstrate healthy nail care practices as shown by:
Each tooth has three parts: the crown, the root, and the pulp cavity.
Assessment of the client’s mouth and hygiene practices includes:-
The nurse obtains data about the client’s oral hygiene practices, including dental visits, self care abilities, and past or current mouth problems.
Most common problems affect the teeth.
Tarter is a visible, hard deposit of plaque and dead bacteria that forms at the gum lines.
Gingivitis "red, swollen gingival", bleeding, receding gum lines, and the formation of pockets between the teeth and gums.
Pyorrhea; the teeth are loose and pus is evident when the gums are pressed.
Certain clients are prone to oral problems because of lack of knowledge or the inability to maintain oral hygiene. Among these are seriously ill, confused, comatose, depressed, and dehydrated clients. In addition, people with nasogastric tubes or receiving oxygen are likely to develop dry oral mucous membranes. Clients who have had oral or jaw surgery must have meticulous oral hygiene care to prevent the development of infections.
Clients in long-term care settings are at high risk for oral health problems.
A dry mouth can be aggravated by poor fluid intake, heavy smoking, alcohol use, high salt intake, anxiety, and many medications.
Clients who are receiving or having radiation treatments to the head and neck may have permanent damage to salivary glands
Nursing diagnosing related to problems with oral hygiene and the oral cavity are:
*Self –care deficit: oral hygiene will be used for clients unable to perform oral care independently.
*Impaired oral mucous membrane related to
- Ineffective oral hygiene
- Physical injury or drying effect (mouth breathing, oxygen therapy)
Specific detailed nursing activities taken by the nurse may include the following:
Teach clients about good oral hygiene practices and other measures to prevent tooth decay.
Good oral hygiene includes daily stimulation of the gums, brushing, flushing of the mouth.
Promoting Oral Health through the Life Span
Newborn may have lanugo" fine hair on the body of the fetus’’.
In older adults the hair is generally thinner, grows more slowly and loses its color as a result of aging.
The nurse collect data about usual hair care, self care abilities, history of hair or scalp problems.
Scabies; is a contagious skin infestation by the itch mite. Treatment involves through cleansing of the body with soap and water to remove scales and debris from crusts, and then an application of the scabicide lotion. All bed linens and clothing should be washed in very hot or boiling water.
Hirsutism; the growth of excessive body hair. The cause is not always known.
Dandruff;Often accompanied by itching.
Nursing diagnosing related to hair hygiene and hair and scalp problems include:
* Self – care deficit: Grooming related to
- Activity intolerance
- Pain in upper extremities
- Altered level of consciousness
- Lack of motivation associated with depression
- Scalp laceration
- Insect bite
* Risk for infection related to
- Scalp laceration
- Insect bite
*Disturbed body image related to alopecia
Assessment of the client’s eyes includes:-
- Nursing health history
The nurse obtains data about the client’s eyeglasses or contact lenses, recent examination by an ophthalmologist, and any history of eye problems.
- Physical assessment
Nursing diagnosing related to eye problems may include:
*Self – care deficit (insertion and removal contact lens, cleaning) related to
- Deficient Knowledge
- Impaired vision associated with cataracts
- Improper contact lens hygiene
- Accumulation of secretions on eyelids
*Risk for injury related to
-Prolonged wearing of contact lenses
- Absence of blink reflex associated with unconsciousness
Nursing activities may include:-
Eye Care; dried secretions that have accumulated on the lashes need to be softened and wiped away.
Removing Contact Lenses
Inserting Contact Lenses
General Eye Care; many clients may need to learn specific information about care of the eyes. Some examples follow:
The desired outcomes to evaluate the effectiveness of nursing interventions follow:
Normal ears require minimal hygiene. Clients who have excessive earwax and dependent clients who have hearing aids may require assistance from the nurse.
Cleaning the Ears
Care of Hearing Aids
Nurses usually need not provide special care for the nose, because clients can ordinarily clear nasal secretions by blowing gently into a soft tissue.
Supporting A Hygienic Environment
When providing a comfortable environment it is important to consider the client’s age, severity of illness, and level of activity
Commonly used bed positions
- Fowler’s position (semisitting position in which head of bed is raised to angle of at least 45.)
- Semi- Fowler’s position (head of bed is raised only to 30 angle.)
- Trendelenburg’s position (head of bed is lowered and the foot raised in a straight)
- Reverse Trendelenburg’s position (head of bed raised and the foot lowered)