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Module 8. Personal Hygiene. Personal Hygiene. It is the nurses responsibility to provide the patient with the opportunity for hygiene. HYGIENE. PART 6-A. Bathing. Purpose of Bathing. Cleansing the skin

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Module 8

Personal Hygiene

personal hygiene
Personal Hygiene
  • It is the nurses responsibility to provide the patient with the opportunity for hygiene



purpose of bathing
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 bathing1
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
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
Before You Begin Bathing

It is the Nurses Role to:

  • Assess Your Patient
factors affecting personal hygiene
Factors Affecting Personal Hygiene
  • Cultural / Religious
  • Developmental Stage
  • Mobility
  • Emotional
  • Physical Illness
  • Personal Preference
critical thinking
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 thinking1
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
Types of Baths
  • Cleansing Baths
    • Used to clean the patient
cleansing baths
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 baths1
Cleansing Baths
  • Tub Bath
    • Much easier for bathing and rinsing than in a bed
    • Varies in style
types of baths1
types of baths
  • Shower
    • Used by ambulatory patients who require only minimal assistance
    • Can be used with a shower chair
types of baths2
Types of Baths
  • Therapeutic Baths
    • Bath used for treatment
    • Usually requires a doctor’s order
therapeutic baths
Therapeutic Baths
  • Medicated solutions may be used in bathing
  • Range from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol
back rub
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.
back rub1
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
Guidelines for Bathing
  • Provide Privacy
  • Maintain Safety
  • Maintain warmth
  • Promote the patient’s independence as much as possible
procedure for bathing
Procedure for Bathing
  • Bed Bath
    • Harkreader p. 799-803
  • Tub Bath or Shower
    • Harkreader p. 806-807
part b perineal care
Part B: Perineal Care
  • Hygienic measures

related to the

care of the genitalia.

perineal care
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 care1
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
Perineal Care ProcedureNormal conditions, Discharge, Menses


  • 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
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
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


cont perineal care male
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
  • Procedure 31-2: Harkreader, p. 804-805
perineal care with catheter
Perineal Care with Catheter
  • Follow similar procedure in the male patient.
  • Start at the urethra opening and clean outward.
part c oral hygiene
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.

Why do oral hygiene?

assessment oral hygiene
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


oral hygiene assessment
Oral Hygiene Assessment

c. Abnormalities

  • Loose or missing teeth
  • Swelling and bleeding of gums
  • Unusual mouth odor
  • Pain or stinging in mouth structures
  • Major concerns are:
    • Thoroughness in cleansing
    • Maintaining the condition of the oral mucosa.
  • Procedure for Conscious Patient:
    • Upright position
    • Get out your textbook--Harkreader:

p. 813-814

brushing unconscious patient
Brushing: Unconscious Patient

See performance checklist in syllabus

Safety is of utmost importance

  • Prevent aspiration
    • 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.
    • Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device.
oral hygiene unconscious patient
Oral Hygiene: Unconscious Patient
  • Keeping the mouth open
    • Use a padded tongue blade to open the patients mouth and separate the upper and lower teeth
    • Never 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.

Harkreader p. 814-815

denture care
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 care1
Denture Care
  • Procedure: Harkreader p. 815
  • 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
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
Major Goals in Hair Care

Stimulate Circulation

Prevents Matting

brushing and combing
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
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 – see procedure in Harkreader p. 817-818.
    • “Shampoo in a Bag” or dry shampoos are available
part e shaving
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
  • 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
  • Safety Precautions
  • Electric razors must be used in patients who are at risk for bleeding, confused, or depressed
part f foot and nail care
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
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 care1
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
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
Hearing Aids
  • Check that the device is functioning correctly and clean any body oils or cerumen from the hearing aid
  • Make sure the hearing aid is off and volume is down before insertion
  • Insert hearing aid in ear by pulling earlobe downward while pressing the hearing aid inward
  • Turn on and adjust volume
  • Ask the patient if comfortable and can they hear!
part g eye care
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
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
Part H: Elimination Care
  • Optimum elimination occurs when the patient can use a toilet and eliminate in private.
elimination hygiene
Elimination Hygiene
  • There are various circumstances when a patient will have to use a bedpan or urinal for elimination
elimination hygiene1
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
Elimination Hygiene Types of Devices
  • Bedside commode
  • Urinal
  • Bedpan
    • Regular
    • Orthopedic / fracture
elimination hygiene procedure for using bedpan urinal
Elimination HygieneProcedure for Using Bedpan / Urinal
  • Bring to the bedside
  • Warm the bedpan if it is metal
  • Place bed in appropriate position
  • Fold the top linen back to allow for placement of bedpan or urinal
  • Have patient assist by bending knees and lifting up, place hand under lower back and slip into place.


use of bedpan
Use of Bedpan
  • Turn to the side

and roll back onto

the bedpan

  • 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
Procedure for using bedpan / urinal
  • Raise head of bed to upright sitting position
  • Place call light and toilet within reach. Leave the patient if safe to do so, with side rails up
  • Removal
    • Same manner as offered; hold steady
    • Cover the pan
May need to clean up the patient
  • Note character of contents, chart
  • Clean the pan or urinal
  • Unglove and Wash hands
assisting with a condom catheter
Assisting with a Condom Catheter
  • Purpose:
    • Control incontinence in a male patient without the risk of urinary tract infection
    • Greater comfort to the patient than an indwelling catheter
  • Equipment Needed
    • Condom catheter
    • Soap and water, washcloth, towel
    • Disposable gloves
    • Drainage bag and tubing
condom catheter procedure
Condom Catheter - Procedure
  • Wash hands
  • Place patient in supine position, provide privacy, close door and drape with only penis exposed
  • Apply gloves, Cleanse area with soap and water, dry
  • Assess for any skin breakdown, redness
  • Wrap adhesive spirally around the shaft of the penis
  • Place rolled condom over the penis and unroll over the penis and adhesive, press condom to the strip
Attach drainage bag and

tubing to the catheter

  • Check that tubing is not

twisted and lies over top of leg.

  • Cover the patient, return bed to low position
  • Assess later to be sure that it is secure and not leaking.
  • Empty bag as necessary
  • Remove condom daily to clean the area and assess the skin integrity.
part i antiembolic prevention
Part I: Antiembolic Prevention
  • Patients who are immobile are at risk for stasis of blood in the lower extremities and development of thrombophlebitis.
  • Contraction and relaxation of skeletal muscles helps to move blood through veins toward the heart
  • Valves within the veins prevent the blood from slipping back toward the feet under the influence of gravity.
When circulation slows, clots (thrombi) are more likely to form in those patients with limited activity or incompetent valves.
  • A blood clot can break loose and travel through the blood stream as an embolus leading to potential severe complications.
purpose of antiembolic measures
Purpose of Antiembolic Measures
  • Promote the circulation of blood from the legs back to the heart- increase venous return; decrease venous stasis
  • Support valves within peripheral leg veins so that blood is less likely to pool in a dependent position- decreases dependent edema
  • Prevent thrombus formation
  • Identify conditions that increase the potential for poor circulation and clot formation
    • Post-operative
    • Varicose veins
    • Thrombophlebitis
    • Dehydration
    • Pregnancy
  • Examine lower extremities for poor circulation (Cold, cyanosis), intact skin or ulcerations, distended leg veins, peripheral pulses
  • Assess past history for developing blood clots
interventions preventive measures
Interventions / Preventive Measures
  • 1. Leg and Foot Exercises
  • 2. Antiembolism stockings
  • 3. Sequential Compression Devices
  • 4. Avoiding compression of leg vessels
leg and foot exercises
Leg and Foot Exercises
  • Alternately flex and extend the foot five times.
  • Make circular movement with the feet five times to the left and then repeat to the right.
  • A leg exercise is to bend the knee and draw the foot up to the thigh, and then extend the leg.
  • These exercises can be active – just have the patient do these ever so often on their own;
  • Or passive. It is common to include these range of motion exercises as part of the bath for the immobile patient and at least every 2 hours for the post-operative patient.
antiembolism hose
Antiembolism Hose
  • Antiembolism stockings are elasticized stockings that provide varying degrees of pressure at different areas of the legs.
  • To provide the optimum amount of pressure, the stockings should fit properly and be free of wrinkles.
    • To ensure a proper fit, the patients leg is measured in length and circumference and then refer to the manufacturer’s chart to obtain the correct hose size.

Length Circumference

procedure for applying ted hose do not follow procedure in book
Procedure for Applying TED Hose Do not follow procedure in book
  • Place patient in supine position in bed with leg horizontal for 15 minutes
  • Turn the stocking inside out by placing one hand into sock, holding the toe with the other hand, and pull inside out
  • Place patient’s toe into foot of elastic stocking
application of ted hose
Application of TED Hose
  • Slide remaining stocking over foot, Now the stocking will be right side out

Never allow to make a tight band around the leg.

  • Be sure to smooth stocking having no wrinkles.
antiembolism hose1
Antiembolism Hose
  • Nursing Care:

1. Assessthe lower extremities EVERY SHIFT.

Toe area should have an opening that can be pulled back and the toes and feet assessed for function and any neuro-circulatory problems.

      • Toes should be warm, pink, good capillary refill, can wiggle toes, has feeling in toes with no tingling.

2. Remove ONCE EACH DAY and inspect the feet and toes.

ted hose
TED Hose
  • Document

0830 -- Calf length TED hose applied, skin warm and pink with no lesions. Instructed patient in use, verbalized understanding. Stated they felt good

--------------------------------------J. Ward R.N.

sequential compression devices scd s
Sequential Compression Devices SCD’s
  • Purpose:
    • Enhance venous return by applying intermittent external compression to the tissues and veins similar to the normal physiologic pumping mechanisms of the muscles.
sequential compression device
Sequential Compression Device
  • Disposable plastic sleeve wrapped

around the patients leg and secured with velcro.

  • The sleeves are then connected

to an air pump that alternately inflates and deflates the air tubes in the sleeves. The sleeves are inflated in sequence from the bottom of the leg to the top, helping to move venous blood out of the leg veins and toward the heart.

sequential compression devices
Sequential Compression Devices
  • Place patient in supine position with legs horizontal for 15 minutes.
  • Apply antiembolism hose, if desired
  • Measure circumference of upper thigh
  • Open inflatable sleeve on the flat bed, cotton side up, and place

the patients leg on the sleeve

  • Wrap sleeve snugly around

the leg, fasten with velcro

sequential compression devices1
Sequential Compression Devices
  • Connect tubing on sleeve

to compression controller

  • Turn on ordered settings
  • Remove three times

daily and inspect skin

sequential compression devices2
Sequential Compression Devices
  • Document:

0900 – sequential compression devices placed on both legs set on low. Skin on lower extremities warm, dry, pink. Explained use to patient, verbalized understanding. -----------J. Ward R.N.

0900 – SCD’s in place on both lower extremities. Toes warm and pink, pedal pulses present---------------------------------------------------J. Ward R.N.

avoid compression of legs
Avoid Compression of Legs
  • Watch positioning of the patient’s lower extremities. Do not allow the tubes, equipment to be placed under the legs to compress circulation
  • Place lower extremities on pillows to position correctly.
  • Encourage patient to not cross legs or feet.