10-Jan-21 1

Hygienic Care
• Involves care of:
• Skin, Feet, Nails, Oral and nasal cavities, Teeth, Hair,
Eyes, Ears, Perineal-genital area

10-Jan-21 2
 Types of Hygienic Care
• Early morning care
•Urinal or bedpan
•Washing face and hands
•Oral care
• Morning care
• Usually after breakfast
• Elimination
• Bath or shower
• Perineal care
• Back massage
3
• Oral, nail, and hair care
10-Jan-21
 Factors Influencing Personal Hygiene
• Culture
• Religion
• Environment
• Developmental level
• Health and energy
• Personal preferences

10-Jan-21 4
 Common Skin Problems
• Abrasion
• Excessive dryness
• Ammonia dermatitis
• Acne
• Erythema
• Hirsutism

10-Jan-21 5
 Nursing Process: Assessment
• Nursing history to determine:
•Client’s skin care practices
•Self-care abilities
•Past or current skin problems
• Physical assessment of the skin

10-Jan-21 6
 Nursing Process: Nursing Diagnoses
•Bathing Self-Care Deficit
•Dressing Self-Care Deficit
•Toileting Self-Care Deficit

10-Jan-21 7
 Nursing Process: Planning
• Nurse and, if appropriate, the client and/or family set
outcomes for each nursing diagnosis

• Nurse performs nursing interventions and activities to

achieve the client outcomes

10-Jan-21 8
Nursing Process: Interventions
• Assisting dependent clients with bathing, skin care,
and perineal care
• Providing back massages to promote circulation
• Instructing clients/families about appropriate
hygienic practices and alternative methods to
dressing
• Demonstrating use of assistive equipment and
adaptive activities

10-Jan-21 9
 General Guidelines for Skin Care
 An intact, healthy skin is the body’s first line of defense
 The degree to which the skin protects the underlying tissues
from injury depends on the general health of the cells, the
amount of subcutaneous tissue, and the dryness of the skin
 Moisture in contact with the skin for more than a short time
can result in increased bacterial growth and irritation
 Body odors are caused by resident skin bacteria acting on
body secretions
 Skin sensitivity to irritation & injury varies among
individuals and in accordance with their health
 Agents for skin care have selective actions and purposes

10-Jan-21 10
Purposes of Bathing
1. Removes accumulated oil, perspiration, dead skin cells,
and some bacteria
2. Stimulates circulation
3. Produce a sense of well-being

Categories of Bathing
• Cleaning baths
• Therapeutic baths

10-Jan-21 11
 Cleansing Baths
Complete bed bath, Self-help bed bath, Partial bath,
Bag bath, Towel bath, Tub bath, Shower
• Semidependent: Nurse provides all equipment; positions
client in bed/ bathroom. Client completes bath, except for back &
feet.
• Moderately Dependent: Nurse supplies all equipment;
positions client; washes back, legs, perineum, and all other parts, as
needed. Client can assist.
• Totally Dependent: Client needs complete bath; cannot
assist at all.

10-Jan-21 12
 Therapeutic Baths
• Given for physical effects
• Soothe irritated skin
• Treat a certain area (e.g. the perineum)
• Medication may be placed in the water
• The client remains in the bath for a designated
time, often 20 to 30 minutes. If the client’s back,
chest, and arms are to be treated, these areas need
to be immersed in the solution.
• The bath temperature is generally included in the
order; 37.7°C to 46°C
10-Jan-21 13
Long Term Care Setting
• Today’s nursing world the bath is seen as necessary,
routine task and is often delegated to unlicensed assistive
personnel “UAP”

• Person-Centered Approach
• Becoming less about tasks
• More about people & the relationships between people
• Bathing needs to focus on the experience for the client
rather than the outcomes (i.e. getting a bath or shower)

10-Jan-21 14
 Box 33-2 General
Guidelines for Bathing
Persons with Dementia

10-Jan-21 15
 General Guidelines for Bathing Persons with Dementia

Box 33-2 (continued) General Guidelines for Bathing Persons with Dementia

10-Jan-21 16
 Common Foot Problems
• Calluses
• Corns
• Unpleasant odors
• Plantar warts
• Fissures between the toes
• Fungal infections
• Ingrown toenails

10-Jan-21 17
Nursing Process: Assessment
• Nursing history to determine:
• Normal nail and foot care practices
• Type of footwear worn
• Self-care abilities
• Presence of risk factors for foot problems
• Any foot discomfort
• Any perceived foot problems with foot mobility
• Physical assessment of the feet

10-Jan-21 18
Nursing Process: Nursing Diagnoses
• Bathing Self-Care Deficit (foot care)
• Risk for Impaired Skin Integrity
• Risk for Infection
• Deficient Knowledge (diabetic foot care)

10-Jan-21 19
 Nursing Process: Planning
• Identify nursing interventions that will help the
client maintain or restore healthy foot care
practices
• Establishing desired outcomes for each client

10-Jan-21 20
 Nursing Process: Interventions
• Teaching the client about correct nail and foot care
• Proper footwear
• Wearing the correct size
• Ways to prevent potential foot problems
• Physical assessment of the feet

10-Jan-21 21
 Nails
• Normally present at birth
• Continue to grow throughout life
• Nails tend to be tougher, more brittle, and
some cases thicker as we get older
• Older person may grow slower and be ridged
and grooved

10-Jan-21 22
 Nursing Process: Assessment
• Nursing history to determine:
• Normal nail care practices
• Self-care abilities
• Any problems associated with them
• Physical assessment of the nails

10-Jan-21 23
Nursing Process: Nursing Diagnoses
• Bathing Self-Care Deficit
• Risk for Infection

Nursing Process: Nursing Planning

• Identify measures that will assist the client to
develop or maintain healthy nail care practices
• A schedule of nail care needs to be established

10-Jan-21 24
Nursing Process: Interventions
• Check agency’s policy regarding nail care
• One hand or foot is soaked, if needed, and dried
• Nail is cut or filed straight across beyond the end of the
finger or toe
• Avoid trimming or digging at the lateral corners
• Diabetics should have them filed rather than cut
• Infections around the cuticle or inflammation of the
tissues should be recorded and reported

10-Jan-21 25
Common Problems of the Mouth
• Halitosis
• Glossitis
• Gingivitis
• Periodontal disease
• Reddened or excoriated mucosa
• Excessive dryness of the buccal mucosa
• Dental caries
• Stomatitis
• Parotitis

10-Jan-21 26
Nursing Process: Assessment
• Nursing history to determine:
• Oral hygiene practices
• Dental visits
• Self-Care abilities
• Past or current mouth problems
• Physical assessment of the mouth

Nursing Process: Nursing Diagnoses

• Impaired Oral Mucus Membrane
• Deficient Knowledge
10-Jan-21 27
Nursing Process: Planning
• The nurse and, if appropriate, the client and/or family set
outcomes for each nursing diagnosis
• The nurse performs nursing interventions and activities
to achieve the client outcome

Nursing Process: Interventions

• Daily stimulation of the gums
• Mechanical brushing and flossing of the teeth
• Flushing of the mouth

10-Jan-21 28
 Problems of the Hair
• Dandruff
• Hair loss
• Ticks
• Pediculosis
• Scabies
• Hirsutism

10-Jan-21 29
Nursing Process: Assessment
• Nursing history to determine:
• Usual hair care
• Self-Care abilities
• History of hair or scalp problems
• Conditions known to affect the hair
• Physical assessment of the hair

Nursing Process: Nursing Diagnoses

• Dressing Self-Care Deficit
• Impaired Skin Integrity
• Risk for Infection
•10-Jan-21
Disturbed Body Image 30
Nursing Process: Planning
• The nurse and, if appropriate, the client and/or family
set outcomes for each nursing diagnosis
• The nurse performs nursing interventions and activities
to achieve the client outcome

Nursing Process: Interventions

• Hair needs to be brushed or combed daily

• Washed as needed to keep it clean

10-Jan-21 31
Eyes
• Require no special hygiene
• Lacrimal fluid washes the eye
• Eyelids & eyelashes prevent entrance of foreign particles

Nursing Process: Assessment

• Nursing history to determine:
• Client’s eyeglasses or contact lenses
• Recent examinations by ophthalmologist
• Any history of eye problems and related treatments
• Physical assessment of the eye
10-Jan-21 32
Nursing Process: Nursing Diagnoses
• Risk for Infection
• Risk for Injury

Nursing Process: Planning

• The nurse identifies nursing activities that will assist the client
to maintain the integrity of the eye structures
• Prevent eye injury and infection

Nursing Process: Interventions

• Teaching clients how to insert, clean, and remove contact
lenses
•10-Jan-21
Ways to protect the eyes from injury and strain 33
 Removing hard contact lenses
Figure 33-11 Removing hard contact lenses.

10-Jan-21 34
Ears
• Minimal hygiene
• May have excessive cerumen or wear hearing aids may require
nursing assistance
• Hearing aids are usually removed before surgery

Types of Hearing Aids

• Behind-the-ear open fit
• Behind-the-ear with earmold
• In-the-ear aid
• In-the-canal aid
• Completely-in-the-canal aid
• Body hearing aid
10-Jan-21 35
 Practice Guidelines Bed-Making
• Wash hands thoroughly after handling a client’s bed linen
• Hold soiled linen away from uniform
• Linen for one client is never placed on another client’s
bed
• Place soiled linen directly in a portable hamper or tucked
into a pillow case at the end of the bed for disposal
• Do not shake soiled linen into the air
• Conserve time and energy, make one side of the bed first
• Gather all linen before starting to strip a bed

10-Jan-21 36
Unoccupied Bed
• Closed
• Top sheet, blanket, and bed-spread are drawn up to the top of
the bed and under the pillows
• Open
• Top covers are folded back
• Makes it easier for the client to get in

Changing an Occupied Bed

• Maintain the client in good body alignment
• Move the client gently and smoothly
• Explain the procedure
• Use the bed-making time, like the bed bath time, to assess and
meet the client’s needs
10-Jan-21 37
10-Jan-21 38