Nursing Caring Skills

GNU 132
2/6/16
Unit XI – Client Hygiene;
and Skin Care

Lecturer: Mm Mary Reside

06/26/2020
 Objectives
• Describe and explain the guidelines used for
providing hygiene for a client; or assisting
them with their personal hygiene.
• Describe and demonstrate principles of
privacy, dignity, communication, infection
control and safe mobility when providing or
assisting with a client’s hygiene care.

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 Objectives
• Explain how assisting a client with their
personal hygiene provides opportunity for an
extensive assessment of their health status.
• Describe and demonstrate providing a
complete bed bath as for an unconscious
patient.

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 Objectives
• Describe and demonstrate the precautions
used to minimise transmission of infection
during hygiene care
• Describe and demonstrate providing
appropriate assistance with a client’s personal
hygiene care for specialised areas: mouth,
eyes, hair, perineum, hands and feet.

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 Objectives
• Explain why skin care is important
• Describe nursing interventions to provide
skin care for the bed-bound client.

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 Assisting Client Hygiene
Personal hygiene for nurses and for clients is
especially important for these reasons:
1. Personal dignity and self-esteem
2. Infection control
3. Skin care and protection

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 Client hygiene:
dignity and self-esteem
When assisting a client with personal hygiene the
nurse should promote their Self-esteem.
This is done by such things as:
 Prepare the client; explain what you are doing and why.
(Even if the client is unconscious they may still be able to
hear you)
 Ensure physical privacy (use a screen),
 Check and follow client preferences (frequency of
and time for washing; type of assistance required)
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 Client hygiene; infection control
Personal and environmental hygiene is
important in maintaining infection control. For
this reason:
 Use a clean basin of fresh water for each client.
 Towels and washing cloths should not be shared.
 Clean all soiled areas of the skin and change
soiled linen.
 Avoid contact with body fluids.
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 Client hygiene:
body mechanics and bed mobility
The nurse should remember the principles of
Body Mechanics when assisting the client in order
to protect her/himself.
A client needing assistance with hygiene because
of limited mobility will need assistance with
Range Of Motion exercises.
During all client mobility especial care is needed
for I.V. lines, catheters, oxygen tubing, drains &
wounds .
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 Client hygiene and assessment
Assisting a client with their personal hygiene
gives the nurse opportunity to:
 assess all areas of the client’s skin
 assess the client’s mobility and strength and
their tolerance of movement and exercise.
 have private conversation with the client
about their health status and the effect of the
nursing interventions that have been given.
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 “Bed baths”
‘Bed bath’ is the term used for hygiene care for
a dependent (unable to get out of bed) client.
Types of Bed baths include:
1. Complete bed bath
2. Self-help bed bath
3. Partial bed bath.

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 1. Complete bed bath: process
The nurse (and/or family) washes and dries the
whole body of a dependent client in bed.
1) Prepare the equipment
1) Basin of clean warm water
2) Soap
3) Washing cloths and towels
4) Drapes to keep the client covered. Only
uncover the part of the client that you are
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washing and drying to maintain their dignity.
 1. Complete bed bath: process
The nurse (and/or family) washes and dries
the whole body of a dependent client in bed.
2) Prepare the client and the environment.
2) Explain to the client and family what you are
doing.
3) Bring screen/s to ensure privacy and dignity.

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 1. Complete bed bath: process
3. Wash and dry the client’s face and neck.
4. Wash and dry the arms and hands
5. Wash and dry the client’s chest and abdomen
6. Wash and dry the client’s legs and feet
7. Wash and dry the client’s back and then
perineum.
8. Assist the client into clean clothes and a
comfortable position.
9. Record in the patient file i) assessment data,
ii) the type of bath, iii) the type of exercises
done, iv) any other data.
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 2. Self-help bed bath: process
• The client must stay in bed but is able to
wash him/herself with the nurse and/or
family helping to wash only the back and
perhaps the feet.
1) Prepare the equipment
1) Basin of clean warm water
2) Soap
3) Washing cloths and towels
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 2. Self-help bed bath: process
2) Prepare the client and the environment.
2) Explain to the client and family what you are
doing.
3) Bring screen/s to ensure privacy and dignity.
3) Use this opportunity to:
2) Assess the client’s skin, and mobility
3) Have private conversation with the client
about their well being and the effects of care.
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 3. Partial bed bath
• Only the parts of the client’s body that may
cause discomfort or bad smell or lack of self
esteem or poor health are washed.
• This usually includes:
Face and hands
Axilla
Perineum
Any areas soiled with body fluids.
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 3. Partial bed bath: process
1) Prepare the client and the environment.
1) Explain to the client and family what you are
doing.
2) Bring screen/s to ensure privacy and dignity.
2) Use this opportunity to:
1) Assess the client’s skin, and mobility
2) Have private conversation with the client
about their well being and the effects of care.
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 Assisting with Oral hygiene

1. ASSESS ORAL HEALTH: =>Pink, moist

and intact tongue and oral mucosa (lining of the
mouth). Lips moist and intact. No debris or
plaque on teeth; or teeth decay.

2. Set regular oral care routine e.g. after meals

and at bedtime.
3. At set times clean all surfaces of teeth with a
soft toothbrush and fluoride toothpaste.
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 Assisting with Oral hygiene

4. Rinse mouth with mouthwash of warm water

and salt or baking soda (1/2 teaspoon to 500 mls
water).
5. If the client has dentures (false teeth) these are
carefully removed and cleaned as per the oral care
routine,
6. Inspect all surfaces of oral cavity each shift,
including colour and moistness of oral mucosa,
gums and lips; look for presence of debris, odour
and lesions.
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 Assisting with personal hygiene: Eyes
ASSESS EYE HEALTH: should be clear
conjuctiva and white sclera with no inflammation;
no dried secretions on eyelashes or eyelids.
At least daily, clean eyes with sterile gauze that is
moistened with saline or sterile water.
Gently soften and loosen any dried secretions.
Wipe from inner canthus to outer canthus to outer
canthus to prevent the debris from draining into the
nasolacrimal duct.
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 Assisting with personal hygiene: Eyes
• If the client has no corneal reflex (blink reflex).
Or cannot close their eyelid completely there
is risk of drying and irritation of the cornea.
• Administer lubricating eye drops as prescribed.
• An eye patch may be placed over the eye/s for
protection.
If the client has contact lenses, the nurse needs to
check and give the specialised care needed for
these.
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Assisting with personal hygiene: Hair

Hair may need shampooing and /or oiling to

prevent it becoming tangled and a source of
infection.
Shampooing or massaging oil into the scalp can
 Stimulate blood circulation to the scalp
through massage
 Clean the hair and increase the clients’ well-
being.
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 Assisting with personal hygiene: Hair

Check scalp for: Dandruff (scaling of scalp);

Ticks, Pediculosis (lice) or Scabies.
Position (supine or semi-fowlers) and prepare the
client.
Comb hair gently and remove tangles
gradually.
When shampooing or oiling hair be careful
that the fluid does not go into the eyes or ears.
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 Assisting with personal hygiene:
Perineum
Prepare and position the client. (supine then Sims
/lateral)
Screen the area for privacy.
Drape the client and clean the upper thighs.
Inspect the perineal area for inflammation, lesions or
discharge.
Wearing gloves, wash and dry the perineal area.
Clean between the buttocks.
Leave the client dressed or covered with sheets and in a
comfortable position.
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 Assisting with personal hygiene:
hands and feet
• These areas may have been exposed to extra
soiling or dirt so may require additional washing.
• A screen is not usually required.
• Use a basin of fresh water.
• Wash and dry the hands first, then the feet.
• Check that nails are clean and not too long.
• Observe temperature, colour and sensation.
• Observe for any lesions.
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 Client hygiene: Skin Care
• The skin is the largest organ in the body.
• Its main functions include:
• Helps regulate body temperature
• Protects underlying body tissues
• Secretes sebum
• Contains sensory nerve receptors that detect
things which may cause damage to the body.

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 Client hygiene: skin care
• When assisting a client with their personal
hygiene gives the nurse should assess all areas
of the skin for:
• Colour
• Texture
• Turgour (fullness and moistness of the tissues below
• Temperature the skin surface).
• Intactness
• Lesions
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 Client hygiene:
skin care
Clients with limited mobility
• have difficulty doing their own hygiene care
• are at greater risk for damage to the skin.
Assisting a client with their personal hygiene
gives the nurse opportunity to:
 assess all areas of the client’s skin
 check that the bed linen is smooth and clean.
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 Skin care; and preventing damage
Damage to the skin may be caused by
Internal and/or External factors.

• Internal factors include: malnutrition;

dehydration; electrolyte & fluid imbalance
• External factors include: unrelieved pressure;
wounds; moisture (maceration); shear (friction
of skin against bed linen or chair); chemical
damage; burns.
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 Pressure areas
At risk (‘pressure’) areas especially include
‘bony prominences’ e.g.
• shoulders,
• hips,
• sacrum,
• Ankles and heels

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 Pressure areas
Pressure areas are protected through Care
Interventions; and Patient positioning
Care interventions:
 observe for redness or darker colour of skin
in at-risk areas.
 Gently massage those areas of skin with a
body lotion or cream.
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 Regularly reposition the client
• A schedule can be made to turn the client
throughout his "awake" hours. The patient
should be rotated through four positions
(unless a particular position is
contraindicated).
1. Prone
2. Supine
3. Left Sim’s
4. Right Sim’s
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 Prone position

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 Supine position

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 Sim’s position

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 Regularly reposition the client
• Plan a schedule and follow it. Record the position
change each time to ensure that all positions are
used.
E.g. 1000-- Prone position
1200--Left Sim's position
1400--Supine position
1600--Right Sim's position
1800--Prone position
• If the client has developed pressure sores (‘decubitus
ulcers’) position changing should continue through
all of the 24 hour period
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 Summary
The nurse may need to help clients to maintain
their personal hygiene as part of the health
care plan.
When assisting with client hygiene, the
principles of (i) dignity, (ii) respect, (iii)
communication, (iv) infection control and
(v) safe mobility must be practiced.

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 Summary
There are three types of bed-baths:
Complete bed bath
Self-help
Partial
The client may need additional care with their
personal hygiene for their mouth, eyes, hair,
perineum, hands or feet.

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 Summary
Skin care is especially required for the client
with limited mobility.
The areas at greatest risk for skin breakdown
are the areas where bones are prominent.
Pressure sores are prevented by:
Observation and gentle massage to those areas
Regular position changes.

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 References
• Kozier, B., Erb, G., Blais, K. & Wilkinson, J.M.
Fundamentals of Nursing. 1995(5th Ed). Addison
Wesley Publishing Co. US

• Turley, S. Medical Language. 2011 (2nd Ed.)

Pearson Education Ltd. US.

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 You can get copies of these
power-point slides at Imani
Stationery.

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 Asanteni kwa
usikivu na ushirikiano

Thank you for your

attention and
participation.

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