AIM: To comprehend individual hygiene

requirements.
INDIVIDUAL HYGIENE LEARNING OBJECTIVES:
PRACTICES Understanding the concept of hygiene
Explaining the skin and its appendages
Understanding the need for oral care
Understanding the need for hair care
Understanding the need for foot care
Banu
Understanding the need for perineal care
Akdeniz University, Faculty of Nursing, Fundamentals of Nursing Understanding the need for body bath
Department

CONTENTS Hygiene: It is the science of protecting and improving the

health of the individual/society.
Hygiene Individual Hygiene: It includes self-care practices
Individual hygiene aimed at protecting and improving the health of the individual.
The structure and functions of the skin
Normal features of the skin Individual Hygiene Practices:
Features of the skin according to developmental periods * Oral care
Evaluation of the skin * Eye, ear and nose care
Common skin problems * Hand-face-hair care
Risky situations in terms of skin health * Perineal care
General principles in skin care * Foot care
Ethical principles in skin care * Body care
Individual hygiene requirements
 SKIN AND FUNCTIONS OF SKIN
ADDITIONS
largest organ of our body 1. Regulates body temperature
2. Prevents water loss from the
Surface area: 1.5-2.5 square
body by diffusionblood stores
meters
3. Protects the body from external
Weight: 4.5-5 kg factors, creates a protective
Makes up 7% of total body cover
weight 4. Contains cells related to the
immune system
Waterproof 5. Allows us to perceive sensations
Flexible related to the skin
WashableSoft yet durable 6. Provides substance absorption
and excretion
7. Substance syntheses (e.g.
vitamin D)

LAYERS OF THE SKIN

1. Epidermis Composed of keratinized epithelial cells
2. Dermis
Located under the epidermis No blood flow
Composed of fibrous connective
tissue Thicker on palms and soles (0.8-1.4mm)
It is durable
Blood flow is rich
Subcutaneous/Hypode
rmis
Located under the dermis
It consists of subcutaneous
adipose tissue and connective
tissue.
Connects skin to underlying
tissues
 CELL TYPES IN THE EPIDERMIS CELL TYPES IN THE EPIDERMIS
1. KERATIN CELLS :

Makes up 90% of epidermal cells

It is produced in the lowest layer of the epidermis, as new cells are
produced, they move towards the upper layers and lose their
vitality.
Millions are excreted through the skin every day
Produces keratin, a fibrous protein
Keratin protects the skin and underlying tissues against tearing,
germs, heat and chemicals
It also secretes granules that form a waterproof layer.
These granules reduce the water inflow and outflow into the body
and prevent the entry of foreign substances.

CELL TYPES IN THE EPIDERMIS CELL TYPES IN THE EPIDERMIS

3. LANGERHANS CELLS:
2. MELANOCYTE CELLS:
Makes up 1-4% of epidermal
cells
Makes up 8% of epidermal cells
Produced in the red bone
Synthesizes the melanin pigment
marrow and transferred to the
- Melanin; skin
- It is a yellow-red or brown-black pigment Also known as intraepidermal
- Gives color to the skin macrophage cells
Melanocyte cells transfer melanin to keratin cells, thus protecting They initiate an immune
the skin from ultraviolet rays. response against microbes that
However, they themselves are very sensitive to UV rays. enter the skin
Langerhans cells are very
sensitive to UV rays
CELL TYPES IN THE EPIDERMIS
4. MERKEL CELLS:
They are the least common
epidermal cells
It has a pointed appearance
It is located in the lowest layer
of the epidermis and thus
connects with nerve cells in the
dermis
Acts as a sensory receptor for
the sense of touch
SUBCUTAN/HYPODERMIS
Composed of loose
connective tissue and
adipose tissue
- Adipose tissue is an
important energy store
- Provides insulation
Contains the major blood
vessels of the skin
Average thickness 1-2 mm
Composed of dense irregular
connective tissue
Connects epidermis layer to
hypodermis layer
Blood and lymph vessels
nerves sensory receptors
sweat glands
sebaceous glands
hair follicle
erector pili muscle
Normal Characteristics of the Skin
Color according to body parts (dark brown, dark pink, light
pink) varies,
Tissue turgor (elasticity and strength) is good; straight it is
soft and flexible,
Its integrity is intact (no peeling etc.),
It is warm to the touch,
There is no cyanosis, jaundice or pallor.
The characteristics of the skin according to the developmental
periods;
If the structure of the skin is examined, it is seen that each
period has its own characteristics in terms of skin care.
- Newborn baby; skin is not fully developed. The Evaluation of the skin;
epidermis and dermis are loosely connected to each
other, the skin is rather thin. Skin integrity can be
easily damaged and infected.
- In the pre-school period; skin layers are more firmly Developmental changes
attached to each other, more resistant to irritations and The skin is evaluated using skin inspection and
infections. Increased movement is associated with the
risk of injury. It is the most suitable age group for palpation skills in terms of features such as color,
hygiene education. turgor, tone, temperature and moisture.
- During adolescence; sebum secretion and the work of
sweat glands increase, hair growth begins. In the presence of lesion; color, localization,
- In adulthood; On the other hand, skin health depends structure, size and borders are determined.
on hygienic practices and environmental factors.
- Elderly individual; wrinkles, sagging and color changes
are seen on the skin, the skin is dry.

Skin Lesions;
Skin Lesions;

Macule: Non-palpable color Papule; A firm bump on the

changes less than 1 cm in
the skin (eg, freckle, skin smaller than 0.5 cm that
petechiae). can be palpated (eg, raised
mole)
 Skin Lesions;
Skin Lesions;

Nodule; Harder and Tumor; Solid mass larger than 1-2

cm that may extend into the
deeper raised mass
subcutaneous tissue (e.g.
(eg, wart) than papule
epithelioma = cancer that develops
in epithelial cells.

Skin Lesions; Skin Lesions;

Wheal; Raised area with Vesicle; Circular swelling Bullous; Caused by

irregular borders or superficial,
enlargement of the
less than 0.5 cm filled vesicle, a serous fluid-
localized edema (e.g. mosquito
with serous fluid (eg; filled swelling (eg; as a
bite) result of traumas such as
chickenpox, herpes) shoe hits, epidermis burns)
 Skin Lesions;
Skin Lesions;

Pustule; The pus is the Ulcer; Deep loss of the

vesicle (eg; acne) skin surface that can
extend to the dermis of
various sizes, often
bleeding and scarring

Skin Lesions; Skin Lesions;

Atrophy; Thinning of the Ecchymosis; Color

skin in various sizes as a
result of skin loss,
wrinkled, shiny and
translucent skin (various
sizes)
change caused by cracks in
the capillaries under the
skin, bruise.
Frequently Encountered Problems in
the Skin;
Xerosis (extreme dryness of the skin),
Abrasion (opening of the epidermis layer by friction
and scraping),contact dermatitis (scaly, red, itchy
condition),
Hirsutism (excessive facial and body hair growth,
especially in women)
Risky Conditions for Skin Health;
Inactivity,
Sensory change,
Changes in nutrition and fluid intake,
Presence of bodily secretions and wastes on
the skin,change in blood circulation,
Mechanical tools (plaster, bandage,
dressing, etc.)

General Principles in Skin Care General Principles in Skin Care

Intact skin forms the body's first line of defense, Body odor occurs when persistent bacteria of the
The protection of the skin from injuries to the skin settle in body secretions (deodorants,
underlying tissues depends on the healthy cells, antiperspirants),
the amount of subcutaneous tissue and the The susceptibility of the skin to injury or irritation
characteristics of the skin (number of baths, differs between individuals, and skin sensitivity is
lotion-cream, not using alcohol for massage), related to the individual's general health status
Keeping the skin wet for a while causes skin (infant/old, very thin/obese)
irritation and reproduction of microorganisms The substances used in skin care (soap, shampoo,
(sweat, urine, faeces irritation), lotion, etc.) should be selected in accordance with
their effects and intended use.
Ethical Principles to Consider in Hygienic CAFE BREAK
Practices

Informing and getting permission,

Respect for human dignity (beliefs, values, habits),

Respect for privacy,

Benefit,

Do no harm,

Maintain/enhance independence.

ORAL CARE
Oral care is done to clean and revitalize the
mouth, teeth and gums. In this way, infection
and wound formation are prevented, and a
sense of cleanliness and comfort is
provided.When oral care is not taken care of,
problems such as bad breath and gum disease
ORAL CARE
may occur.

36
 MOUTH ANATOMY OF THE MOUTH
Oral/buccal cavity;
The mouth (oral cavity) is the
Lips surrounding the open part of the mouth,
initial part of the digestive tract.
Cheeks,
The oral cavity is lined with
mucous membrane. Tongue and tongue muscles,

The mucous membrane is an It consists of hard and soft palate, teeth and gums.
epithelial layer that performs the
functions of protection,
secretion and absorption.

Oral mucosa is normally pale

pink in color and moist.

37 38

ANATOMY OF THE MOUTH ANATOMY OF THE MOUTH

Lips: They are soft formations made of muscle and membrane
surrounding the mouth cleft. Its blood supply, lymphatic
vessels and sensory nerves are quite dense. The free edges of
the lips vary in thickness and size from individual to individual
and are red-pink in color.
Cheeks: The outer surface is skin, the inner surface is covered
with a stratified flat, non-keratinized epithelium.
Palate: The hard palate forms the anterior 2/3 of the roof of the
mouth, while the soft palate forms the posterior 1/3 of the roof
of the mouth.
Tongue and tongue muscles: It is a mobile organ located on
the floor of the mouth, which completely fills the oral cavity at
rest, covered with mucous, made of striated muscles. The
tongue plays a role in swallowing, speaking, chewing, cleaning
the mouth and tasting functions. In the oral cavity, there are
various muscle groups that allow the tongue to change shape,
attach to neighboring structures and escape back.
Teeth and gums: Teeth that provide mechanical breakdown of
ingested nutrients are hard and sharp formations located in the
dental cavities of the maxilla and mandible.

39 40
The structure of the tooth Cavitas Oris

41

Risk Factors Associated with Intraoral Risk Factors Associated with Intraoral
Problems-I Problems-II
Patients with paralysis, weakness or limitations associated Patients using chemotherapy drugs (It stops the division
with the inability to use their upper extremities, of cancerous cells, including in healthy cells. Ulcers and
Dehydrated patients who cannot be fed orally (It causes inflammations may develop.),
drying and sensitization of the mucosa, causes Patients treated with radiotherapy to the head and neck
accumulation of secretions on the tongue and gums), (reduces salivary flow and lowers salivary pH. This may
Oral-breathing patients fed with a nasogastric tube or cause stomatitis and calculus),
administered oxygen therapy (It causes drying of the Patients who have had oral surgery, oral trauma, or have
mucosa), an endotracheal tube or airway (may cause swelling,
ulceration, inflammation and bleeding in the mouth.)

43 44
 Risk Factors Associated with Intraoral Common Oral Problems
Problems-III
Dental caries

Patients receiving immunosuppressive therapy Record

(Inflammation and gingivitis predispose.) Periodontal disease

Diabetic patients (may cause dry mouth, Tartargin

gingivitis, tooth and gum diseases and tooth loss) Givitis

Halitosis
Stomatitis
Kellosis

45 46

Tooth Decay: Caries is the

irreversible destruction of the main
structure of the tooth enamel by acidic
by-products formed by the bacteria
existing in our oral flora, as a result of
feeding with food residues.
Plaque: It is a sticky and colorless bacterial film that
accumulates on the teeth.
Halitosis: It is bad breath that often develops due to poor
Tartargin: It is the accumulation of dead bacteria in the
formed plaques. They are soft at first. But they quickly turn
into hard sheets. They cannot be removed from the teeth by
brushing.
Periodontal disease/Pyorrhea: These are inflammatory
diseases that affect the gums and other tissues that support
the teeth. The main symptoms are: bleeding gums, red,
swollen and sensitive gums, plaque, tooth loss, halitosis,
inflammatory discharge between teeth and gums, gingival
recession, etc.

oral hygiene and periodontal disease. Gingivitis: Inflammation of the tissues surrounding the

Kellosis: It is the ulceration of the lips that is usually seen teeth.

due to vitamin B deficiency.

47 48
 Oral care includes three main applications.
Stomatitis: It is the inflammation of the oral mucosa
that develops due to bacteria, viruses, mechanical
trauma, irritation, vitamin deficiency, use of Rinsing the mouth with plenty of water,
chemotherapy drugs or systemic infections.
Brushing teeth,

Using dental floss.

49 50

Brushing the Teeth Process: USE OF TOOTH BRUSH

1. First one side of the mouth (right
upper jaw), from the upper back
teeth to the midline of the jaw, Keeping your toothbrush inclined at 45
2. The other side of the mouth (left
upper jaw), from the upper back degrees, a sweeping motion is made
teeth to the midline of the jaw, with oval movements outward from the
3. One side of the mouth (right lower
jaw), from the lower posterior teeth
gingiva.
to the midline of the jaw, After brushing the front and inner
4. The other side of the mouth (left
lower jaw), from the lower back surfaces of your teeth, complete your
teeth to the midline of the jaw, brushing by brushing the chewing
5. Right buccal mucosa
surface.
6. Left cheek mucosa
7. Palate By brushing your tongue, you can prevent
8. Over tongue plaque and bad breath on your tongue.

52
Oral care
Brush the tongue surface with soft
movements (avoid stimulating the
gag reflex).
The mouth is rinsed with a little
water and the kidney is taken out of
the tub.
The process is repeated until the
mouth is cleaned.
53
Flossing
Cut at least 2 pieces of floss,
approximately 30 cm, and make sure
that some of it remains outside after
wrapping it around two fingers.
Brush gently by following the contours of
your teeth.
Take care to clean that area by placing the
floss a little under the gum, and do not
put excessive pressure on your gums
while doing this.
55
Oral care
It is provided to clean between the teeth by using dental
floss.
The mouth is rinsed again and the mouth is dried.
The materials are removed, the patient is given a
comfortable position.
The materials are cleaned and removed.
Hands are washed.
Oral care and abnormal findings are recorded.
54
PROSTHETIC DENTAL CARE
Prosthetic teeth should be removed with
the help of a gauze cloth and cleaned in
accordance with tooth brushing
technique.
After the dentures are removed, they
must be stored in a closed special
container and in water.
Prostheses must be cleaned before
they are stored in the container.
It should be removed at night while
sleeping.
Before putting the dentures back on, all
surfaces of the teeth should be brushed
with a soft brush and the mouth should
be rinsed with plenty of water.
Prostheses should be placed carefully
and slowly, first in the upper jaw and
then in the lower jaw.

EYE, EAR, NOSE CARE
HAND-FACE-HAIR
CARE
Principles to be considered in eye care:
While the eyes are closed, they are
wiped from the inner canthus to the outer
canthus with only clear water.
Eyes are made with warm water,
washcloth, sterile gas sponge/gauze.
Separate corners of the cloth or two
separate gauze pads are used for each
eye.
If there is a dried secretion (burr) around
the eye, gauze moistened with hot water
is kept on the eyelid for a while to soften
it.
In unconscious patients who do not have
a blink reflex, sterile saline or special eye
ointment can be applied to the eyes
every 4 hours.
Tools such as glasses and lenses require
special care.
Eye Care
Since the eyes are constantly washed with tear secretion, no special
care is normally required.
The eyelids and eyelashes also prevent foreign bodies from entering
the eye.
However, in unconscious patients, special eye care is required after
eye surgery, in the presence of problems such as infection, injury,
irritation in the eye.
It is important to clean the eye secretions that accumulate in the inner
canthus of the eye or eyelashes and dry up.
In unconscious patients, the blink reflex may not be present. For this
reason, dry eyes may occur, and the secretions accumulated in the
eyes may dry and cause the eyes to close.
Ear care and principles to be considered
During the bath, first the far side,
then the near side, behind the
ear and around the neck are
wiped with soapy and then clear
water and dried thoroughly.
The deletion process is done by
pulling the auricle, auricle
downwards, in the order of the
external ear canal, earlobe, back
of the ear, and neck.
Pushing foreign objects into the
external ear canal can cause
damage to the eardrum.
If the earwax does not block the
ear canal in a way that causes
hearing loss, it should not be
tried to be removed with foreign
objects.
 Nose, facial care and principles to be
considered
If soap is used for face cleaning,
wipe from the center outward
with soapy water and then clear
water.
First the forehead, then the sides
of the nose, cheeks and chin are
wiped on the face.
If there is a probe inserted in the
nose, it is checked whether it
irritates the nasal mucosa and
skin.
The rinsing process is repeated
HAIR CARE
until there is no soap left on the
skin.
When the process is finished,
the face is dried with a towel.

HAIR STRUCTURE Hair Root

The root of the hair is in the hair (hair) The sebum secreted by the sebaceous glands that open
follicles and the follicle is fed through the
into the hair follicle gives the hair a shiny appearance.
capillaries to which it is adjacent.
Sebum also prevents hair breakage and drying of the
Hair grows regularly and the growth rate of
hair is 12 mm per month on average. as
scalp. Compared to other parts of the body, sebum is
much. Hair also falls out regularly. secreted more on the face and scalp.
Normally, 50-100 hairs per day are lost by
shedding.
 The development, distribution and shape of Hormones
the hair show us the general health level Age can affect the
of the hair and scalp, as well as the Diseases
health of the
individual's hygiene knowledge and
Infections
Treatments individual's hair.
habits, socio-cultural, politico-economic
and psychological status.
E.g; Hypothyroidism causes the hair to be dry
and rough. Hair loss is observed in patients
receiving chemotherapy.

HAIR CARE

An individual's ability to establish positive

Appropriate hair care is important in developing
Interpersonal relationshipsin feeling good
an individual's body image. At the same time,
the cleanliness of the hair also affects the
health of the individual. Because some
The appearance, shape and cleanliness of the hair,
infectious agents and parasites settle more
which is a part of its appearance, also has an
easily on dirty hair and the skin in that area.
important effect.
Factors affecting hair care Hair During Lifetime

Diseases, In infancy, the hair is thinner, dry and weak.

Inadequacies in individual care, During adolescence, the activity of the sebaceous glands
increases with the effect of hormones and more sebum
Lack of knowledge about self-care and self-care
is secreted.
It also affects people's daily hair care at an
For this reason, the hair of individuals in the adolescence
adequate level.
period has a more oily appearance.
The hair of immobilized (immobile-dependent) In older individuals, the hair is drier than normal, thins
individuals can take on a messy and tangled over time, slows down its growth and loses its color.
appearance in a short time.

Individuality in Hair Care

The color of the hair depends on the amount of The methods used for hair care and cleaning,
melanin in the skin. Accordingly, the color of the hair the frequency of application, the cleaning
is yellow, red, brown, black or in shades of these agent used are completely individual.
colors.

As the age progresses, as a result of the aging of

the tissues and the slowing down of circulation,
melanin is replaced by small air bubbles and the hair
turns white.
 Brushing and Shampooing of Hair

Regular brushing, adequate and balanced nutrition and

While some individuals wash their hair daily, some
individuals may prefer to wash their hair as it gets dirty. proper shampooing are required for healthy hair.
While planning hair care for a healthy/sick individual, the
Brushing acts as a remover of dirt and dust, natural
presence of plaster cast, paralysis, loss of balance, joint
diseases and affecting the movement should be evaluated. oil deposits.

At the same time, combing, brushing, massaging with

fingertips accelerate blood flow and nourish the hair.

Hair should be washed every day, if not every other day or at

Hair should not be left untidy, but should be
least 2 times a week. Oily hair should be washed more often.
combed neatly and regularly with a comb.
The basis of all shampoos is an easily soluble oil-melting
substance. Brushes and combs used in hair cleaning should
In addition, odor, color and thickening agents are added. It is be washed with hot soapy water at frequent
possible that these additives may cause irritation on the scalp.
intervals.
Therefore, in the selection of shampoo, substances of unknown
quality should be avoided.
 Purpose of Hair Care-I:

To ensure that the hair and scalp are clean and healthy,
Hair should be brushed regularly to remove dirt and
dead hair. Cleaning the hair and scalp and maintaining the cleaning,
Brushing should not be done harshly.
To relax physically and mentally,
When the hair is washed, the brush and comb should
also be washed. Accelerating blood circulation in the scalp

Brushes and combs are personal tools and someone

else's brush and comb should not be used.

Purpose of Hair Care-II:

To increase the self-confidence of the

individual, PROBLEMS THAT MAY BE
SEEN ON HAIR AND SCALP
To ensure the participation of the individual in
their own hygienic care,

Ensuring the development of positive body

image in the individual
Common Problems in Hair and Scalp

DANDRUFF IN HAIR
Dandruff is the flaking of the scalp. Dandruff on
the scalp causes itching.
Dandruff can also make individuals feel
uncomfortable or unwell.
It is more common especially in adolescence.

Contamination of Dandruff in Treatment of dandruff in hair

the Hair
In severe cases, dandruff can also appear on
Specially produced medical dandruff
the eyebrows. Dandruff is irritating and
shampoos are useful.
can cause conjunctivitis or infection if it
In severe cases, a doctor should be
gets into the eyes.
consulted.
TICK Treatment of Tick

Tick is a small light brown parasite that lives in skin pores

and sucks blood. Ticks detected on the skin should not be tried to be pulled
Features out as they can cause infection in the human body. Oily
Ticks can cause many infectious diseases in the human
drugs or petroleum jelly can be easily removed by
body. For example, tularemia (a febrile disease
transmitted from ticks to humans). suffocating with gas.

PEDICULOZIS Pediculus Capitis (Head Lice)

It is a thin, gray-white parasite. Three types
of lice can appear on the human body.
Pediculus Capitis (Head Lice)
Pediculus Corporis (Body Lice)
It is found in the scalp and hair shaft. It is hidden
between the hair strands. Head lice eggs are oval in
shape and similar to dandruff. It is difficult to clean.
Lice can transmit disease from person to person. If left
untreated, it spreads to the environment and other
individuals.

Pediculus Pubis (Pubis Lice)

Pediculus Corporis (Body Lice) Pediculus Pubis (Pubis Lice)
It is very difficult to see because it is among the It is found in the hairs in the pubis area. Pubic lice are

laundry. Lice cling to clothing. Body lice suck blood and transmitted through bed linen, clothing and sexual

lay their eggs on clothes. Hemorrhages appear in places
where the lice suck blood. It causes constant itching and
therefore irritation.
intercourse. It lays its eggs between the pubic hairs and its
eggs are red in color and oval shaped. In the treatment of
pubic lice, the pubic area is washed, the pubic hairs are
shaved, and a kwell lotion is applied to the area. After 12-
24 hours, the area is washed again.

ALOPECIA (Hair Loss) Head Lice Care and Treatment-I

Head lice are treated using lotion or
Alopecia is seen in all races. The spilled part is
special shampoo (gamma benzene
separated from the hairy area with certain limits. hexachloride).

It occurs due to genes, hormones, and aging. Hair a) If shampoo is used, the hair is washed
and a special treatment shampoo is
care applications that damage the hair should be
used instead of normal shampoo.
stopped. According to the recipe in the shampoo
leaflet, the hair is washed after
leaving it on for a certain period of
time. The process is repeated after
12-24 hours.

Clothes and bedding are changed.

Head Lice Care and Treatment-II Head Lice Care and Treatment-III

b) When lotion is used: The lotion recommended by the The patient's head is covered with a triangular wrap
physician is applied to the hair. Before the application, so that it covers all the hair.
vaseline is applied to the forehead, temple, behind the
After waiting for the required amount of time for
ears and the nape of the scalp to prevent the lotion
the lotion used, the patient's head is washed.
from irritating the hairless skin. Lotion; The hair is
Bedding is changed and sent to the laundromat in a
separated by tufts and applied with dampened tampons.
sealed bag labeled as contagious.
The used tampon is thrown into a bag and the bag is
closed.

Body Lice Care and Treatment

In case of body lice, first a bath is made, Kwell lotion is

applied to the body surface.

Clothes and bedding are changed.

After 12-24 hours, the Kwell lotion is removed from the

body by taking a bath again.
FOOT CARE
Feet are important structures that enable the A foot consists of 26 bones
individual to move, such as walking and (tarsals, metatarsals, and
standing.
phalanges), 33 joints, 107
ligaments, and 19 muscles, in
addition to nerves and blood
vessels.

The bones are arranged in the form of an

Foot movements:
arch and the ligament is supported
externally by the muscles.All of these
structures function together when the
individual is standing or walking.

Plantar fleksiyon Dorsal

fleksiyon Eversion, Inversion
(dorsiflexion),

The concavity of the foot (plantar) resembles a semi-
dome.
Feet due to excess adipose tissue in children flat
base (up to 3 years old).
Body weight while standing on the heels, soles
and falls on the outside of the foot.
In cases where foot health is not taken care of
fatigue as the weight falls on the inside and
outside,
It causes foot, leg and back pain.

The main features of a healthy

foot are;
The integrity of the foot skin is
intact. The pulse from the standing dorsalis pedis and
swelling, posterior tibial artery is regular and of normal
inflammation. fullness (=> blood circulation is normal).
The skin is pink, smooth, soft and There is no feeling of pain or discomfort in the
warm. foot.
The position of the fingers is correct. There is no edema in the ankle or foot.
The mobility of the feet is within
normal limits, there is no problem in
standing or walking.
 NAIL
It is an extension of the
The skin surrounds the nails and the cuticle is epidermis layer of the skin and
intact. consists of keratinized
epidermal cells.
The color of the nail turns pale when the
It is located on the nail bed. Its root is embedded in
toenails are pressed, but immediately turns pink
the skin and is covered by the cuticle, which extends
again when the pressure is removed. over the nail.

It allows the fingers to move freely, the soft part of

the phalanx is protected from trauma, small objects
are felt and held, it is used for scratching.

Common foot and nail problems

Callus
A healthy nail; Foot Odors
It is transparent, the surface is smooth, smooth, Foot Cracks
Tinea Pedis
slightly protruding; The nail bed is pink and the nail
Plantar Warts
tips are translucent. The skin and cuticle around the
Halluks valgus-Bunyon
nail bed are smooth and intact. Ingrowing Nails
Since many microorganisms can easily settle and Panaris
reproduce under the nail tips, the hygiene of the nail Hammer Finger
bottoms must be ensured. Flat foot/pes planus
Foot Drop
 Callus:
Massage, keeping the foot skin soft, eliminating
pressure-creating factors (not wearing tight
It is the thickening of the
shoes) prevents calluses.
epidermis due to pressure
and friction and the
accumulation of horny
cells in a certain area,
forming a cone whose
base is on the skin.
Calluses usually occur in the areas where the bones
protrude, on the 4th and 5th toes, on the soles of If there are calluses, they cannot be cut with a
the feet and on the lateral surface of the feet. razor.After softening in the bath, it is treated slowly
and gently using special foot files (pumice stone, etc.).

Foot Odors
It is formed as a result of the
interaction of sweat and
microorganisms. Foot Cracks
Regular and frequent washing of
feet, use of clean socks,
It usually develops between the toes due to the
deodorants prevent odor
formation. dryness of the skin. When foot cracks occur, good
In order to prevent foot odor, foot hygiene should be provided and these cracks
mercerized or cotton socks that
should be prevented from becoming infected.
make the feet sweat less should be
preferred.
 Tinea pedis
Bacteria and fungi normally live in our bodies
without causing disease. When they find a suitable
environment, they can multiply rapidly and cause
infection. Foot fungus is a very common skin
disease.
It is a condition that settles between the toes and
causes itching, exfoliation on the skin, and nail loss in
advanced cases.
To prevent it, socks should be changed
frequently, closed slippers or rubber shoes that
make the feet sweat should not be worn.
Wearing tight shoes, keeping the skin moist for
a long time, minor nail and skin abrasions can
increase sensitivity.
It is contagious and can be transmitted by
direct contact or by using the same shoes or
shower floor.
Athlete's foot (Tinea Pedis)
It is caused by a fungal infection. Especially between
the fingers, cracks, exfoliation and severe itching are
seen.
It is important to clean feet, use clean socks, and
have sweat absorbing socks.
 Plantar Warts
Halluks valgus-Bunyon
The cause is the papilloma virus. They are often As a result of the lateral
painful and may cause walking difficulties as their deformation of the
metatarsophalangeal joint of
number increases. It can be contagious. According
the big toe, a sac or callus
to the doctor's recommendation, it can be forms in the area above the
treated with drugs, electro cautery and burning. joint.

It may occur due to

genetic disposition and
wearing high-heeled shoes
with pointed toes.

Halluks Varus Ingrown nail :

It is the outward turning of the thumb. The tip of the nail bends and extends into the
soft tissue around the nail.

It mostly occurs as a result of incorrectly
cutting nails and wearing shoes with narrow or
pointed noses.
Warm foot baths prepared with antiseptic
solutions are helpful.
Panaris
It is an inflammation of the skin and soft tissue
surrounding the nail.
The causative agent is usually bacteria or fungi.
There are signs of infection (edema, redness,
tenderness, burning, pain) around the nail.

Hammer Finger Hammer toe can happen for many reasons.Familial

predisposition, wearing tight shoes and weakness of
They are deformities that some muscles in the feet are known causes.
are usually seen in one
finger.
Calluses develop on the
joint that has become
protruding due to the
deformity.
Over time, joint movement In the front, wearing shoes that allow the
decreases and pain occurs. movement of the toes has a particularly preventive
effect.
 Flat foot/pes planus: The muscles and bones forming the foot dome are
put under extreme strain as a result of long periods
It is the decrease or complete loss of the
of inactivity, especially in overweight and heavy
longitudinal arch height of the foot.
load-bearing individuals.

As a result of this strain, the ligaments loosen and

the sole of the foot collapses and flattening is
It can be congenital, or it can develop as a result of
observed. Footprint evaluation is important in
standing still for a long time, sudden weight loss,
carrying heavy loads, and not wearing suitable diagnosis.
shoes for the feet.

Foot Drop:
It is the foot falling forward. Usually the thumb is
turned outward. Diabetic foot
Necessary precautions should be taken in patients
who are on bed rest for a long time. Foot care is very important
in these individuals due to
neuropathy (decreased sense
of sensation), peripheral
vascular disease (circulatory
disorder), and delayed wound
Precautions: Supporting the feet with foot boards healing seen in diabetes.
or a pillow.
Neuropathy leads to decreased
Diabetic foot wounds are an important cause of
perception of touch, deep
disease, death and economic loss.
pressure, heat, and joint
position.
It is the most common cause of hospitalizations due
Peripheral vascular disease in
to diabetes.
diabetes especially affects the
vessels between the knee and
Diabetes ranks first among the causes of amputation
heel.
due to non-traumatic causes worldwide.
Mechanical damage to the tissue
with decreased blood flow and
20% of the expenditures made for diabetes are for
insufficient nutrition easily leads
foot problems.
to ischemic ulcer opening.

To have healthy feet

-It should be washed daily with

However, it is the only diabetes warm water and soap.
complication that can be easily prevented
with good patient education and care. -Should be rinsed with plenty
of water

- After washing the feet, it is

necessary to dry thoroughly,
especially between the toes.
 -If the nails are thick and
hard, they should be cut after
softening by soaking in warm
water.
If the skin is dry, moisturizing solutions should be
used.
-Toenails should be cut
-If there are calluses, they should not be cut with a
straight to avoid ingrown
razor blade.
toenails.
After softening in the bath, it should be treated slowly
and gently using a pumice stone.

-Socks should not be tight, feet should not sweat

- Do not walk barefoot

-Shoes must fit the foot -Exercise should be done

A shoe that fits perfectly; to increase blood
should not squeeze the toes, hold circulation
- Movements that prevent
the heel tightly and support the
circulation should not be
arch of the foot well. done and clothes should
The heel of the shoe should be not be worn.
wide and not too high.
-Direct heat should not be
The same shoes should not be worn every day. applied

IN WHICH INDIVIDUALS FOOT CARE
IMPORTANT?
Foot care is extremely important for healthy/sick
individuals in every age group. The foot care of the
individual who cannot fulfill his own self-care is the
responsibility of the nurse.
Foot care gains special importance especially in the
elderly (since the skin is dry), Diabetes Mellitus and
individuals with circulatory disorders.
If the foot skin is dry after washing, it can be
softened by using vaseline pomade or neutral lotion.
If the toenails are thickened and hard, the feet should
be soaked in warm water before the nails are cut to
soften the nails and the nails should be trimmed.
Toenails should be cut straight, not rounded, and not
cut deep.
IMPORTANT PRINCIPLES IN FOOT CARE:
After keeping the feet in warm water for 5-10 minutes
IS
every day, they should be cleaned by washing with a
non-irritating soap. Prolonged foot baths can lead to
drying of the skin of the feet and loss of flexibility.
After the feet are cleaned with soap, they should be
rinsed and dried thoroughly, especially between the
toes. Good drying between the toes prevents the
formation of fungal infections.
If the feet sweat a lot, they should be washed at
regular intervals during the day and socks should be
changed.
Socks should not tighten the feet and legs, clean socks
should be worn every day, and there should be no tears
or holes that can create pressure in the socks.
The feet should be observed every day, the fingers,
between the toes, soles and lateral surfaces of the
feet should be examined with a mirror if necessary.
 -Do not walk barefoot at home or outside,
- Shoes that are suitable for the size of the feet,
closed in the front, flexible soles, and that do not
prevent foot movements should be used.
- -The inside of the shoes should be checked before
they are put on.
- The foot should be kept away from heat sources
(fire, radiator, hot water bag), direct hot application
BED BATH
should not be made.
- - Exercise should be done to improve blood
circulation in the lower extremities, while sitting,
legs should not be crossed to prevent circulation in
the legs.

BATH AND SKIN CLEANING Bath effect and purposes-2

The bathroom is a part of the general hygienic
care of the individual.is part of it.
The effect of the bath on the body and its
purposes -1
Bathing removes sweat, sebum, dead skin
cells andcleaning by removing some
microorganismsprovides.
Bathing stimulates blood circulation: with
warm or hot waterbaths cause vasodilationIt
provides more blood and oxygen to the skin.
The wiping / rubbing movement during the bath also stimulates
blood circulation.
Venous blood flow is particularly facilitated when wiping is
performed in the extremities from distal to proximal (from the
farthest point to the nearest point to the body).
The bath gives the individual a sense of well-being, vitality and
self-confidence.
Bathing reduces body odors.
The bath allows the patient to be evaluated biophysiologically
and psychosocially (observation of the skin, physical strength,
limitations, emotional reaction, fears and worries, need for
information, etc.).
Bathing increases muscle tone and provides joint movements.
The bathroom allows the nurse to communicate with the
patient.
 Full Bed Bath Given by the Nurse can
be done in two different ways:
1. METHOD (UPPER 2. METHOD (FRONT
SIDE + BOTTOM SIDE) SIDE+REAR SIDE)
Oral Cleansing Oral Cleansing
Facial Cleansing Facial Cleansing
Arm+Hand Cleaning Arm+hand Cleaning
Breast Cleansing Breast Cleansing
Abdominal Cleansing Abdominal Cleansing
Back Cleaning+Massage Leg + Foot Cleaning
Genital Area Cleaning Back Clean + Massage
Leg+Foot Cleaning Genital Area Cleaning

Materials:
Face towel (2 pcs)
Bath towel (2 pcs)
Washcloth
Soap and soap dispenser
Washing tub (2 units)
Water (41-43oC)
Clean underwear and
nightgown/pijamas
Clean bedding (If
necessary)
Deodorant etc.
Disposable gloves
Trash bin
 PERINEAL CARE

Perineal Care Female Perineum Care

Cleaning up process;
First, the symphisis pubis is
erased by zig zag from the
inside out,
Then the far side, then the near
side leg crotch area is wiped in
a zigzag shape,
The labia major on the far side
is wiped from top to bottom, and
the labia major on the near side
is wiped from top to bottom in a
single motion,
Again, first the far side and then
the near side, the labia minora
are removed with a single
movement from top to bottom.
 Male Perineum Care
Cleaning up process;
In male patients, it is held from
the body of the penis;
First, the symphisis pubis is
erased from the inside out by
drawing a zig zag,
Then the far side, then the near
side legthe groin area is wiped in
a zig-zag pattern,
First the urethral meatus,In a
circular motion, the pubis is
wiped downwards,
The patient is asked to open his BACK MASSAGE
legs a little;
The testicles are wiped from top
to bottom without applying
pressure.

Materials 1. Efflorage (Passing)

Do not place your hands on the
sacral region, on either side of
Body lotion the spine.
Bath towel Do not make an efflorescence
(stroking) movement by
Disposable glove following a straight line from the
sacral region to the shoulders
Vital signsmeasuring along the spine.
materials Repeating the efflorage
movement 3-4 times according
to the patient's needs.
Do not move your hands at the
same time during the massage.
2. Petrissage (Kneading) 3. Friction
Slide your hands to one side of
the spine over the hips.
Subcutaneous tissue and Vertebrae by overlapping
muscles, thumb and other fingers. your index and middle
Do not make a petrissage fingers rubbing
(kneading) movement.
Do not go up from the hips to the
shoulders in this way.
Do not perform the same
movement on the shoulder and
neck.
Downward from the side of the
spine that reaches up to the
shoulders repetition of the
movement.
Repeat the process 2-3 times

4. Hashur and Taputman

Striking the ulnar edges of

both hands in succession
with rhythmic touches from
the bottom up on one side
of the spine.
After applying
-3 times, applying
deed for 2-3 times by
doming the palms