HYGIENE

Hygiene
Copyright © 2017, Elsevier Inc. All Rights Reserved.
2 SCIENTIFIC KNOWLEDGE BASE
• Apply knowledge of pathophysiology to provide preventive hygiene care.

• Recognize disease states that create changes in the integument, oral cavity,
and sensory organs.
• Use time spent providing hygiene care to identify abnormalities and initiate
appropriate actions to prevent further injury to sensitive tissues.
3 CASE STUDY
• Mrs. Winkler is a 58-year-old white woman admitted

recently to an assisted-living nursing facility. She has a
medical history of multiple sclerosis (MS) and diabetes
mellitus plus a family history of coronary artery disease.
• Mrs. Winkler uses a wheelchair for mobility. She has
recently become weaker (in both upper and lower
extremities), is unable to push the chair herself, and
requires assistance in transferring to and from the chair.
4 THE SKIN
• Functions include
• Protection, secretion, excretion, temperature regulation, and
sensation
• Primary layers
• Epidermis: shields underlying tissue
• Dermis: contains bundles of collagen, nerve fibers, blood vessels,
sweat glands, sebaceous glands, and hair follicles
• Subcutaneous tissue
• Lies just beneath the skin; contains blood vessels, nerves, lymph,
and loose connective tissue filled with fat cells
5 THE FEET, HANDS, AND NAILS
• Feet, hands, and nails require special attention to prevent

infection, odor, and injury.
• The condition of a patient’s hands and feet influences his or
her ability to perform hygiene care.
• The normal nail is transparent, smooth, and convex, with a
pink nail bed and a translucent white tip.
6 THE ORAL CAVITY
• The oral cavity is lined with mucous membranes.

• Normal oral mucosa is light pink, soft, moist, smooth, and
without lesions.
• Medications, exposure to radiation, and mouth breathing
can impair salivary secretion.
• Xerostomia—dry mouth.
• Gingivitis—inflammation of the gums.
• Dental caries—tooth decay.
7 CASE STUDY (CONT.)
• Jamie Johnson is a 20-year-old nursing student assigned to

the nursing facility. She is single and works part-time in a
skilled nursing facility near her home. Jamie knows how
important it is for patients to feel comfortable and to have
their basic needs met.
• To provide basic hygiene, Jamie needs to learn about what is
important for Mrs. Winkler’s comfort. When hygiene needs
are not fulfilled, patients experience complications such as
oral lesions and infections.
8 HAIR
• Growth, distribution, and pattern indicate general health

status.
• Hormonal changes, nutrition, emotional stress, physical
stress, aging, infection, and other illnesses can affect hair
characteristics.
• The shaft itself is lifeless, and physiological factors do not
directly affect it.
• However, hormonal and nutrient deficiencies of the hair follicle cause
changes in hair color or condition.
9 EYES, EARS, AND NOSE
• When hygiene care is provided, the eyes, ears, and nose

require careful attention.
• Clean the sensitive sensory tissues in a way that prevents
injury and discomfort for a patient, such as by taking care to
not get soap in his or her eyes.
• The sense of smell is an important aid to appetite.
• Jamie needs to review the effect of dependency on the

patient’s self-esteem and to review ways to give patients
opportunities to maintain self-care needs. At an optimal
level of functioning with assistance, Mrs. Winkler is at risk
for potential self-care deficits, impaired skin integrity,
impaired oral mucosa, and altered health maintenance.
• During hygiene care, Jamie interacts with Mrs. Winkler to
assess her readiness to learn and to teach health
promotion practices.
11 NURSING KNOWLEDGE BASE
• Many factors influence personal hygiene.

• Use communication skills to promote the therapeutic
relationship.
• Hygiene care is never routine.
• During hygiene, assess:
• Emotional status
• Health promotion practices
• Health care education needs
FACTORS INFLUENCING HYGIENE
Social practices Personal preferences
Body image Socioeconomic status
Health beliefs and

Cultural variables
motivation
Developmental stage Physical condition
Copyright © 2017, Elsevier Inc. All Rights Reserved. 12

13 CRITICAL THINKING
Integrate nursing knowledge.

Consider developmental and cultural
influences.
Think creatively.
Be nonjudgmental and confident.
Draw on your own experiences.
Rely on professional standards.

14 QUICK QUIZ!
1.You are caring for a non–English-speaking male patient.When preparing to

assist him with personal hygiene, you should:
A. use soap and water on all types of skin.
B. ensure that culture and ethnicity influence hygiene practices.
C. shave facial hair to make the patient more comfortable.
D. know that all patients need to be bathed daily.
• Before entering Mrs. Winkler’s room, Jamie reviews

knowledge about the effects of chronic illness on body
image and independence, principles of communication and
the pathophysiology for MS, diabetes, and oral lesions.
• Previous clinical experience has taught Jamie that patients
need to have an opportunity to determine how nurses
implement nursing care.
16 NURSING PROCESS: ASSESSMENT
• Through the patient’s eyes

• Assess patient expectations about hygiene
• Assess:
Self-care ability Skin Feet and nails

Oral cavity Hair and hair care Eyes, ears, and
nose
Use of sensory aids Hygiene care Cultural
• Patients at risk for hygiene problems
practices influences
17 NURSING ASSESSMENT (CONT.)

• Jamie learns that Mrs. Winkler likes to have her face and
hands washed first and then her teeth brushed before
breakfast. But then, she tells Jamie that it is really not
important.
• Mrs. Winkler says, “I am not going to have breakfast today
because my mouth is sore. I took my dentures out
yesterday. They hurt my mouth too much. I guess I just can’t
wear them anymore.” Jamie determines that assisting Mrs.
Winkler with oral care is a priority.
19 NURSING DIAGNOSIS
• Common diagnoses associated with hygiene:

• Activity intolerance
• Bathing self-care deficit
• Dressing self-care deficit
• Impaired physical mobility
• Impaired oral mucous membrane
• Ineffective health maintenance
• Risk for infection
• Use the patients’ actual alteration or the alteration for which

they are at risk.
• Mrs. Winkler states that she wants to be able to wear her

teeth and to feel clean.
• Mrs. Winkler reports mouth pain and sores.
• Jamie’s examination reveals reddened oral mucosa, red sores
and patchy white lesions, a thick coating on the gums and
tongue, and some bleeding from swollen tissues.
• Mrs. Winkler states that she has trouble holding her arms
above her waist and trouble holding small things because her
muscles are so weak.
21 NURSING PROCESS: PLANNING
• Goals and outcomes

• Partner with the patient and family
• Measurable, achievable, individualized
• Set priorities based on assistance required, extent of

problems, nature of diagnoses
• Teamwork and collaboration
• Health care team members
• Family
• Community agencies
• Goals:
• Knowledge: illness care
• Mrs. Winkler will verbalize preventive and routine oral and
denture care by the time of discharge.
• Oral hygiene
• Mrs. Winkler will have return of intact oral mucosa within 1
week.
23 IMPLEMENTATION
Use caring to reduce anxiety, promote comfort.
Administer meds for symptoms before hygiene.
Be alert for patient’s anxiety or fear.
Assist and prepare patients to perform hygiene as

independently as possible.
Discuss signs and symptoms of problems.
Inform patients about community resources.

24 IMPLEMENTATION (CONT.)
• Health promotion
• Make instructions relevant.
• Adapt instruction to patient’s facilities and resources.
• Teach the patient ways to avoid injury.
• Reinforce infection control practices.
• Acute, restorative, and continuing care

• Hygiene measures vary by patient needs and health care setting.
• Consider normal grooming routines, and individualize care

• Bathing and skin care
• Therapeutic: sitz, medicated
• Complete bed bath, shower
• Partial bed bath
• Soap and water vs. Chlorhexidine Gluconate (CHG)
• Perineal care
Bath Guidelines
Provide privacy.
Maintain safety.
Maintain warmth.
Promote independence.
Anticipate needs.
• Back rub
• Foot and nail care
• Oral hygiene
• Brushing removes particles, plaque, and bacteria; massages the gums;
and relieves unpleasant odors and tastes.
• Flossing removes tartar at the gum line.
• Rinsing removes particles and excess toothpaste.
• Patients with special needs: diabetes, artificial airways,

unconscious, chemotherapy
IMPLEMENTATION (CONT.)
28
• Denture care
• Keep dentures covered in
water when they are not
worn
• Store in an enclosed,
labeled cup with the cup
placed on patient’s
bedside stand
• Hair and scalp care

• Brushing and combing
• Distributes oil
• Prevents tangling, as does braiding
• Obtain permission before braiding or cutting.
• Combing is more effective than use of pediculicidal shampoos
in the case of head lice
30
• Shampooing
• Frequency depends on
patient routines and hair
condition
31
• Shaving
• Mustache and beard care
32 QUICK QUIZ!
2. A young girl with long hair is experiencing a problem with matting.The most
appropriate action to take would be:
A. cutting the matted hair away.
B. braiding the hair to reduce tangles.
C. using a grease-type product to tame the hair.
D. keeping the hair oil free by applying powder every morning.
33
• Care of the eyes, ears, and

nose:
• Medical devices
• Basic eye care
• Eyeglasses
• Contact lenses
• Artificial eyes
34
• Care of the eyes, ears, • {Insert Figure 40-7 here}

and nose (cont.):
• Ear care
• Hearing aid care
• Nasal care
35
• Patient’s room
environment
• Maintaining comfort
• Temperature, noise,
lighting, ventilation, odors
• Room equipment
36
• Foot boots
• Special mattresses
37
• Beds
• Bed making
38
• Surgical or recovery Bed

• Linens
• What interventions are appropriate for restoration of oral

health?
• What is the rationale supporting each intervention?
• Example intervention: Remove, clean, and do not replace
dentures except for meals (if desired).
• Rationale: This promotes healing during cases of mild to moderate
stomatitis.
40 EVALUATION
• Through the patient’s eyes

• Were the patient’s expectations met?
• Patient outcomes
• Evaluate after each hygiene intervention
• Use teach back
• If outcomes were not met, revise the care plan
• Jamie asks Mrs. Winkler about reporting of symptoms.

• Mrs. Winkler states she now knows that her oral
discomfort and sores are related to how she cares for her
dentures, and that she will report these symptoms if they
reoccur.
• Achievement of outcome is shown because Mrs. Winkler is
able to participate in prevention of oral problems by
reporting symptoms indicating a problem.
42 SAFETY GUIDELINES FOR

NURSING SKILLS
• Identify the patient with two identifiers.
• Move from the cleanest to less clean areas.
• Use clean gloves for contact with nonintact skin, mucous
membranes, secretions, excretions, or blood.
• Test the temperature of water or solutions.
• Use principles of body mechanics and safe patient handling.
• Give proper direction to NAP when delegating.

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Hygiene

Copyright © 2017, Elsevier Inc. All Rights Reserved.

2 SCIENTIFIC KNOWLEDGE BASE

• Apply knowledge of pathophysiology to provide preventive hygiene care.

• Mrs. Winkler is a 58-year-old white woman admitted

5 THE FEET, HANDS, AND NAILS

• Feet, hands, and nails require special attention to prevent

6 THE ORAL CAVITY

• The oral cavity is lined with mucous membranes.

7 CASE STUDY (CONT.)

• Jamie Johnson is a 20-year-old nursing student assigned to

• Growth, distribution, and pattern indicate general health

9 EYES, EARS, AND NOSE

• When hygiene care is provided, the eyes, ears, and nose

10 CASE STUDY (CONT.)

• Jamie needs to review the effect of dependency on the

11 NURSING KNOWLEDGE BASE

• Many factors influence personal hygiene.

Social practices Personal preferences

Body image Socioeconomic status

Health beliefs and

Developmental stage Physical condition

Copyright © 2017, Elsevier Inc. All Rights Reserved. 12

Integrate nursing knowledge.

Be nonjudgmental and confident.

Draw on your own experiences.

Rely on professional standards.

1.You are caring for a non–English-speaking male patient.When preparing to

15 CASE STUDY (CONT.)

• Before entering Mrs. Winkler’s room, Jamie reviews

16 NURSING PROCESS: ASSESSMENT

• Through the patient’s eyes

Self-care ability Skin Feet and nails

17 NURSING ASSESSMENT (CONT.)

18 CASE STUDY (CONT.)

• Common diagnoses associated with hygiene:

• Use the patients’ actual alteration or the alteration for which

20 CASE STUDY (CONT.)

• Mrs. Winkler states that she wants to be able to wear her

21 NURSING PROCESS: PLANNING

• Goals and outcomes

• Set priorities based on assistance required, extent of

22 CASE STUDY (CONT.)

Use caring to reduce anxiety, promote comfort.

Administer meds for symptoms before hygiene.

Be alert for patient’s anxiety or fear.

Assist and prepare patients to perform hygiene as

Discuss signs and symptoms of problems.

Inform patients about community resources.

• Acute, restorative, and continuing care

• Consider normal grooming routines, and individualize care

• Patients with special needs: diabetes, artificial airways,

• Hair and scalp care

• Care of the eyes, ears, and

• Care of the eyes, ears, • {Insert Figure 40-7 here}

• Surgical or recovery Bed

39 CASE STUDY (CONT.)

• What interventions are appropriate for restoration of oral

• Through the patient’s eyes

41 CASE STUDY (CONT.)

• Jamie asks Mrs. Winkler about reporting of symptoms.

42 SAFETY GUIDELINES FOR

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