Chapter 18

Personal Hygiene and Bed Making

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 Hygiene
 Promotes and preserves health
 When performing hygiene, the nurse can:
 Discuss health-related concerns
 Perform a physical assessment
 Provide patient education
 Providing personal hygiene is necessary for an
individual’s comfort, safety, and sense of well-
being

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 Principles for Practice
 Regular bathing is essential to skin integrity
 Promotes circulation and hydration
 Bathing patients with dementia is complicated
 Difficult to apply physical, emotional, and
environmental factors
 Maintain privacy and comfort
 Encourage patients to participate in hygiene care

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 Patient-Centered Care
 Accommodate patient’s preferences and culture
when performing hygiene
 Consider patient’s normal oral and bathing
hygiene routines
 Involve family members when possible
 Preserve patient dignity of patients with
dementia

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 Evidence-Based Practice
 Recent evidence supports the use of daily
bathing with chlorhexidine gluconate
 A recent systematic review and meta-analysis
confirmed that 2% CHG reduces central line
associated bloodstream infections (CLABSIs)

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 Safety Guidelines

1. Patients who are totally dependent on

someone else require assistance with
personal hygiene or must learn or adapt new
hygiene techniques.
2. Keep all personal hygiene care items within a
patient’s reach.
3. Use clean gloves when you anticipate
contact with nonintact skin or mucous
membranes or when there is or may likely be
contact with drainage, secretions, excretions,
or blood.
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 Safety Guidelines (Cont.)

4. Always perform hygiene measures moving

from cleanest to less clean or dirty areas.
5. When using water or solutions for hygiene
care, be sure to test the solution
temperature to prevent burn injury.
6. Use principles of body mechanics and safe
patient handling.
7. Assess and evaluate a patient before and
after care.
8. Monitor laboratory findings.

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 The Skin
 The largest human body organ
 Three primary layers
 Epidermis
 Dermis
 Subcutaneous tissue

What common skin problems might you observe?

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 The Mouth
 The oral cavity
 Teeth
 Gums
 Saliva
 Regular oral hygiene
is necessary for
health

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 The Hair
 Grows from follicles
 Supporting structures
 Blood vessels
 Sebaceous glands
 Purpose is protection
 Condition indicates
health

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 The Nails
• Epithelial tissues

• Grow from the root of the nail bed

• Indicate health

• Feet and nails require special care to

prevent infection, odor, and injury

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 Quick Quiz!
A male nurse is preparing to help shampoo the hair of an
Amish woman. The woman refuses the nurse’s assistance.
What action should the nurse take?
A.Explain to the woman that this is the only time the nurse has to help
her.
B.Seek the assistance of a female nurse to put the patient more at

ease.
C.Enlist the help of family members, giving them the supplies needed to

complete the care.

D.Leave the patient alone; eventually she will need to cooperate with
the male nurse.

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 Complete or Partial Bed Bath
Skill 18-1
 Bathing principles
 Clean skin regularly and at time of soiling
 Avoid extreme water temperatures
 Avoid use of force or friction
 Maintain an ideal room temperature
 Assess patient during the bath
 Assist with range-of-motion (ROM) exercises during
the bath
 Keep patient limitations in mind

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 Complete or Partial Bed Bath
Skill 18-1 (Cont.)
 Cleansing bath
 Bed
 Tub
 Sponge
 Shower
 Therapeutic bath
 Sitz
 Medicated

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 Delegation and Collaboration
 The task of bathing can be delegated to nursing
assistive personnel (NAP)
 The nurse instructs NAP about:
 Not massaging reddened skin areas
 Contraindications to soaking patient’s feet
 Reporting impaired skin integrity
 Proper patient positioning

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 Recording and Reporting
• Record procedure, observations, level of
patient participation, and how the patient
tolerated procedure in nurses’ notes in
electronic health record (EHR) or chart
• Report evidence of alterations in skin
integrity, break in suture line, or increased
wound secretions to nurse in charge or
health care provider. Patient may require
special skin care

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 Special Considerations
 Teaching
 Teach patients how to inspect surfaces between skinfolds
and explain the signs of irritation or breakdown
 Include family caregiver in learning the bathing process
 Pediatric
 Adolescents may require more frequent bathing because
they have active sebaceous glands
 Young adolescent girls should learn basic perineal hygiene
measures

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 Special Considerations (Cont.)
 Gerontological
 Incontinence requires meticulous skin care
 Caregiver behavior can be considered by the patient
as assault in dementia patients
 Guidelines for dementia patients:
• Do not rush
• Speak in low, pleasant voice
• Inform patient all through bath
• Use distraction if agitation occurs
• Concentrate on the person’s feelings and reaction

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 Special Considerations (Cont.)
 Home care
 Type of bath chosen depends on assessment of the
home, availability of running water, and condition of
bathing facilities
 Set up equipment according to patient’s established
routines
 Use assist devices for patients at risk of fall
 Long-term care
 Use baths with thermometers and hydraulic patient
lifts as needed

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 Quick Quiz!
The nurse will administer a complete bed bath to
which of the following patients?
A.12-year-old boy with a long leg cast
B.92-year-old woman in assisted living

C.25-year-old ventilator-dependent man

D.40-year-old patient with Parkinson’s disease

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 Perineal Care
Procedural Guideline 18-1
 Performed during a complete bed bath
 May be performed more frequently on patients
with fecal or urinary incontinence, an indwelling
Foley catheter, or rectal or genital surgery
 Wear gloves
 Always act in a professional manner and provide
privacy at all times

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 Delegation and Collaboration
 The task of perineal care can be delegated
to NAP
 The nurse instructs NAP to:
 Avoid any physical restriction that affects proper
positioning of patient
 Properly position a patient with an indwelling Foley
catheter
 Inform the nurse of any perineal drainage, excoriation,
or rash observed

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 Use of Disposable Bed Bath,
Tub, or Shower
Procedural Guideline 18-2
 Disposable washcloths (CHG) have antiseptic
solution
 Replace soap and water baths
 Cleanse and remove bacteria
 Antiseptic binds to skin for persistent antibacterial
activity
 Tub and shower bathing is more common in
long-term care

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 Delegation and Collaboration
 The task of bathing in a tub or shower or using a
disposable bed bath can be delegated to NAP
 The nurse instructs NAP to:
 Not massage reddened skin
 Properly position patient
 Report changes in skin or perineal area or signs of
impaired skin integrity

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 Oral Hygiene
Skill 18-2
 Daily oral hygiene prevents and controls plaque-
associated oral disease
 Oral hygiene promotes health, comfort, nutrition,
and verbal communication
 Ill patients may require assistance with activities
ranging from preparing supplies to brushing
teeth
 Care for dentures as frequently as natural teeth

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 Delegation and Collaboration
 The task of oral hygiene can be delegated
to NAP
 The nurse instructs NAP to:
 Note types of changes in oral mucosa
 Report patient’s complaints of pain or occurrence of
bleeding during oral care
 Be aware of special precautions, such as aspiration
precautions
 Not floss when a patient has a bleeding tendency

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 Recording and Reporting
• Record procedure and note condition of
oral cavity in nurses’ notes

• Report bleeding, pain, or presence of

lesions to nurse in charge or health care
provider

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 Special Considerations
 Teaching
 Teach patients about methods to prevent tooth decay
 Educate patients to visit a dentist regularly
 Include family caregiver in teaching
 Avoid mints
 Pediatric
 Every infant should have oral assessment
 Oral hygiene starts no later than first eruption
 Use smear of toothpaste with first tooth
 Teach parents that infants should be put to bed with a
bottle

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 Special Considerations (Cont.)
 Gerontological
 Normal age-related changes
 Home care
 During initial admission, document condition of
patient’s mouth, teeth, and gums to provide a
baseline for assessing patient’s ability to comply with
special diets and fluid intake and to carry out oral
hygiene practices

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 Care of Dentures
Procedural Guideline 18-3
 Clean dentures as often as natural teeth
 Store in an enclosed, labeled cup when not worn
 Reinsert as soon as possible
 When inserting, ensure a good fit
 Loose dentures cause discomfort and make it difficult
to chew food and speak clearly

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 Delegation and Collaboration
 The task of denture care can be delegated
to NAP
 The nurse instructs NAP to:
 Understand the importance of water temperature
when caring for dentures
 Inform the nurse if there are cracks in dentures
 Inform the nurse if the patient has any oral discomfort

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 Quick Quiz!
Which of the following issues can contribute to
malnutrition for an elderly man?
A.Loose-fitting dentures
B.Moist mucous membranes

C.Visible layer of tooth enamel

D.Clear-colored saliva

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 Performing Mouth Care for the
Unconscious or Debilitated Patient
Skill 18-3
 These patients are at risk for:
 Alterations of the oral cavity
 Infection
 Aspiration
 For safety, two nurses/NAPs provide care
 One nurse or NAP provides oral care, while the other
suctions oral secretions

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 Delegation and Collaboration
 The task of providing oral hygiene to an
unconscious or debilitated patient can be
delegated to NAP
 The nurse instructs NAP to:
 Have another NAP assist
 Properly position patient for mouth care
 Use special precautions (e.g., aspiration)
 Use an oral suction catheter
 Report impaired integrity of oral mucosa
 Report bleeding, coughing, or choking

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 Recording and Reporting
• Record procedure, appearance of oral cavity,
presence of gag reflex, and patient’s response to
procedure in medical record in EHR or chart

• Report any unusual findings (e.g., bleeding,

ulceration, choking response) to nurse in charge
or health care provider

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 Special Considerations
 Teaching
 Instruct family members on mouth care, and how to
prevent aspiration
 Use teach-back
 Home care
 Irrigate oral cavity with bulb syringe
 Instruct on risk of aspiration
 Encourage oral cleansing twice a day

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Hair Care—Combing and Shaving
Procedural Guideline 18-4
 Brushing, combing, and shampooing are basic
measures for all patients unable to provide self-
care
 Many factors can influence the health of the
scalp and the condition of the hair
 Dependent patients with beards or mustaches
need assistance keeping facial hair clean; keep
cultural considerations in mind and obtain
consent as needed

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 Delegation and Collaboration
 The tasks of combing and shaving can be
delegated to NAP
 The nurse instructs NAP to:
 Properly position the patient with head or neck
mobility restrictions
 Report how the patient tolerated the procedure and
any concerns
 Use an electric razor for any patient who is at risk for
bleeding tendencies

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 Hair Care—Shampooing
Procedural Guideline 18-5
 Frequency of shampooing depends on the
condition of the hair and the person’s daily
routines and cultural preferences
 Two types of shampooing are available:
 Traditional soap and water
 Disposable dry shampoo cap
 Make sure that a patient’s condition does not
contraindicate neck hyperextension

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 Delegation and Collaboration
 The task of shampooing the hair of bed-bound
patients and the use of disposable shampoo
product can be delegated to NAP
 The nurse instructs NAP about:
 Proper way to position a patient with a head or neck
mobility restriction
 How to provide care for patients with lice, stressing
steps that should be taken to prevent transmission to
other patients

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 Performing Nail and Foot Care
Skill 18-4
 When is the best time to provide nail and foot
care?
 Patients with peripheral neuropathy and
peripheral vascular disease (PVD) are at
greatest risk for developing serious foot
problems
 PVD is a factor in diabetic foot ulcers
 Teach patients about proper foot care

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 Delegation and Collaboration
 The task of providing nail and foot care for
patients without diabetes or circulatory
compromise can be delegated to NAP
 The nurse instructs NAP about:
 Not trimming patient’s nails
 Special considerations for patient positioning
 Reporting any breaks in skin, redness, numbness,
swelling, or pain

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 Recording and Reporting
• Record procedure and observations of
condition of nails and skin around nails in
medical record

• Report any areas of discomfort, breaks in

skin or ulcerations to nurse in charge or
health care provider

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 Special Considerations
 Teaching
 Do not walk barefoot or use corn or callus products
 The patient with diabetes
 Pediatric
 Trim children’s nails to prevent injury from scratching
themselves
 Use clippers, not scissors

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 Special Considerations (Cont.)
 Gerontological
 Age-related skin changes
 Impaired mobility
 Home care
 Assess home for foot injury risks
 Avoid going barefoot/wearing open-toed shoes
 Consider alternative therapy
 Post provider contact information

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 Making an Occupied Bed
Procedural Guideline 18-6
 This skill is easiest with two people
 Position the patient safely while the bed linens
are changed
 Try to conserve the patient’s energy
 Use safe handling techniques

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 Delegation and Collaboration
 The task of making an occupied bed can be
delegated to NAP
 The nurse instructs NAP about:
 Being aware of any position or activity restrictions
 Looking for wound drainage, drainage tubes, or
intravenous (IV) tubing
 Obtaining help with positioning patient
 Using special precautions such as aspiration
precautions

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 Making an Unoccupied Bed
Procedural Guideline 18-7
 Types of bedmaking
 Unoccupied bed
 Postoperative surgical bed
 Closed bed

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 Delegation and Collaboration
 The task of making an unoccupied bed can be
delegated to NAP
 The nurse instructs NAP about:
 Position or activity restrictions that apply to patient’s
ability to get out of bed
 Use of special linen instructions if patient is on an
airflow mattress

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