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HYGIENE

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HYGIENE

Science of health and its maintenance

highly personal matter determined by

individual values and practices

Involves care of the skin, hair, nails, teeth,oral and nasal cavities, eyes, ears, and

perineal-genital areas

PERSONAL HYGIENEself-care by whichpeople attend to functions such as bathing,

toileting, general body hygiene and

grooming

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SKINLargest organ of the body

Functions:

- first line of defense against injury and

microorganism

- maintains body temperature

- secretes sebum

- sensory organ- produces and absorbs Vit D

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TYPES OF HYGIENIC CARE

EARLY MORNING CAREprovided to client asthey wake up in the morning

MORNING CAREoften provided after the

clients have breakfast; includes making the bed

HS or PM CAREprovided to clients before

they retire for the night

AS-NEEDED (PRN) CAREprovided as

required by the client

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BATHING

Removes accumulated oil, perspiration, dead

skin cells and some bacteriaStimulates circulation

Produces sense of well-being

Offers an excellent opportunity for nurses tomake ASSESSMENTS

Categories:

- Cleaning bathsgiven chiefly for hygiene purposes

- Therapeutic bathgiven to produce specific effects

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CLEANING BATH

COMPLETE BED BATHthe nurse washes

the entire body of a dependent client in bed

SELF-HELP BED BATHnurse help a

client to wash the back and feetPARTIAL/ABBREVIATED BATHonly the

parts of the clients body that might cause

odor or discomfort is washed

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CLEANING BATH

BAG BATHbath that is commercially

prepared product that contains a pre-

soaked disposable washcloth that contains

a no-rinse cleanser solutionTUB BATH

SHOWER

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THERAPEUTIC BATH

Given for physical effects such as to sooth

irritated skin or to treat an area

Medications may be placed on the water

KINDS:

Tepid Sponge Bath

- done by sponging the body with htin

washcloth from cold or tepid water to reducebody temp & refresh patient

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THERAPEUTIC BATH (KINDS)

Alcohol Sponge Bath

- sponging the body with a washcloth from amixture of alcohol and tap water (1:3), to reducetemp

Hot Sitz Bath

- consists of immersion of the pelvic region andthe upper thighs in a tub of hot water, to relievecongestion and pain in the pelvic region

- to relieve pain and hasten healing afterhemorrhoidectomy

- to induce urination in some case of urinaryretention

- to produce muscular relaxation

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BED BATHING

Explain the procedure

Perform appropriate client assessment

Condition of the skin

Physical or emotional factors

Presence of pain

ROM

Need to use gloves

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BED BATHING

Assemble equipment and supplies

wash basin

wash cloth

2 bath towels

bath blanket soap & soap dish

hygiene supplies (e.g. powders, lotions)

warm water

bedpan/urinal

gloves (optional)

laundry hamper

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BED BATHING

Identify yourself and verify clients identity

Perform hand hygiene and other

appropriate infection control measures

Provide for client privacy

Prepare the client and the environment

Invite a significant other to participate if desired

Close the windows and doors Offer to use the toilet, commode or bedpan/urinal

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BED BATHING

Position the bed at a comfortable working

height. Lower the side rail on the side close

to you while keeping the other side rail up.

Assist the client to a comfortable positionand to move near you.

Place a bath blanket over the top sheet.

Remove the top sheet from under the bath

blanket starting at the clients shouldersmoving down towards the clients feet

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BED BATHING

Remove the clients gown while keeping the

client covered with the bath blanket. Place

the gown in the linen hamper

Fill the wash basin with warm water.Change water as necessary

Make a bath mitt with the wash cloth

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BED BATHING

Wash the face Place the towel under the clients head

Wipe one eye with one side of the wash cloth

moistened with clan water from inner to outer

canthus. Repeat it to the other eye using the

other side of the wash cloth

Wash, rinse, and dry the clients face, ears and

neck. Ask whether the client prefers to use soap

then remove the towel from under the clientshead

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BED BATHING

Wash the upper extremities

Place the towel lengthwise under the arm fartheraway from you. Wash the extremity from the wrist to the

shoulder including the axilla using firm strokesby elevating the arm and supporting the clientswrist and elbow

Rinse and dry the extremity. Apply powder ordeodorant if desired

Place a towel on the bed adjacent to the clients

hands and place the basin over it. Soak the hand in the basin. Wash, rinse and dry

the hands Repeat the procedure to the other extremity

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BED BATHING

Wash the chest and abdomen

Place the bath towel lengthwise over the chest.

Fold the bath blanket down to the clients pubic

area.

Lift the bath towel off the chest and bathe the

chest and abdomen with your mitted hand using

long, firm strokes.

Rinse and dry well then replace the bath blanketwhen the areas have been dried

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BED BATHING

Wash the legs and feet Expose the leg farther from you by folding the

bath blanket towards the other leg. (Keep theperineum covered)

Lift the leg and place the bath blanket

lengthwise under it. Wash, rinse, and dry the legusing long, firm strokes from the ankle to theknee to the thigh.

Reverse the coverings and repeat for the other

leg. Wash the feet by placing them in the basin of

water then dry each foot. Obtain fresh, warm water now or when

necessary

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TYPESOFMASSAGE

Back Rub

- massage of the back with 2 chief

objectives: (1) relax and relieve

muscle tension (2) stimulate bloodcirculation to the tissues and muscles

- effleurage

- tapotement- petrissage

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TYPESOFMASSAGE

Effleuragesmooth, long stoke,moving the hands up and down theback

Tapotementthe little finger side ofthe hand is used in a sharp, hackingmovement on the back (tapping)

Petrissagea large pinch on theskin, subcutaneous tissue and muscleis quickly done (kneading)

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BED BATHING

Assist the client to supine position

and determine if the client can

wash the perineal areaindependently. If the client cannot

do so, drape the client and wash

the area

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BED BATHING

Assist the client to wear a clean

hospital gown and attend to the

personal grooming aids such as

powder, lotion or deodorant

Assist the client to a comfortable

position. Lower the bed and raise the

side railsClean and store bath equipments

Document all relevant information

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PERINEAL-GENITAL CARE

PERINEAL CARE or PERICAREAlways wipe from clean to dirty

Female: from front to back

Male: cleanse the urinary meatus by moving in circular

motion from center of urethral opening around theglans

Purpose:

- remove normal perineal secretions and

odor

- prevent infection

- promote comfort

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PERINEAL GENITAL CARE

Explain the procedurePerform appropriate client assessment

Irritation, excoriation, inflammation,

swelling Excessive discharge

Odor; pain or discomfort

Urinary or fecal incontinence

Perineal-genital hygiene practices

Self-care abilities

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wash basin

wash cloth

bath towels

bath blanket

cotton balls/gauze

warm water

bedpan/urinal

gloves (optional)

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Provide for client privacyPrepare the client. Fold the top bed linen to

the foot of the bed and fold the gown up to

expose the genital area. Place the bath

towel under the clients hips

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(FEMALE)

Position (dorsal recumbent position) and

drape the client by tucking the bottom

corners of the bath blanket under the

insides of the legs and bring the middleportion of the base of the blanket up over

the pubic area

Put on gloves and wash and dry the upper

inner thighs

Inspect the perineal area. Note for

inflammation, excoriation, or swelling

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(FEMALE)

Clean the labia majora then spread the

labia to wash the folds between the

labia majora and the labia minora. Use

separate quarter of the wash cloth foreach stroke and wipe from pubis to

rectum

For menstruating women and clients withindwelling catheter, use clean wipes,

cotton balls or gauze and take a clean

wipe for each stroke

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(FEMALE)

Rinse the area well and dry the perineumthoroughly

Inspect perineal orifices for intactness

Assist the client to turn unto side facing awayfrom you. Pay particular area to the anal area.Clean the anus with toilet tissue beforewashing it if necessary

Dry the area well and apply a perineal pad asneeded from front to back

Clean/dispose equipments/suppliesappropriately

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(MALE)

Position the client in a supine position

with his knees slightly flexed. Provide

appropriate drapes

Put on gloves and wash and dry the

upper inner thighs

Inspect the perineal area. Note for

inflammation, excoriation, or swelling

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(MALE)

Assist the client to turn unto side

facing away from you. Pay particular

attention to the anal area and posterior

folds of the scrotum. Clean the anuswith toilet tissue before washing it if

necessary.

Dry the area wellClean/dispose equipments/supplies

appropriately

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Perform hand hygiene


Redness

Excoriation

Skin breakdown

Discharge

Any localized areas of tenderness

Any unusual findings

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CARE OF THE FEET

FEETessential for ambulation

Inspect for shape, size, presence of lesions

Palpate for tenderness, edema, circulatory status

Common problems: Callus

Corn

Plantar warts

Fissures

Ingrown toenail

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CARE OF THE FEET

INGROWN TOENAILthe growing

inward of a nail into the soft tissues

around it, most often results from

improper nail trimming

UNPLEASANT ODORSoccurs as a

result of perspiration and its interaction

with micoorganisms

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CARE OF THE FEET

Wash feet daily, dry thoroughly esp the

interdigital spaces

Use warm water for foot soak to soften nails

and loosen debris under themUse cream or lotion to moisten skin and

soften calluses

Use deodorant sprays or foot powder to

prevent or control unpleasant odor

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NAIL CARE

Trim nails straight across, or follow thecontour of the fingers

File nails to have smooth edges Do not trim at the lateral corners to

prevent ingrowns (inguis incarnatu) Diabetic clients: do not cut hangnails or

cuticles

Onycholysisseparation of the nail fromthe nail bed Paronychiainflammation of the skin

folds at the nail margin

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MOUTHCARE/ORALHYGIENE

Explain the procedure

Purpose:

- Remove food particles from around and between

the teeth- Remove dental plaque

- Promote sense of well-being

- Prevent sores and infection of oral tissues

Assessment:- lips, gums, oral mucosa, tongue, tooth caries,

halitosis, gingivitis, loose or broken teeth,

dentures

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Equipment:

- Towel

- Disposable gloves

- Emesis basin

- Soft bristled toothbrush

- Water

- Toothpaste

- Mouthwash

- Dental floss

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Perform hand hygiene and other appropriate

infection control measures

Provide for client privacy

Lower the side rail nearest to you and assistclient to a sitting or high fowlers position, if

health permits; or assist to a side-lying position

with head turned

Place the towel under the his chin then put on

the gloves

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Moisten the bristle of the toothbrush then

apply the toothpaste to the toothbrush. Placeand hold the emesis basin under the clientschin

Hold the brush against the teeth with thebristles at a 45 angle then move the bristlesup and down using a vibrating or jugglingmotion. Repeat until all outer and inner

surfaces of the teeth and sulci of the gumsare cleaned. Clean the biting surfaces bymoving the brush back and forth in shortstokes. Brush the tongue gently

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Hand the client the glass of water to rinse mouth

vigorously. Remove emesis basin after then

assist client in wiping his mouth.

Assist client to floss independently or floss his

teeth by holding the dental floss in both hand andfloss between all teeth. Assist the client in rinsing

and wiping is mouth

Clean and return the equipment to the

appropriate location


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Artificial dentures:

- Wear cloves when handling and

cleansing dentures

- Place a washcloth in a basin or bowl ofthe sink when brushing dentures to

prevent damage if the dentures are

dropped

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Unconscious client:

- Place in side lying position to prevent

aspiration

- Have suction apparatus readily available

- Use padded tongue blade to open mouth

- Brush teeth and gums, using toothbrush

or soft spongeended swab- Apply thin layer of petroleum jelly to lips

to prevent drying or cracking

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CARE OF THE HAIR

PROBLEMS (HAIR)

DANDRUFF

HAIR LOSS

TICKS

PEDICULOSIS

SCABIES

HIRSUTISM

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CARE OF THE HAIR

DANDRUFFappears as diffuse scaling of the

scalp

HAIR LOSSpermanent thinning of the hair

usually because of agingTICKSsmall gray-brown parasites that bite into

tissue and suck blood

SCABIEScontagious skin infestation by the

itch mite

Burrow lesion

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CARE OF THE HAIR

HIRSUTISMgrowth of excessive

body hair

PEDICULOSISparasitic insects that

infest mammals (lice); infestation oflice

PEDICULOSIS CAPITIS (head louse)

PEDICULOSIS CORPORIS (body louse)

PEDICULOSIS PUBIS (crab louse)

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HAIRSHAMPOO

Purpose:

- Stimulate circulation of the blood in the

scalp

- Clean the hair and improve the clientswell being

Assessment:

- Hair care practices, condition of the hairand scalp, self-care abilities, evenness of

hair growth

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HAIRSHAMPOO

EQUIPMENTS: water pitcher

waterproof pad

3 bath towels wash cloths

shampoo drain/Kelly pad

shampoo

comb

basin

warm water

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HAIRSHAMPOO




Provide for client privacy Assist the client to the side of the bed from

which you will work. Remove pins and

ribbons from the hair and comb it to remove

any tangles

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HAIRSHAMPOO

Remove the pillow from under the clients

head and place it under the shoulders

(unless contraindicated). Tuck a bath towel

around the clients shoulders. Place theshampoo drain under the head, putting a

folded washcloth or pad where the clients

neck rests

Fanfold the top sheet down to the waist andcover the upper part of the body with a bath

blanket.

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HAIRSHAMPOO

Place the receiving receptacle on the bedside

and put the spout of the shampoo drain over thereceptacle

Place a damp washcloth over the clients eyes

Wet the hair thoroughly with water using thewater pitcher. Apply shampoo to scalp and make

a good lather while massaging the scalp

Rinse the hair thoroughly to remove all the

shampoo. Squeeze as much water as possibleout of the hair with your hands

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HAIRSHAMPOO

Remove the shampoo drain and dry the hair

thoroughly with the towel placed under the

head or another towel

Comb the clients hairAssist the client to a comfortable position

Clean/dispose equipments/supplies

Perform hand hygieneDocument all relevant information

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EYECARE

Cleanse the eyes from inner to outer

canthus, use a new cotton balls for each

wipe

Avoid rubbing eyesMaintain adequate lighting when reading

Avoid regular use of eye drops

If dirt/FB gets into the eyes, clean them withcopious, clean, tepid water as emergency

treatment

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EARCARE

Cleanse the pinna with moist

wash cloth

Do not use bobby pins, toothpicksor cotton-tipped applicators to

remove cerumen

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NOSECARE

Clean nasal secretions by blowing the

nose gently into a soft tissue

Both nares should be open when

blowing the nose to prevent forcingdebris into the middle ear

May use cotton-tipped applicator

moistened with saline or water toremove encrusted, dried secretions

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MAKING BEDS

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ENVIRONMENT

ROOM TEMPERATURE

VENTILATIONimportant to remove

unpleasant odors and stale air

NOISE

HOSPITAL BEDS

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HOSPITAL BEDSMATTRESSESusually covered with a water-

repellent material that resist soiling and can becleaned easily

SIDE RAILSsafety sides; prevents client fromfalling out of bed

FOOTBOARD/FOOTBOOTused to support theimmobilized clients foot in normal right angle to thelegs

BED CRADLESdevice designed to keep the top

bedcloths off the feet, legs and abdomen INTRAVENOUS RODSpoles, stands, standards;

supports IV infusion containers while IVF isadministered

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MAKING BEDS

UNOCCUPIED BED

OPEN BED

CLOSED BED

OCCUPIED BED

SURGICAL BED

UNOCCUPIED BED

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UNOCCUPIED BED

Perform appropriate client assessment


2 flat sheets or 1 fitted sheet & 1 flat sheet

bottom sheet

pillowcase

waterproof draw sheet

cotton draw sheet

blanket

linen hamper

gloves (optional)

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UNOCCUPIED BED




Assist client out of bed to a comfortablechair

Adjust the bed to a comfortable height and

lower both side rails

Remove pillowcase and set pillows aside in

a clean area

UNOCCUPIED BED

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UNOCCUPIED BED

Strip the bed Check the bed linens for any items belonging to

the client. Loosen all beddings starting on the head of the

bed on the far side moving around the bed up to

the head of the bed to the near side. Removereusable linens and fold it. Remove the waterproofpad and discard it if soiled.

Roll all soiled linens inside the bottom sheet. Holdit away from your uniform and place it directly in

the linen hamper Move the mattress securely up to the head of the

bed

UNOCCUPIED BED

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UNOCCUPIED BED

Apply the bottom sheet and draw sheet

Place the bottom sheet with its centerfold on the center ofthe bed. Position the sheet high enough to tuck under thehead of the mattress and along the edge of the mattress atthe foot of the bed. Spread the sheet out over the mattress.

Tuck the top of the sheet under the mattress and miter the

corner nearest you. Tuck the remaining sheet under themattress from head to the foot of the bed If waterproof drawsheet is used, place the centerfold over

the center line of the bottom sheet and position it from theclients back to the knee area. Fanfold the upper most halfand spread over the lower half.

Place the cotton drawsheet in the same manner over thewaterproof drawsheet.

Tuck the drawsheets securely over the side of the mattress

UNOCCUPIED BED

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UNOCCUPIED BED

Move to the other side, secure the bottom linens

Pull the bottom sheet firmly, tuck in the bottom sheetand miter the corner of the sheet. Ensure that there

should be no wrinkles

Complete this same process for the drawsheets

Apply or complete the top sheet. Place the top sheet on the bed with its centerfold atthe center of the bed and the top edge is even with the

top edge of the mattress. Spread the sheet over the

bed.

Make a horizontal or vertical toe pleat

UNOCCUPIED BED

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UNOCCUPIED BED

VERTICAL TOE PLEAT: make a fold in the sheet

2-4 inches perpendicular to the foot of the bedHORIZONTAL TOE PLEAT: make a fold in the

sheet 2-4 inches across the bed near the foot Tuck in the sheet and miter the corner. Leave the

sides of the sheet hanging freely unless toe pleatswere provided.

Move to other side of the bed and secure the top

bedding in the same manner then fold the top of the

top sheet down over the spread, providing a cuff

UNOCCUPIED BED

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UNOCCUPIED BED

Put on the clean pillowcases on the pillows

Grasp the closed end of the pillowcase then gather up

the sides of the pillowcase and place them over the

hand grasping the case and with the free hand, pull

the pillowcase over the pillow. Adjust the pillowcase so

that it fits snugly.

Place the pillows appropriately at the head of the bed

with the open ends facing away from the door. Place

the pillows appropriately at the head of the bed with

the open ends facing away from the door

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UNOCCUPIED BED

Clean and return the equipment to the

appropriate location


OCCUPIED BED

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OCCUPIED BED

Perform appropriate client assessmentAssemble equipment and supplies

2 flat sheets or 1 fitted sheet & 1 flat sheet

bottom sheet

waterproof drawsheet cotton drawsheet

blanket

bath blanket

pillowcase

gloves (optional)

linen hamper

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OCCUPIED BED

Identify yourself and verify clients identity.Explain the procedure


appropriate infection control measuresProvide for client privacy

Adjust the bed to a comfortable working

height and lower the side rails nearest you

leaving the opposite side rail up

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OCCUPIED BED

Remove the top bedding

Remove any equipment attached to the

bed linen Remove any equipment

attached to the bed linen Spread the bath blanket over the patient

and pull gently the top linens by grasping

the top edge of the sheet drawing it down

to the foot of the bed, leaving the blanketin place. Put the soiled linen in the

hamper

OCCUPIED BED

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OCCUPIED BED

Change the bottom sheet and drawsheet

Assist the client in a side lying position

facing away from you. Keep the side rail

on the far side up or have another nursesupport the client on the other side.

Loosen the bottom linens from the head,

side to the foot of the bed. Roll/fanfoldsoiled linens as close as possible to the

client. Keep the client covered throughout

the procedure

OCCUPIED BED

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OCCUPIED BED

Place the clean bottom sheet with its centerfold in the

middle of the bed and the edge of the sheet even withthe foot of the mattress. Vertically fanfold the half to be

used on the far side of the bed as close to the client as

possible. Spread the bottom sheet, tuck and miter the

sheet at the head of the bed. Tuck the remaining sheetfrom head to foot of the bedPlace the clean bottom

sheet with its centerfold in the middle of the bed and the

edge of the sheet even with the foot of the mattress.

Vertically fanfold the half to be used on the far side ofthe bed as close to the client as possible. Spread the

bottom sheet, tuck and miter the sheet at the head of

the bed. Tuck the remaining sheet from head to foot of

the bed

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OCCUPIED BED

Place the waterproof and cotton drawsheetin the same manner as the bottom sheet.

Position the drawsheet at the middle from

the clients back to the knee area. Unfold

and tuck the drawsheet at the side of the

bed.

Assist the client to roll over toward you onto

the clean side of the bed. Move the pillowsto the clean side of the bed. Raise the side

rail near you

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OCCUPIED BED

Move to the other side f the bed.Lower the side rail and remove the

soiled linen and pace it in the hamper

Pull the bottom sheet firmly, tuck andmiter the corner at the head of the bed.

Tuck the remaining side of the sheet

from the head to the foot of the bed.Repeat this with the drawsheet

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OCCUPIED BED

Reposition the client to the center of thebed, reposition the pillow on the center of

the bed and assist him/her to a comfortable

position

Apply or complete the top bedding

Spread the top sheet over the client and pull the

soiled top sheet or bath blanket.

Tuck the top linen at the bottom of the bed andmiter the corners leaving the sides hanging

freely

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OCCUPIED BED

Change the pillowcase and replace itunder the clients head with the open

ends facing away from the door

Ensure patient safety and comfortDispose/clean equipments/supplies


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6.hygiene

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