Personal Hygiene

By : Ns. Lilik supriati, MKEP

What is it???
Hygiene : Health
Personal hygiene : the self care measures people use to maintain their health

PURPOSE OF NURSE PROVIDED HYGIENE

Remove microorganisms Do physical assessment Increase circulation
Distal to proximal Return to heart

Improve self image Provide comfort

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Factor Affecting Personal Hygiene

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SOCIOCULTURAL FACTORS
Bathe daily; not all cultures do Economics Some cultures wear items not to be removed in bath
examples: wigs, head dressings, medals or shawls

Male nurse only or female nurse only may be necessary in some cultures
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SOCIOCULTURAL FACTORS
Male relative may not allow male nurse alone with woman patient Autonomy of patient is paramount; in others, family makes decisions for care Level of education Nurse accepts all who lovingly participate
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KNOWLEDGE
May need teaching regarding:
Front to back perineal care Special foot care for circulatory problems Skin inspections by dermatologist

DEVELOPMENTAL LEVEL: NEWBORNS

Do not place under running faucet Do not submerge until umbilical cord drops off Dry carefully, especially the head Place cap after bath
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YOUNG CHILDREN
Children can drown in 2 inches of water; never leave alone during bathing No milk or juice bottles in bed Wipe off teeth after eating with soft cloth Demonstrate on teddy bear
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CHILDREN
Children may have natural parents, stepparents, four sets of grandparents For decision making, some cultures must ask father, some must ask grandmother
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ADOLESCENTS
Modesty essential Normal clothes, not gowns Bed pans not acceptable Allow decision making

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OLDER ADULTS
Heat insensitivity; can burn easily

Foot care
Skin very fragile

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Personal Preferences
In providing hygiene, may find very personal details Report on need to know basis Decide together on what to take further Must break personal preferences if signs of abuse
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Physical Condition
Patient receiving chemotherapy
Patient receiving radiation therapy Unconscious patient

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Hygiene Care Schedule

Early morning care: Urinal/bedpan, wash hands and face, brush teeth Morning care: After breakfast, complete bath or shower, hair care, nail care, oral care, back rub, linen change Afternoon care: straighten linen, offer urinal/bedpan/commode, wash hands/face Evening care: Elimination, wash hands and face, oral care, linen straightening, back rub
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HYGIENE includes:
Care of the skin Care of the feet and nails Oral hygiene Hair care Care of the eyes, ears, and nose Clients room environment
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Care of Skin

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SKIN
Regulates body temperature First line of defense against harm Antibacterial and antifungal Transmits sensations Signs of problems
Redness (erythema) Wet Not intact
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PATIENTS AT RISK FOR SKIN PROBLEMS

Altered level of consciousness Altered nutrition Immobility Dehydration Altered sensation Secretions on skin Mechanical devices, restraints Altered venous circulation
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Nursing Diagnosis
Impaired skin integrity related to immobilization, exposure to chemical irritants
Hygiene self care deficit : bathing related to pain in hands, forced immobilization, musculoskeletal weakness
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NURSING INTERVENTIONS
Goals : - Client will have intact skin - Client will be free of odors

Expected outcomes : - Skin will be without redness - Skin will be warm, soft, smooth, and well hydrated - Odors will be reduced or eliminated
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Continue
Intervention : Bathe client daily Dry skin thoroughly after each cleansing Apply lotion to skin after bathing
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NURSING ASSESSMENT WHILE BATHING

Color and condition of skin Pain on movement Level of consciousness Injuries Scars Skin turgor Nevi Weight loss or gain
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PERINEAL CARE
Professionalism always Female
Always sterile to contaminated (urethra to rectum)

Male
Assess for circumcision
If not, cleanse under foreskin and replace

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Care of the feet and nails

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Common Foot & Nail Problems

Callus Corns Plantar warts Ingrown nails Rams horn nails Paronychia Foot odors
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Nursing Diagnosis
Pain related to callus formation, ingrown toenails Impaired physical mobility related to painful foot lesion Impaired skin integrity related to improper nail-cutting practices, friction of shoes, injury to nail
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FOOT CARE
Soak feet as part of bath Clean toes and toenails Teach as you go Range of motion of legs Feet of diabetic patients and patients with vascular disease are inspected carefully; Never cut toenails of these patients
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NAIL CARE
Observe circulation; color, capillary refill time Observe color, sensation, and movement (CSM) Cut nails straight across and file smooth; Do not go down into corners Assess for rings too tight or too loose
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Oral hygiene

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Oral Hygiene
Common oral problems :
Dental caries Periodontal diseases

Nursing Diagnosis :
Altered oral mucous membrane related to radiation of oral cavity

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MOUTH CARE
Examine with gloves and light, especially smokers Use only water soluble lubricants Unconscious patient has no gag reflex, position on side for care Teach about brushing and flossing

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Hair care

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Hair and Scalp Problems

Dandruff Pediculosis (Lice)
Pediculosis Capitis (Head Lice) Pediculosis Corporis (Body Lice) Pediculosis Pubis (Crab Lice)

Hair Loss (Alopecia)

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Nursing Diagnosis
Impaired skin integrity related to scalp laceration Pain related to scalp lesion, accumulated secretions in hair Body image disturbance related to unkempt physical appearance Risk for infection related to scalp laceration
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Nursing Interventions
Brushing Combing Shampooing Shaving Mustache and beard care

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Care of the eyes, ears, and nose

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Nursing Diagnosis
Sensory perceptual alterations (visual, auditory, or olfactory) related to obstruction in ear canal, nasal obstruction, inflammation of eyes or local eye infection
Risk injury related to decrease of visual, auditory, or olfactory function
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EYE CARE
Contact lenses usually removed Stored in saline liquid; case labeled Also label and safeguard glasses in drawer Clean inner to outer canthus Patient must be able to blink to protect cornea Never use cotton near eyes Treat each eye separately Eyes considered sterile
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EARS
Allow nothing sharp in ears Hearing aids now miniscule in size dont lose! Label case Cerumen in ears may need softening and removing Speak directly to patients face

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Continue

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Clients room environment

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BEDMAKING
Make bed for patient comfort If incontinent, wash, rinse, dry, change linen Position as ordered

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NURSE SAFETY IN BEDMAKING

Raise bed to working height Face patient Bend knees Conserve steps Dont lift alone Side rails as ordered Lower bed and place call bell when leaving
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Any Questions ???

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