HYGIENE

Katrina H. Garcia

Hygienic care

Factors Influencing
Individual

Agents commonly used on

skin

bathing

Purpose of Bathing
Cleansing the skin
Removes perspiration, bacteria,

which minimizes skin irritation

and reduces chance of infection
Stimulation of circulation
Warm water and gentle strokes
from distal to proximal increase
circulation and promote venous
return
Improve self-image
Promotes feeling of being

Purpose of Bathing
Reduction of body odors
Especially in axillae and pubic

areas
Promotion of Range of Motion
Movement of extremities while
bathing

Types of Baths
Cleansing Baths
oUsed to clean the patient

Therapeutic Baths

Cleansing Baths
Complete Bed Bath
Nurse baths entire body of

dependent patient in bed

Partial Bath
Parts of the body are washed by
the patient and some by the
nurse

Cleansing Baths
Tub Bath
Much easier for bathing and

rinsing than in a bed

Varies in style
Shower
Used by ambulatory patients who
require only minimal assistance
Can be used with a shower chair

Therapeutic Baths

Bath used for treatment

Usually requires a doctors

order
Medicated solutions may be
used in bathing
Range from warm water baths,

cool water baths, alcohol

Guidelines for Bathing

1.Provide Privacy
2.Maintain Safety
3.Maintain warmth
4.Promote the patients
independence as much as possible

Assessment
Condition of the skin
Physical and emotional factors
Presence of pain need for

adjunctive measure
Range of motion
Aspect of health
Need for use of gloves

Equipment
Washbasin

and water (110-115F).

Hygiene articles, such as lotion, powder,
and deodorant.
Pajamas or gown.
Linen as necessary.
Laundry bag or hamper.
Soap and soap dish.
Bath towels.
Washcloths.
Disposable gloves.

implementation
Preparation
Before bathing
1. purpose/type of bath
2. Self care ability
3. Any movement/ precautions
position
4. Client comfort
5. Necessary bath equipment

Performance
1. Visit the patient; introduce

yourself and inform him of the

procedure. Offer him a
bedpan, urinal, or use of
bathroom.
2. Wash your hands.
3. Privacy
4. Environment

Bed bath
5. Prepare the bed and position the

client
Position the bed at a comfortable
working height
Place bath blanket
Remove clients gown

Bed bath
6.

Make bath mitt

Bed bath
Start with the clients
face.
Begin the bath with the
cleanest area and work
downward toward feet.
Place the bath towel under the
patients head
7.

Bed bath
Bathe the eyelids, using a different

portion of the cloth for each eye.

Cleanse from inner to outer canthus
Apply soap to the cloth, unless soap is
not to be used on the patients face. Do
not leave soap in water. Rinse bath
cloth. Using firm, gentle strokes, wash
the face to the hairline. Wash the ears
and neck. Use cotton-tipped applicators
to cleanse pinna of ear.

Bed bath
Wash the clients arm and
shoulder.
Remove the bath towel from under the
patients head. Expose the arm farthest
from you. Place the bath towel
lengthwise under his shoulder and arm.
Wash the arm, using long firm strokes
from the wrist to the shoulder. Wash the
armpit thoroughly. Rinse and dry. Apply
deodorant if applicable.
8.

Bed bath
Fold the towel in half. Place basin on

folded towel on the bed; immerse

patients hand in the water. Wash
hands and nails while encouraging
finger movements. Clean and trim
the fingernails as needed.
Remove basin and dry the hand.
Repeat the procedure on the near
arm and hand.

Bed bath
9.Wash the chest and abdomen
of the client
Cover the patients chest with bath

towel; fold bath blanket down to

waist; and wash the chest with a
circular motion. Be sure to cleanse
and dry under breast and skin folds
very well.

Bed bath
Fold bath blanket down to pubic area,

keeping chest covered with dry towel.

Wash abdomen including umbilicus
(using cotton-tipped applicators) and
skin folds. Dry thoroughly.
Raise side rail; empty basin into
hopper or stool. Rinse basin and wash
cloth. Refill basin 2/3 full with water at
110 to 115F (43 to 46C).

Bed bath
Legs and feet
Expose the far leg, draping the
sheet securely into the groin
and under the thigh. Check to
see that genitalia are not
exposed when the leg is flexed.
Wash, rinse, and dry the thigh
and leg.
10.

Bed bath
Place the basin on a towel on
the bed so that the patients
foot can be immersed in the
basin with no pressure on the
calf of the leg. Wash the foot,
paying particular attention to
the skin between the toes, at
the heels, and at the ankles.
Encourage toe and ankle

Bed bath
Support the leg at the knee and heel

when moving his foot from the basin.

Place the basin on the table. Dry the
foot thoroughly, rubbing any calloused
area with a towel to remove dead skin.
Apply lotion to the foot and ankle,
massaging the heel in circular motion
with the palm of your hand.
Repeat the procedure on the near thigh,
leg, and foot.
Change the bath water and rinse the
washcloth thoroughly.

Bed bath
11. Back and perineum
Turn the patient to wash his back

and buttocks. His position may be

prone (on the abdomen) or lateral
recumbent (on the side), but the
entire back and buttocks should be
exposed.
Place the towel close to the back
and lengthwise on the bed.

Bed bath
Bathe, rinse, and dry the back from the

neck to the sacrum (region in back of

pelvis). Pay particular attention to the
folds of the buttocks and anal areas.
Rub the back with lotion. Use firm, gentle,
circular movements, starting at the base
of the spine and rubbing with the heel of
both hands, up and out, and over the
shoulders. Finish with circular movements
at the upper spine and nape of the neck.

Bed bath
Assist the client with
Grooming aids

12.

Tub bath or shower

Important Points.

(1) Provide safety measures to

prevent slipping, tripping, or
falling.
(2) Maintain privacy.
(3) Encourage performance.

Tub bath or shower

Assist patient to tub or shower. Be certain

patient wears robe and slippers.

Instruct patient on how to use call signal
and place in use sign on tub or shower
door if private bath is not being used.
If tub is used, fill with warm water (109F
(43C). Have patient test water; adjust
temperature if needed. Instruct patient on
use of faucetswhich is hot and which is
cold. If shower is used, turn water on and
adjust temperature.

Tub bath or shower

Caution patient to use safety bars.

Discourage the use of bath oil in water.

Check on patient every 5 minutes. Do not
allow the patient to remain in tub more than
20 minutes.
Return to room when patient signals. Knock
before entering.
Assist patient out of tub and with drying. If
patient complains of weakness, vertigo, or
syncope, drain tub before patient gets out
and place towel over patients shoulder.

Tub bath or shower

Assist patient into clean gown,

robe, and slippers. Accompany to

room and position for comfort in
either chair or bed.
Make unoccupied bed if patient
can tolerate sitting in chair.
Perform back, hair, nail, and skin
care.
Return to shower or tub. Clean
according to SOP. Place all soiled

Perineal care

Perineal Care
Pericare
Purpose
remove normal perineal

secretions and odor

Promote client comfort

Assessment
Presence of :
irritation, excoriation,

inflammation, swelling
Excessive discharge
odor, pain and discomfort
Urinary/ fecal incontinence
Perineal/rectal surgery
Indwelling cath.

assessment
Determine:
Perineal hygiene
practices
Self care abilities

equipment
Bath towel
Bath blanket
Clean gloves
Bath basin with water
Wash cloth
Cotton swab
Bedpan
Perineal pad

implementation
Preparation:
Determine experience
discomfort
Obtain and prepare the
necessary equipment and
supplies

implementation
Performance:
1. Visit the patient; introduce

yourself and inform him of the

procedure. Offer him a bedpan,
urinal, or use of bathroom.
2. Wash your hands.
3. Privacy
4. Environment

Perineal care
5. Prepare client
6. Position and drape
Female
Back lying position with knees flexed
and spread well apart
Male
Supine position with knees flex and

hips slightly externally rotated

Perineal care
7. Inspect perineal care
8. Wash and dry
Women
Wipe labia majora (outer) from front to
back in downward motion using clean
surface of wash cloth for each swipe.
Wipe labia minora (inner) from front to
back in downward motion using clean
surface of wash cloth for each swipe

Cont. female perineal care

Wipe down the center of the

meatus from front to back. If

catheter in place, clean around
catheter in circular fashion,
using clean surface of wash
cloth for each swipe.
Wash inner thighs from
proximal to distal
Rinse with warm to tepid water

Cont. female perineal care

Pat dry using clean towel in

same order as wash

Remove bedpan if one is used
Verbalize turning patient on side

to wash anal area from front to

back and dry

Male perineal care

Retract foreskin of penis if

uncircumcised
Wash around the urinary meatus in a

circular motion, using clean surface of

washcloth for each stroke and around
the head of penis in circular motion
Wash down shaft of penis toward the

thighs changing washcloth position with

each stroke

Cont. male perineal care

Wash inner thighs
Rinse with clean wash cloth or peri-bottle using

warm water in same sequence as the wash

Dry with clean towel in the same sequence
Replace foreskin, as appropriate
Turn patient on side to wash anus from front to

back and dry

ORAL HYGIENE

Oral hygiene
Maintains the healthy state of the

mouth
Cleanses teeth of food particles,
plaque, and bacteria
Massages the gums
Relieves discomfort from unpleasant
odors and tastes.
Refreshes the mouth and gives a
sense of well-being and thus can
stimulate appetite

Assessment: Oral Hygiene

a. Frequency

Depends on the condition of the patients mouth.

Some patients with dry mouth or lips need care every

2 hours.

Usually done twice a day or after each meal

b. Assistance Needed

Does the patient need assistance to do oral care

*The nurse can help patients maintain good oral hygiene
by:
1. Teaching them correct techniques
2. Actually performing for weakened or disabled
patients.

Cont. Assessment: Oral

Hygiene
Abnormalities
Loose or missing teeth
Swelling and bleeding
of gums
Unusual mouth odor
Pain or stinging in
mouth structures

Brushing
Major concerns are:
Thoroughness in cleansing
Maintaining the condition of

the oral mucosa.

Procedure for Conscious Patient:
Upright position

equipment
Brushing and flossing
Towel
Disposable gloves
Curved basin
Toothbrush
Cup of tepid water
Toothpaste
Mouth wash
Dental floss

Implementation
Preparation:
Assemble equipments
Performance
1. Visit the patient; introduce yourself

and inform him of the procedure.

2. Wash your hands.
3. Privacy
4. Environment

brushing
5. prepare equipment
Place the towel under the clients
chin.
Put on disposable gloves
Moisten the bristles of the
toothbrush with tepid water and
apply the dentrifice to the
toothbrush

brushing
Use a soft toothbrush
For the client who must remain

in bed, place or hold the curved

basin under the clients chin
fitting the small curve around
the chin or neck

6. Brush the teeth

Hold the toothbrush to the client, or

brush the clients teeth as follows:

> 45 degree angle
Move the bristle up and down gently
Repeat until all outer and inner
surfaces

brushing
Clean the biting surfaces by

moving the brush back and forth

over them in short strokes.
Brush the tongue gently with
the toothbrush
Hand the client the water cup
or mouthwash to rinse the
mouth vigorously.

brushing
7. Floss the teeth
Assist the client to floss

independently .
Move floss up and down between
teeth .
Start at the back on the right side,
and work around to the left side .
Give the client tepid water to rinse
the mouth.

brushing
. Remove and dispose of
equipment appropriately.

Brushing: Unconscious
Patient
Safety is of utmost importance
Prevent aspiration
1.Positioninglateral position with head
turned to the side or side-lying. Position
back of head on a pillow so that the face
tips forward and fluid/ secretions will flow
out of the mouth, not back into the throat.

2.Place a bulb syringe or suction machine

with suction equipment nearby. Yankuer
end on suction device.

Keeping the mouth open

1.Use a padded tongue blade to open
the patients mouth and separate the
upper and lower teeth
2.Never place your hand in the
patients mouth or open with your
fingers. Oral stimulation often
causes the biting down reflex and
serious injuries can occur.

Denture Care

Clean dentures as frequently as natural teeth

Dentures are the patients personal property

and should be handled with care because they

can be easily broken.

Care:

Remove before going to bed allows gums to

rest and prevents buildup of bacteria.

Store in a labeled container covered with

water or denture cleaner if available

Tips to remember:
Use gauze squares or washcloth to

grasp front of dentures to prevent from

slipping
Place wash cloth or paper towel in sink
to line it while you are cleaning the
dentures
Work close to the bottom of the sink in
case you drop them.
Use tepid water