Hygiene and Comfort

Factor Influencing Individual Hygienic Practices
Factor Variables
Culture North American culture places a high value on cleanliness. Many North Americans bathe or shower once or twice a day, whereas people from some other cultures bathe once a week. Some cultures consider privacy essential for bathing, whereas others practice communal bathing. Body odor is offensive in some cultures and accepted normal in others.
Religion Ceremonial washings are practiced by some religion
Environment Finances may affect the availability f facilities for bathing. For example, homeless people may not have warm water available; soap, shampoo, shaving lotion, and deodorants may be too expensive for people who have limited resources.
Developmental Level Children learn hygiene in home. Practices vary according to the individual’s age; for example, preschoolers can carry out most tasks independently with encouragement.
Health and Energy Ill people may not have the motivation or energy to attend to hygiene. Some clients who have neuromuscular impairments may be unable o perform hygienic care.
Personal Preferences Some people prefer a shower to tub bath. People have different preferences regarding the time of bathing (e.g. morning versus evening)
Skin Care
General Guidelines for Skin Care
  1. An intact, healthy skin is the body’s first line of defense
  2. The degree to which the skin protects the underlying tissues from injury depends on the amount of subcutaneous tissue and the dryness of the skin.
  3. Moisture in contact with the skin can result in increased bacterial growth and irritation.
  4. Body odors are caused by resident skin bacteria acting on the body secretions. Cleanliness is the best deodorant.
  5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health.
  6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent, bath oil, cream, lotion, powder, deodorant, and antiperspirant.
Common Skin Problem
Problem and Appearance Nursing Implication
Abrasion

  • Superficial layers of the skin are scraped or rubbed away. Area is reddened and may have localized bleeding or serous weeping.
  1. Prone to infection; therefore, wound should be kept clean and dry.
  2. Do not wear rings or jewelry when providing care to avoid causing abrasions to clients.
  3. Lift, do not pull, a client across a bed.
  4. Use two or more people for assistance.
Excessive Dryness

  • Skin can appear flaky and rough.
  1. Prone to infection if the skin cracks; therefore, provide alcohol-free lotions to moisturize the skin and prevent cracking.
  2. Bathe client less frequently; use no soap, or use nonirritating soap and limit its use. Rinse skin thoroughly because soap can be irritating and drying.
  3. Encourage increased fluid intake if health permits to prevent dehydration.
Ammonia Dermatitis (Diaper Rash)

  • Caused by skin bacteria reacting with urea in the urine. The skin becomes reddened and is sore.
  1. Keep skin dry and clean by applying protective ointments containing zinc oxide to areas at risk (e.g., buttocks and perineum).
  2. Boil an infant’s diaper or wash them with an antibacterial detergent to prevent infection. Rinse diapers well because detergent is irritating to an infant’s skin.
Acne

  • Inflammatory condition with papules and pustules.
  1. Keep the skin clean to prevent secondary infection.
  2. Treatment varies widely.
Erythema

  • Redness associated with a variety of conditions, such as rashes, exposure to sun, elevated body temperature.
  1. Wash area carefully to remove excess microorganisms.
  2. Apply antiseptic spray or lotion to prevent itching, promote healing, and prevent skin breakdown.
Hirsutism

  • Excessive hair on a person’s body and face, particularly in women.
  1. Remove unwanted hair by using depilatories, shaving, electrolysis, or tweezing.
  2. Enhance client’s self concept.
Bathing
  • Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
  • Excessive bathing, can interfere with the intended lubricating effect of sebum, causing dryness of the skin.
  • Bathing stimulates circulation
  • Bathing offers an excellent opportunity for the nurse to assess all clients.
Cleaning baths

Given chiefly for hygiene purposes and include these types:

  • Complete bed bath. The nurse washes the entire body of a dependent client in bed.
  • Self- help bed bath. Clients confined to bed are able to bathe themselves with help from the nurse for washing the back and perhaps the feet.
  • Partial bath (abbreviated bath). Only the parts of the client’s body that might cause discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area and back.
  • Bag bath. This bath is a commercially prepared product that contains 10 to 12 presoaked disposable washcloths that contain no- rinse cleanser solution.
  • Tub bath. Tub baths are often preferred to bed baths because it is easier to wash and rinse in a tub.
  • Shower. Many ambulatory clients are able to use shower facilities and require only minimal assistance from the nurse.
Ear Care
Nursing Interventions
  • Cleanse the pinna with moist wash cloth
  • Remove visible cerumen by retracting the ears downward. If this is ineffective, irrigate the ear as ordered.
  • Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen. These can rupture the tympanic membrane or traumatize the ear canal. Cotton- tipped applicators can push wax into the ear canal, which can cause blockage.
Eye Care
Nursing Interventions
  • Cleanse the eyes from the inner cantus to the outer cantus. Use a new cotton ball for each wipe. To prevent contamination of the nasolacrimal ducts.
  • If the client is comatose, cover the ayes with sterile moist compresses. To prevent dryness and irritation of the cornea.
  • Eyeglass should be cleaned with warm water and soap; dried with soft tissue.
  • Clean contact lens as directed by the manufacturer
  • To remove artificial eyes, wear clean gloves, depress the client’s lower eyelid.
  • Hold the artificial eye with thumb and index finger
  • Clean the artificial eye with warm normal saline, then place in a container with water or saline solution.
  • Avoid rubbing the eyes. This may cause infection.
  • Maintain adequate lighting when reading.
  • Avoid regular use of eye drops
  • If dirt/ foreign bodies get into eyes, clean them with copious, clean, tepid water as an emergency treatment.
Nose Care
Nursing Interventions
  • Clean nasal secretions by blowing the nose gently into the soft tissue.
  • Both nares should be open when blowing the nose to prevent forcing debris into the middle ear, via Eustachian tube.
  • May use cotton tipped applicator moistened with saline or water to remove encrusted, dried secretions. Insert only up to cotton tip.
Oral Cavity Care
Measures to Prevent Tooth Decay
  • Brush the teeth thoroughly after meals and at bedtime.
  • Floss the teeth daily.
  • Ensure adequate intake of food rich in calcium, phosphorous, Vit. A, C and D and fluoride.
  • Avoid sweet foods and drinks between meals
  • Eat coarse, fibrous foods (cleansing foods) such as fresh fruits ant raw vegetables.
  • Have dental check up every 6 months.
  • Have topical fluoride applications as prescribed by the dentists.
Brushing and Flossing the Teeth
Purposes
  1. To remove food particles from around and between the teeth.
  2. To remove dental plaque.
  3. To enhance the client’s feelings of well- being
  4. To prevent sordes and infection of the oral tissues.
Nursing Interventions When Providing Oral Care for Conscious Patient
  • Inform the client and explain purpose of the procedure.
  • Provide privacy.
  • Assist in sitting or side-lying position.
  • Place towel under the client’s chin.
  • Moisten bristles of toothbrush and apply dentifrice.
  • Hold kidney basin under the chin.
  • Allow the client to brush his teeth, if possible.
  • Use downward strokes fro upper front teeth; upward strokes for lower front teeth; back and forth strokes for the biting surfaces of the teeth; and hold the brush against the teeth with bristles at 45 degrees angle to penetrate and clean under the gingival margins.
  • Rinse the mouth with adequate amount of water. Floss the teeth.
  • Keep the client comfortable.
  • Do after-care of the equipment and articles.
  • Document relevant data.
For Unconscious Client
  • Place in side-lying position to prevent aspiration.
  • Have suction apparatus readily available.
  • Use padded tongue blade to open the mouth.
  • Brush teeth and gums, using toothbrush or soft sponge-ended swab.
  • Apply thin layer of petroleum jelly to lips to prevent drying or cracking.

Note: Lemon glycerin swabs can be drying to the oral mucosa if used for extended periods.

Care of Artificial Dentures
  • Wear gloves when handling and cleansing dentures.
  • Place a washcloth in a basin or bowl of sink when brushing dentures to prevent damage if the dentures are dropped.
  • Store the dentures in a container with water.
Common Problems of the Mouth
  1. Plaque. An invisible soft film of bacteria, saliva, epithelial cells and leukocytes that adhere to the enamel surface of the teeth.
  2. Tatar. A visible, hard deposit of plaque and bacteria that forms at the gum lines.
  3. Halitosis. Bad breath.
  4. Glossitis. Inflammation of the tongue.
  5. Gingivitis. Inflammation of the gums.
  6. Stomatitis. Inflammation and dryness of oral mucosa.
  7. Parotitis. Inflammation of the parotid salivary glands (mumps).
  8. Sordes. Accumulation of foul matter (food, microorganisms, and epithelial elements) on the gums and teeth.
  9. Periodontal disease. Gums appear spongy and bleeding (pyorrhea).
  10. Cheilosis. Cracking of the lips.
  11. Dental Caries. Teeth have darkened area, may be painful (cavities).
Hair Care
  • The appearance of the hair may reflect a person’s sense of well being and health status.
  • Brushing and combing the hair stimulate circulation of blood in the scalp; distribute the oil along the hair shaft; help to arrange the hair.
Hair shampoo
Purposes
  1. To stimulate the circulation of the blood in the scalp through massage.
  2. To clean the hair and improve the client’s sense of well-being.
Nursing Interventions during Hair Shampoo
  • Determine if the institution requires doctor’s order for hair shampoo.
  • Place client diagonally in bed.
  • Remove pins from hair. Comb and brush hair thoroughly. This is to remove tangles.
  • Place Kelly pad under the head, with neck hyper extended.
  • The trough of the Kelly pad should be directed to a pail. To prevent spillage of the water onto the floor.
  • Cover the eyes with wash cloth. To protect them from irritation.
  • Plug the ears with cotton balls. To prevent entry of the water into the external auditory canal.
  • Apply small amount of shampoo.
  • Massage the scalp with the fat pads of the fingers and make a rich lather.
  • Massage promotes circulation on the scalp. Rich lather ensures through cleansing of the hair.
  • Rinse the hair thoroughly. Soap residue in hair may cause irritation of the scalp and may dry hair.
  • Dry the hair thoroughly.
  • Keep he client comfortable.
  • Do after-care of equipment and articles.
  • Make relevant documentation.
Common Hair and Scalp Problems
  • Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus (seborrheic dermatitis).
  • Alopecia. Lair loss or baldness.
  • Pediculosis. Infestation with lice.
    • Padiculosis capitis is head louse
    • Pediculosis corporis is body louse
    • Pediculosis pubis is crab louse
  • The usual treatment for pediculosis is gamma benzene hexachloride (Kwell), which comes in lotion, cream and shampoo. Pubic lice are difficult to remove, so the shampoo may be applied and left on 12 to 24 hours.
  • Linens and clothing used by clients should be washed in hot water.
  • Scabies. Contagious skin infestation by the itch mite. The characteristic of the lesion is the burrow produced by the female mite as it penetrates the skin. The burrows are short, wavy, brown, or black threadlike lesions.
  • Hirsutism. Excessive growth of body hair.
Foot Care
  • Wash the feet daily, and dry them well especially the interdigital spaces.
  • Use warm water for foot soak, to soften the nails and loosen debris under them. Caution: soaking the feet of diabetic clients is no longer encouraged because excessive moisture can contribute to skin breakdown.
  • Use cream or lotion to moisten the skin and soften calluses.
  • Use deodorant sprays or foot powder to prevent or control unpleasant odor
  • File toe nails straight across. To prevent nail splitting and tissue injury around nail.
  • Change socks or stocking daily.
  • Wear comfortable, well-fitted pair of shoes
  • Do not go bare footed
  • Exercise the feet to improve circulation
  • Avoid using constricting clothing or round garters which may decrease circulation
  • Avoid crossing the legs
  • Avoid self-treatment for corns or calluses
Common Foot Problems
  1. Callus. Painless, flat, thickened epidermis, a mass of keratotic material. Often caused by pressure from the shoe on bony prominence.
  2. Corn. Keratosis caused by friction and pressure from a shoe. It commonly affects the fourth and fifth toe. It appears circular and raised.
  3. Unpleasant odors. This results from perspiration and its interaction with microorganism.
  4. Plantar warts. Caused by virus papova-virus hominis . They appear on the sole of the foot and are moderately contagious. They are painful and make walking difficult.
  5. Fissures. Caused by dryness and cracking of the skin.
  6. Tinea pedis. Characterized by scaling and cracking of the skin, particularly between the toes, caused by a fungus. There may be blisters. (also Athlete’s foot, ringworm of the foot.)
  7. Ingrown Toenail. Inward growth of the nail, causing trauma into soft tissues. It is usually due to trimming the lateral edges of the toenails.
Nail Care
  • Trim nails straight across, or follow the contour of the fingers.
  • File nails to have smooth edges.
  • Do not trim nails at the lateral corners to prevent ingrowns.
  • Diabetic clients are advised against cutting hangnails or cuticles.
  • Ingrown is also called unguis incarnate.
  • Separation of the nail from the nail bed is onycholysis.
  • Inflammation of the skin fold at the nail margin is paronychia.
Perineal- Genital Care
Purposes of Perineal-Genital Care
  1. To remove normal perineal secretions and odor.
  2. To prevent infection.
  3. To promote comfort.
Nursing Intervention during Perineal- Genital Care
  • Inform the client and explain purpose of the procedure.
  • Provide privacy. To maintain client dignity.
  • Position and drape the client as follows:
    • Female: dorsal recumbent position; drape the client diagonally.
    • Male: supine position
    • For female clients, use forceps to hold cotton balls for cleansing the perineum.
    • For male clients, wear clean gloves.

For Female Clients

  1. Use anterior to posterior (front to back) stroke to prevent contamination of urethral meatus and vagina with microorganisms from the anus.
  2. Use one cotton ball for each stroke.
  3. Cleanse perineum with soap/ antiseptic solution. Include the inner thigh.
  4. Rinse the area with copious amount of water. To remove soap adequately and prevent irritation of the perineal area.
  5. Dry perineum thoroughly. Moisture supports microbial growth.

For Male Clients

  1. Wash and dry penis using firm strokes, to prevent erection of the penis.
  2. Use circular motion, from the tip of glans penis towards the penile shaft.
  3. If the client is uncircumcised, retract the prepuce (foreskin). This is to remove smegma that collects under the foreskin and facilitates bacterial growth.
  4. Wash and dry the scrotum and buttocks.
  • For post-delivery or menstruating females, apply a perineal pad as needed from front to back. This prevents contamination of urethra and vagina from anal area.
  • Keep the client comfortable
  • Do the after-care of equipment and articles
  • Document relevant data