FUNDAMENTALS OF NURSING

Nursing 102

Module C: Activities of Daily Living-Hygiene, Comfort

Instructor: Dr. Roark

Reading assignment: Potter & Perry, Fundamentals of Nursing, Chapter 39

Personal Hygiene: How an individual maintains their health with their hygiene
practices

Individual Factors hygiene practices very individualized. Get input from pt. or pt. family

– Social practices can influence times of day, number of times, etc. Ex. Shaving in
diff. cultures
– Personal preferences different brands, etc… Can educate or introduce new
practices; don’t force.
– Body image affects how comfortable a person is w/ help. Weight, pregnancy,
strokes…
– Socioeconomic status homelessness. Mental problems. Poverty, cannot afford
things needed for hygiene.

Other Individual Factors:

– Health beliefs and motivation superstitions, old wives tales, etc…

– Cultural variables some don’t believe in deodorant. Etc… Work w/i cultural
variables.
– Physical condition physical limitations. Ex. COPD- may run out of breath easily.
Schedule breaks. Assess for devices as well as physical conditions.

HYGIENE includes many different concepts these are: make pt feel comfortable,
refreshed and renewed.

Bath, Back Rub, Nail and Foot Care, Oral Hygiene, Hair, Bed

Goals and planning for client hygiene : be sure to schedule around other activities in
hospital (rounds, diagnostics, etc…) as much as possible. Try to schedule around pain assess
for pain.

– Client’s skin is clean, dry, and intact without signs of inflammation

– Client’s skin remains elastic and well hydrated
– Client’s range of motion remains within normal limits
– Client tolerated bathing without excessive fatigue
– Sense of comfort & well-being achieved include pt in planning of hygiene. Ask
what they need and/or have.
Preparation and Implementation of Hygiene Care: WASH HANDS BEFORE
GATHERING EQUIPMENT!

– Provide Privacy treat with respect. Keep door closed, pull curtain in semi-private
room.
– Maintain Safety remain cautious. Bedrails, water, etc…
– Maintain Warmth check room temp before bath, ask client about room setting.
– Promote Independence include pt as much as possible. Allow to do what they can.
– Anticipate needs pain needs. Elimination needs. Etc…
– Assess assess skin, nails, breathing, cognition, etc. while you are bathing. Saves
time.
– Teach whatever you can about illness. Try to make it relevant to pt.

TYPES OF SCHEDULES:

– Early morning care always offer elimination. Offer to wash face and hands before
breakfast. Oral care.
– Morning care offer elimination, bathing, peri care, foot and/or hair care, shaving, get
dressed. Help straighten up room.
– Afternoon care
– Evening care may want shower in evening.

Schedules include changing sheets. Do not have to change everyday as long as there is not
any visible soiling and pt does not want them changed.

Reinforce aseptic techniques.

Mold teaching to home environment and personal factors such as cognition.

A bed bath may be just a nursing task to you, but to your patient it is a highly
personal and intimate experience think about how you would feel.

BATHS :

Complete-for clients who are totally dependent and require total hygienic care
every square inch.

Partial-involves bathing only body parts that would cause discomfort or odor if left
unbathed-includes perineal care allowing pt to do what they can do. Assist only on parts
they want assistance on.

Self-care

On page 869-880 Potter & Perry-Bathing a Client-we will go over supplies

and steps, I will demonstrate, and you see the video demo. UNDRESS THE
UNAFFECTED FIRST! Redress affected first. Wash extremities distal to proximal to
promote venous return to heart.

Skin: Active organ important to prognosis to keep skin intatct.

Functions are:

– Protection keeps microorganisms out of body.

– Secretion sweat helps in protection from
– Excretion sebum micro
– temperature regulation heat loss. Cover all areas not washing. Change wet linens
and gowns asap.
– sensation pressure and pain receptors.

Skin: Implications for CARE

Normal Skin Characteristics:

– Intact with no abrasions can only apply to this type of skin. All others require Dr.
Rx.
– Warm to touch
– Skin color varies take into account ethnicity.
– Smooth, dry, elastic & firm turgor
– Texture – soft, flexible

Feet, Hands, and Nails always look in between digits of fingers and toes when assessing.

Require special attention to prevent infection

Conditions that interfere with movement of the hand can affect a client’s ability for
self care

Nail terms: Cuticle-fold of skin at nail bed root, and Lunula-crescent shaped white
area of nail bed

Normal nail: transparent, smooth, convex, with a pink nail bed and translucent
white tip

Oral Cavity

Oral mucosa-normally pink and moist

Rich supply of blood vessels-floor of mouth and undersurface of tongue

Three pairs of salivary glands that produce 1 L of saliva per day (Buccal glands)

Teeth, for chewing, or mastication check condition of teeth when assessing.

Gingivitis, or gum inflammation, can occur without adequate, regular oral hygiene

Other common findings

Hair-growth, distribution, and patterns can indicate general health status

Alterations that can affect hair condition- malnutrition, cancer, endocrine imbalances,
etc…

Eyes, ears, nose and throat-require special attention during cleansing scleral color,
pupil size, etc… Nasal obstruction or drainage.

ASSESSMENT!

When giving hygiene care, the smart nurse will use this time to also assess the
client’s skin, feet, hands, nails, hair, eyes, ears, nose, and oral cavity!

Assess the skin…

Inspect: color, texture, thickness, turgor, temperature, and hydration

Observe for dryness, flakiness, redness, scaling, and cracking

Be alert for those clients with impaired sensation, vascular insufficiency, and
immobility

Turn client, and assess all surfaces

Assess feet, hands, nails…

Feet: examine all skin surfaces including areas between the toes, and the soles of
the feet; note shape and size of toes

Clients with peripheral vascular disease (such as diabetes) should be assessed for
adequate circulation and sensation

Neuropathy-degeneration of the peripheral nerves characterized by a loss of

sensation

Nails: inspect condition, and look for dryness, inflammation, lesions, or cracking.
Observe for change in shape, and curvature

Assess the oral cavity…

Inspect all areas for color, hydration, texture and lesions

Note condition of gums

Halitosis: bad breath

Note condition of teeth

Assess hair…

Assess condition of hair and scalp

Hair of black skinned clients may be thicker, dryer, and curlier than hair of light
skinned clients

Inspect for lice

Alopecia-loss of hair-can result from chemotherapy, medications, hormonal

changes, improper hair care practices, or stress

Assess the eyes, ears, and nose…

Normally eyes are free of infection, clera are visible and white, conjunctiva (lining of
the eyelids) are clear, pink, and free of inflammation, lashes outward, lid margins
are without inflammation, drainage, or lesions

Eyebrows-symmetrical

Ears-inspect outer structures, and note cerumen

Inspect nares for signs of inflammation, discharge, lesions, edema, and deformity

Nasal mucosa is normally pink and clear with little or no discharge

Tubing

Risk factors for skin impairment

– Immobilization
– Reduced sensation
– Nutrition and hydration alterations
– Secretions and excretions on the skin
– Vascular insufficiency
– External devices
– Pressure Ulcer

Patients at Risk for Hygiene Problems

– Immobilized
– Equipment
– Advanced therapies (such as Cancer therapy)
– Dehydration
– Surgery
– Sensory impairment
– Blood coagulation problems

Eye care

Cleansing-wash with clean washcloth moistened with water

Do not apply direct pressure

Wash eye from inner to outer canthus

Eyeglasses

Contact lenses

Perineal Care

Part of the bed bath

Clients most in need are those with secretions or Foley catheters and following
rectal surgery or childbirth

Be alert to discharge, skin irritation, and odors

Good perineal care prevents skin irritation and breakdown

Turn to page 877, Potter & Perry, and we will review supplies and steps

Foot and Nail Care

Soak/soften cuticles.

Cleanse and dry the feet thoroughly.

Trim nails straight across (check agency policy regarding trimming of nails).

Inspect for lesions, dryness, and signs of infection.

Clients with DM or PVD are at risk for impaired circulation.

Oral Hygiene

Involves cleanliness, comfort, and moisturizing the mouth

Unconscious client check for gag reflex. May require suction if they do not have good
reflex.

Flossing and brushing

Denture care ask preference for cleaning solution. TEPID water. Hot will warp them. Pull up
and out on bottom. Down and out on upper. Same sequence as teeth in mouth. Store in
appropriate container.

Procedure for Oral Hygiene top palate- inner, bottom, outer lower palate- inner, top,
outer.

Turn to procedure in Potter & Perry, pg. 886

We will go over the supplies needed and the steps for oral hygiene
Denture care procedure: page 891, Box 39-13

Hair Care Can have effect on self esteem

Brushing and combing helps to distribute natural oils evenly throughout scalp

Brushing/combing hair from scalp to end brush gently to remove tangles.

Shampooing

Be sure to consider cultural or religious implications for hair care.

Supplies and Procedure for Hair Care

Turn to page 892, Box 39-14, Potter & Perry

We will go over the supplies

We will go over the steps

Shaving be sure to check pt chart to find out if there are any bleeding precautions such as
illnesses or meds like Coumadin or heparin.

Facial hair can be done after a bath or shampoo

Soften the skin first

Electric razor must be used on client’s who are prone to bleeding

Refer to the client’s normal routine

Pull skin taut, use short firm razor strokes in the direction the hair grows

Never shave off a mustache or beard without the client’s consent

Bed Making

Client’s bed should be kept clean and comfortable. Helps prevent injury. Makes pt feel
better.

General Guidelines…

“Open” bed has comforter, blanket, and top sheet folded down to bottom of bed ready for
pt to get back in. When pt. is in and out of bed or gone but coming right back.

“Closed” bed pull everything up to top of bed.

“Surgical” bed Covers and sheets pulled to the side so when pt is brought from surgery
they can slide them off stretcher into bed easier.

ADL - activities of daily living

 – Eating
– Toileting
– Bathing
– Transferring
– Walking
– Going outside

IADL - instrumental activities of daily living

– Meal preparation
– Shopping
– Money management
– Telephone use
– Light/Heavy housework

LIFESPAN depending where you work you may run into all or some of these age groups.
There are differences in conducting hygiene in different age groups.

– Neonate/Infant sensitive skin.

– Toddler
– Childhood
– Adolescence acne, sebum production.
– Adult
– Older Adult dry skin, delicate skin. Limited movement. May not need a complete
bath everyday. Changes in bones and body structures.

Developmental Issues

Skin immature in the neonate, more active in the adolescent

The older client also has special considerations

The Older Client

Aging effects skin

Other hygiene issues associated with aging

Be aware that the process of aging affects the condition of body tissues and
structures fatty distribution, osteoporosis.

Chronic foot problems seen more in the older adult loss of nerve sensation in feet.

Older adults may have sensory aids and sensory deficits hearing aids, glasses, etc…

Infant Bath

Steps similar
 – Temperature control very immature in a neonate. Easily chilled.
– Preserve body heat Keep covered amap
– Acidic covering helps prevent microbe growth. Do not scrub too much and change
pH.
– Soap Choices use body wash like johnsons, etc…
– Avoid alkalines delicate soaps. Johnsons baby wash, etc… Not using powder as
much because of inhalation.

Infant bathing wait about one hour before bathing new baby. Allow parent to assist if they
are able and want to. Bonding.

Umbilical cord sponge bathe until stump falls off usually within 14 days.

Circumcision sm. Amount of blood is natural. Keep clean and dry as possible.

Infection control may still have mother’s blood on them

– Vernix caseosa cheese like substance on skin, grayish white. Protects baby in
womb. Usually dries up after 24-48 hrs.

Infant bathing

– Water temp. warm to the inside of your arm

– Infants’ scalp
– Skin is sensitive try not to rub more than need to. Pay attention to extra skin rolls.
– Girls’ perineal care retract labia. May be vernix caseosa there to clean.
– Boys’ perineal care DO NOT RETRACT UNCIRCUMSISED NEONATE FORESKIN
BEFORE 30 DAYS OLD.
– Diaper under umbilical stump.

Childhood

– Toddler never leave unattended when providing hygiene. Keep hazardous materials
out of reach.
– School-age respect wishes and privacy amap. Allow to conduct as much of their own
hygiene as they can.
– Adolescents skin very active due to hormonal changes. Respect privacy and wishes
amap. Just assist unless physical condition does not allow.

Comfort to soothe. A state of ease and well-being.

Room environment

– Temperature make sure pt is comfy. Do they need blankets? Assess.

– Noise eliminate or decrease noise pt has to deal with. 3rd shift be considerate of
nearby pt rooms.
– Lighting ask pt if they want lights on. Most rooms have night lights for rounding.
– Odors try to decrease odors with good ventilation.
 – Neat and clean

Back Rub

– Usually follows bath

– Benefits
– Method
– Client preferences some don’t want to be touched more than necessary.
– Contraindications spinal injuries, lumbar punctures, etc…

Environmental Safety

Definition-Safe environment

– basic needs are met Food, bathroom, etc…

– physical hazards are reduced cleaning up spills. Floor clear of clutter. Call light in
reach, bed in lowest position, etc…
– sanitation is maintained
– transmission of parasites and pathogens is reduced hand washing, droplet and
airborne precautions, don’t shake sheets, etc…
– pollution is controlled trash taken out, etc…

Environmental Safety Hazards

Health care agencies

– Procedure-related accidents med errors, anything that happens in care of pt. Fluid
admin errors.
– Equipment-related accidents orient pt to facility. Make sure machines work
properly.
– Special equipment necessities

Safety precautions for Personal Hygiene

– Hands/gloves wash before gathering equipment, wearing gloves, change them

when they rip.
– Equipment have all equipment with you and near you
– Falls biggest safety issue in health care agencies. Gait belts, frequent monitoring,
etc…
– Water temp check temp of any water to be used
– Safety bars
– No baby oil creates slippery surface. Hazard for fall.
– Time limit showering or bathing, watch time to avoid skin damage
– Linens do not place soiled linens against your body
– Posture
– Oral hygiene check for gag reflex, working suction at bedside.
– Call light/side rails
If it’s not charted,
it’s not done