Personal Hygiene

• It is the nurses
responsibility to provide
the patient with the
opportunity for hygiene
• The skill may be delegated
but not always, depends on
facility policy.
 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 refreshed,
relaxed
 Purpose of Bathing
• Reduction of body odors
– Especially in axillae and pubic areas
• Promotion of Range of Motion
– Movement of extremities while
bathing
 Nurse’s Advantage

• Provides opportunity to develop a

meaningful nurse-patient relationship

• Provides opportunity for assessment of

the patient including condition of
patient, psychosocial and learning needs.
Before You Begin Bathing

It is the Nurses Role to:

• Assess Your Patient

Factors Affecting Personal Hygiene
1. Social Practices

2. Personal Preferences

3. Body Image

4. Socioeconomic Status

5. Health Beliefs and Motivation

6. Cultural Variables
p 770
• Complete Bed Bath
– Nurse baths entire body of dependent
patient in bed

• Self-Help Bath
– Patients confined to bed are able to bathe
themselves with some help

• Partial Bath
– Parts of the body are washed by the patient
and some by the nurse
 Back Rub
• May be performed after drying off
the back during the bath.

• Position of Patient: Prone or side-lying

• Expose only the back, shoulders, upper arms.

Cover remainder of body
• Lay towel alongside back

• Warm lotion in your hands—still explain that

it may be cool and wet.
 Guidelines for Bathing
1. Provide Privacy

2. Maintain Safety

3. Maintain warmth

4. Promote the patient’s independence

as much as possible
 Procedure for Bathing

• Bed Bath
– Potter and Perry p. 797
 Perineal Care
• Can be embarrassing for the nurse and
the patient.
• Should not be overlooked because of
embarrassment.

• If the patient can do it themselves—let

them.
– Hand them the washcloth and ask if
they would like to “finish their bath.”
 Perineal Care
• Those patients who may need the nurses
assistance:
– Vaginal or urethral discharge
– Skin irritation
– Catheter
– Surgical dressings
– Incontinent of urine or feces
 Perineal Care Procedure
Normal conditions, Discharge, Menses

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
• 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
 Cont. Female Perineal Care
• Rinse with warm to tepid water using pour
from peri-bottle if available.

• 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
 Perineal Care - Male
• 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

• Wash scrotum – front to back

• Wash inner thighs

continued
 Cont. Perineal Care - Male
• 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

• Potter and Perry, p. 801

 Perineal Care with Catheter

• Follow similar
procedure in the male
patient.

• Start at the urethra

opening and clean
outward.
 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 patient’s
mouth.
• Some patient’s 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.
 Oral Hygiene Assessment
c. 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
– Potter and Perry, p. 808
 Brushing: Unconscious Patient

See performance checklist in syllabus

Safety is of utmost importance
• Prevent aspiration
1. Positioning—lateral 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
 Oral Hygiene: Unconscious
Patient
• 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 patient’s

mouth or open with your fingers. Oral
stimulation often causes the biting –down
reflex and serious injuries can occur.

Potter and Perry p. 811

 Denture Care
• Clean dentures as frequently as natural teeth

• Dentures are the patient’s 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
 Denture Care
• Procedure: Potter and Perry p.
787
• 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
 Part D: Hair Care
• A person’s appearance and
feeling of well-being often
depends on the way their
hair looks and feels
Major Goals in Hair Care

Stimulate Circulation

Prevents Matting
 Brushing and Combing
• Keeps hair clean and distributes oil evenly
along the hair shaft
• Combing styles hair and prevents from
tangling
• Assessment while brushing
– Scalp lesions, abrasions
– Dandruff
– Parasitic infestations
– Quality of hair
– Appearance
 Hair Care: Shampooing
• Depends on:
– Personal preference of the patient, does not
have to occur every day with hygiene
– Condition of the hair

• Ways to Shampoo
– If patient can get up and into a shower or sink,
use a hand held nozzle
– If patient can not get up, place on stretcher
and roll to a shower area
– If patient is unable to be moved, may shampoo
in the bed – see procedure in Potter and Perry
p. 789.
– “Shampoo in a Bag” or dry shampoos are
available
 Part E: Shaving
• Improves self-esteem and emotional
needs of the patient

• Usually done after the bath or shampoo

• Assessment:
– Skin for elevated moles, warts,
Rashes, patchy skin lesions, or
pustules
 Shaving
 Provide Safety
 When using a razor blade,
the skin must be softened to
prevent pulling, scraping, or
cutting
 Place a warm wash cloth
over area and then apply
some gel, cream, foam.
 Hold the razor at a 450 angle
 Pull the skin taut
 Shave in the direction of hair
growth
 Shaving
–Safety Precautions

–Electric razors must be used in

patients who are at risk for
bleeding, confused, or
depressed
 Part F: Foot and Nail Care
• Usually part of the bath

• Purpose:
– Eliminate sources of infection and
decrease odors

• Assessment:
– Color, shape length, texture of nails
– Condition of skin around nails and between
toes and fingers – swollen, inflamed,
callused, lesions, temperature
 Foot and Nail Care
• Soak the hand or foot to
soften the cuticles

• Thoroughly cleanse and dry

• Trim the nails ONLY if you

have permission or it is
allowed at that institution.
Most institutions do not
allow nurses to trim the
nails.
 Foot and Nail Care
• Teach patient and family that nails should be
cut – straight across. May need to get a
referral if no one available to cut nails.

• Show close attention to the feet and nails of

the diabetic patient and the elderly

** If feet and nails are in bad condition–

notify doctor so a consult can be ordered
with a podiatrist
 Part G: Ear Care

• Usually requires minimal care

• Cleanse the external auricle with

washcloth when bathing

• Avoid insertion of objects into the ear

 Hearing Aids
a. Check that the device is functioning correctly and
clean any body oils or cerumen from the hearing
aid

b. Make sure the hearing aid is off and volume is

down before insertion

c. Insert hearing aid in ear by pulling earlobe

downward while pressing the hearing aid inward

d. Turn on and adjust volume

e. Ask the patient if comfortable and can they hear!
 Part G: Eye Care
• Assessment:
– Abnormal lesions
– Discharge
– Tearing
– Presence of any infection
– Use of Visual Aids (contacts, glasses)
• Ask when patient needs to use these
devices
 Eye Care
• Wash around the eyes with a warm moist
washcloth with warm water—NO SOAP!

• Clean from the inner canthus to the outer

canthus of the eye. Pay special attention to
the inner canthus.

• Provide special care for the eyes of

unconscious patients.
– May need to tape the eye lids shut if
unable to blink and protect own eyes