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Personal hygiene needs vary with clients health status cultural practices in the daily routines
they follow at home for most clients personal hygiene includes bathing in perineal careOral care
eyecare, hair, nail, and foot care; and shaving. Personal hygiene has such a profound effect on
overall health comfort and well-being it is an integral component of individualized care plans
Oral hygiene for example BrushingFlossing and rinsing or not only important for preventing to a
second I’m disease but they also help promote comfort nutrition and verbal communication
bathing enhances self-worth by improving the clients appearance is it remove sweat oil in micro
organisms from the skinIt’s important to provide these essential aspect of care according to the
facility policy and as often as Asseri to maintain good health and comfort
When clients become ill have surgery or injured and are unable to manage their own personal
hygiene needs it becomes your responsibility to meet those needs before beginning it’s
important to assess each clients ability to participateI n personal hygiene. Encourage clients to
participate in any way they can
bathing is an important part of the clients daily care. Not only does it remove sweat oil in micro
organisms from the client skin but it also stimulates circulation and promotes a feeling of
self-worth by improving the clients appearanceFor clients were on bedrest, bathing can also be
a time for socialization
Besides his therapeutic benefits spelling is also an opportune time to communicate with the
clientPerform a head to toe assessment on their skin and provide client education using both
inspection and palpation assess the skin color texture and thickness temperature and hydration
be sure to assess skin turgor and for any areas of redness or skin breakdown over bony
prominencesThis is especially important for clients who have limited mobility since they are at
greater risk for skin breakdown and pressure ulcers
You may have to reduce the clients bathing schedule based on your assessment of the client
skin condition for example if a client has flaky arms you should be at the client less frequently to
prevent further skin breakdown ensuring the client is rinse thoroughly because soap left on skin
may cause further irritation
Types of baths
Depending on the clients physical abilities health problems and degree of hygiene needed you
can choose from a variety of bathing techniquesThe most common methods are a complete bed
bath partial bed bath therapeutic bath shower and tub bath
Complete bed Bath
For clients who are totally dependent in bed and unable to bed themselves you’ll provide a
complete bed bath using either a commercial bag bath Or cleansing pack. Compared to
traditional basin bath these products reduce the risk for infection by disease producing
gram-negative organisms however a complete bed bath can be exhausting to the client so you
may do a partial bed bath cleaning only the areas that are needed
Partial bed Bath
You were the client can complete a partial bath bathing only the parts of the body that can cause
discomfort if not bestThese include the hands face axillae Back and perineal area clients were
dependent and require only a partial bath or self-sufficient clients who must remain in bed but
cannot reach all body parts often receive a partial bed Bath
Therapeutic bath
A therapeutic bath is part of the treatment plan for such conditions as skin disorders burns
elevated body temperature and muscular injuries. Oatmeal corn starch and commercial bath
products are sometimes added to the bathwater to relieve skin irritation. For clients who have
had rectal or peroneal surgery a sits bath is often prescribed to reduce pain and inflammation to
add this type of bath to a clients plan of care a prescription from the provider is needed
Shower
For clients who are ambulatoryOr are able to sit in a shower chair showering is the preferred
bathing method because it’s gonna be tiring however it is important to provide a shower chair
and monitor clients closely to make sure they are safe and not risk for falls or other injuries
Tub bath
A tub bath involves immersing the clientIn a tub of water to provide more thorough washing and
rinsing than a bed bath can provide this type of bath is appropriate for either independent
clientsAnd for dependent clients if a lifting device is availableTo help with positioning the client in
the tub
Older adult client
Even though bathing has many benefits excessive bathing of older adults can be harmful since
they have reduced skin elasticities decreased collagen and tissue thinning consider only bathing
once or twice a week to prevent skin oil removal the bag bath is also useful for older adults As
well as in critical and long-term care settings since it reduces the risk of infection the bag bath
contains a no rinse surfactant a humectant to trap moisture and an emollientThe cleansing pack
includes pre-moist in towels that clean moisturizer and condition the skin at the same time
When performing a bed bath with soap water and a washcloth for the washcloth instrument over
your hand to keep water from splashing or dripping onto the bed or the clientIt also helps keep
the edges of the washcloth from brushing against the client
To fold a washcloth into a met wrap one edge of the cloth around your palm and fingers wrap
the other edge of the washcloth around your hand and hold it in place with your thumb finally
took the top edge of the washcloth under the edge that is in the palm of your hand
Nail and foot care is performed on a regular basis to assess For lesions dryness and signs of
infection this is especially essential for clients who have peripheral vascular disease diabetes
mellitus Or immunosuppression or otherwise at a higher risk for developing or nail problems
You will perform nail in footcare during bathing. Soak the clients hands and feet in a basin of
water for a short period of time while performing other hygiene procedures. Then wash their
hands And feet with soap and water. When drying the hands and feet be sure to drive between
each finger and each toe
If you trim the clients fingernails or toenails, cut them straight across to prevent injury or trauma
to the surrounding tissue. Before cutting any clients nails check the facilities policy as some
settings and client conditions require provider prescriptions for foot care. In some cases a
podiatrist is required for toenail care
Clean underneath the clients nails using an orange wood stick or the end of a plastic applicator
stick to remove debris that can harbor microorganisms. Shape the nails and smooth and rough
edges using a nail file. Apply lotion to the clients hands and feet focusing on dry or calloused
areas if the clients hands or feet are extremely dry in the skin is cracked use a deep penetrating
moisturizer
Foot and nail care will vary from the standard when caring for a client who has diabetes mellitus
peripheral neuropathy or peripheral vascular disease. Do not soak the fee due to the risk of
infection and do not cut the nails. Instead file them using a nail file.Do not apply lotion between
my fingers or toes since the moisture can cause skin irritation and break down.
Perineal Care is a part of a complete bed bath. Clients who are at risk for infection are most in
need of perineal care. These are usually clients who are uncircumcised, have indwelling urinary
catheters, are recovering from rectal or genital surgery or childbirth, or having a menstrual
period. clients need to be encouraged to perform their own care. Embarrassment can be a
major deterrent for the nurse for performing perineal care. A gender congruent nurse can
perform this care efficiently. It is important to maintain a professional straightforward attitude and
to protect the clients privacy at all times during this procedure
Because your hands will come
into contact with mucous membranes and possibly body fluids
when you provide perineal care follow standard precautions at all times. Not only does this
protect you but it protects the client
Perineal care is often included in bathing and involves cleaning the perineum external genitalia,
and surrounding skin. For clients who are recovering from rectal or genital surgery or from
childbirth or for clients who have an indwelling catheter, you might have to provide perineal care
frequently to prevent skin breakdown, infection, and odor. Inquire about burning during urination
Before beginning perineal care, position the bed at a comfortable working height. Position the
client with knees bent and legs slightly apart, unless contraindicated. This position exposes the
areas you will clean and allows for more thorough bathing
While providing personal hygiene, keep the client covered as much as possible to maintain
privacy and comfort and to keep the client warm. Before perineal care, drape the area with a
bath blanket or a towel. Your technique will vary depending on the client’s genitalia.
Male client: draping a male client for perineal care involves placing a bath blanket over the
abdomen and covering the legs with a sheet or towel. Once you have organized all supplies and
you are ready to begin providing care, fold the blanket or towel back to expose the perineal
area.
Female client: for a female client, place a bath blanket over the abdomen so that one corner is
pointing in the direction of the head and the other corner is covering the perineal area. Secure
the lateral corner of the blanket loosely around the client’s legs. When you are ready to begin,
fold the corner of the blanket loosely around the client’s legs. When you are ready to begin, fold
the corner covering the perineal area back onto the client’s abdomen to expose the area you will
bathe.
Incontinence care:
– If you are caring for a client who is incontinent, provide perineal care frequently to help
prevent skin breakdown and infection. The procedure is the same as for routine perineal
care with one difference: after you have washed, rinsed, and dried the perineal area,
apply a cream or ointment on the perineum and surrounding skin as prescribed to act as
a barrier that will help protect the client’s skin
Maintaining oral hygiene is important for preventing the development of plaque-related
disorders. Regular oral hygiene includes brushing, flossing, and rinsing. Brushing the teeth
helps to remove food particles as well as plaque and bacteria. Brushing also massages the
gums, which helps eliminate odors and unpleasant tastes. Flossing teeth can help remove
debris that the toothbrush could not and helps break up bacteria at the gumline.
The frequency of oral hygiene will vary with each client.
Careful assessment of the oral cavity should be done to help determine how frequently oral
hygiene should be provided. Check with agency policies and procedures for oral hygiene, as
they may vary. Generally, brushing of the teeth should occur at least twice a day with an
approved fluoride toothpaste and flossing at least once a day.
Lack of or inadequate oral hygiene, especially in those who are ill, can lead to discomfort and
infection
or localized soreness, excoriation, or pain in the perineum. The vaginal and perineal areas can
be inspected at this time, as well as noting any abnormal odors.
How you perform oral hygiene for your client will depend on the client’s level of independence
and whether they have natural teeth or dentures.
Independent clients:
– clients who are able to sit in a fowlers or semi-fowler’s position can usually perform their own
oral hygiene as long as the necessary supplies are within easy reach. For independent clients,
sitting on the edge of the bed or standing at the sink is also an option when performing oral
hygiene.
When a client is performing oral hygiene, it is important to observe the process and provide any
necessary teaching about brushing and flossing. This is also a good time to discuss the
importance of oral hygiene and good oral health with the client.
When oral hygiene is performed correctly and often enough, the client’s mucous membranes
and gums should be pink, moist, and intact; teeth should appear clean and shiny; and no mouth
odor should be noticeable. A client whose mouth has any signs of inflammation or infection may
need oral hygiene more frequently as well as education about the proper techniques for
brushing and flossing.
Dependent clients:
When clients become ill, have surgery, or have a medical condition that inhibits the use of their
hands, you must perform oral hygiene for them. Before assuming dependent clients are
incapable of performing any of their oral hygiene, assess their level of dependence and invite
them to participate in any way they can.
Add the level of assistance that is required to the client’s plan of care. The health care team can
then be aware of how and to what extent they have to assist the client with oral care.
For clients who are receiving oxygen therapy, have a nasogastric tube in place, or are NPO
(receiving nothing by mouth), oral hygiene is particularly important. Because these clients often
have dry mouths, the risk of bacteria, mucus, and other mouth secretions accumulating on the
tongue, teeth, and lips increases. As a result, the risks of inflammation, infection, and a general
state of poor oral health increase.
Unconscious clients:
An unconscious client requires frequent and meticulous oral hygiene to prevent oral health
problems from developing. Because these clients usually breathe through their mouth and are
unable to take anything in by mouth, bacteria, secretions, and epithelial particles can easily
accumulate on the lips, teeth, and tongue, causing additional health concerns.
Because unconscious clients are at risk for aspirating during oral hygiene, you must always
have a suction set up at the bedside and ready to be used before you begin providing oral
hygiene.
Proper positioning can help reduce the risk of aspiration. For an unconscious client, the best
position is side-lying with the client’s head turned toward you in either a semi-fowler’s position or
with the head of the bed flat. Placing the client in one of these positions allows fluid and any oral
secretions to collect in the dependent side of the mouth and drain out.
Proper oral hygiene needs to be provided to remove secretions and keep the mucosa of the
mouth moist. You may need assistance to provide care: one person to suction and one person
to complete the oral care. Some agencies use equipment that combines a mouth swab with a
suction device. A small oral airway or a padded tongue blade may be used to keep the mouth
open when providing care using this equipment without resistance.
When oral hygiene is not performed correctly or often enough, oral health problems can
develop. The most common of these are plaque and tartar buildup, tooth decay, gingivitis, and
periodontitis. Plaque is a soft, sticky, colorless substance that forms on the hard, rough,
surfaces of the teeth. If plaque is not removed and accumulates on the teeth, the gums can
become irritated, the outer enamel of the teeth can be destroyed, and halitosis can develop
Another common dental problem resulting from the accumulation of plaque on the client’s teeth
is tooth decay, also known as dental caries or cavities. It is caused by the aid in the plaques
bacteria destroying the outer surfaces of the tooth
Gingivitis is the early stage of periodontal disease. It involves inflammation of the gums and
oftentimes bleeding when the client brushes and flosses the teeth. With proper oral hygiene,
which includes both brushing and flossing, gingivitis can usually be reversed.
If gingivitis is left untreated, periodontitis develops. This gum disease destroys the supporting
structures of the teeth, including bone, and is characterized by red, swollen, bleeding gums.
Denture care:
– Encourage clients who wear dentures to care for them in the same manner as they
would care for their natural teeth. Keeping dentures clean can help prevent the gums
from becoming irritated and infected. To keep bacteria from building up underneath the
dentures and to give the gums a rest, dentures should be removed at night.
– Before removing the client’s dentures, break the seal on the upper denture by gently
moving the denture up and down or by placing your finger on the edge of the denture
and pulling down. Remove the upper denture by grasping the plate between the thumb
and index finger wrapped in gauze and pull downward. To remove the lower denture,
gently lift it from the jaw and rotate one side downward. Place the dentures in emesis
basin or sink
– For clients who are unable to care for their own dentures, it is your responsibility to
provide this care for them. Because dentures are the client’s personal property and are
costly to replace if broken or damaged, handle them with care when cleaning them.
When preparing to clean dentures over a sink, place a towel or a washcloth in the
bottom of the sink to avoid breakage if you drop them.
– When rinsing a client’s dentures, be sure to use cool or tepid water. Avoid hot water
because heat can soften the material that some dentures are made of, resulting in
damage to the dentures.
– If dentures are stained, soak them in a commercial cleaner following the manufacturer’s
directions. If the dentures have any metal pieces, avoid soaking them overnight because
this can cause corrosion. Rinse them well before putting them back into the clients
mouth
– When the dentures are not being worn, store them in a small amount of water in a
denture cup or in a container with a lid. Label the cup with the client’s name and room
number and store it in a safe place to prevent loss. Label the cup with the client’s name
and room number and store it in a safe place to prevent loss. Discourage the client from
placing dentures in a napkin or a facial tissue because they can be easily mistaken as
garbage and discarded.
– Because dentures improve the client’s speech, appearance, and self image, it’s
important to put them back in as soon as possible after oral hygiene or after the client
returns from a procedure. If the dentures are dry, moisten them with water before putting
them back in the clients mouth. After cleaning, ask if the client needs help inserting the
dentures. Moisten the upper denture and press firmly to seal it in place. Insert the
moistened lower denture.
Shaving:
– Shaving is often a component of personal hygiene care. For facial hair, shaving is done
after the bath or after you have shampooed the hair. Some clients need the hair on the
legs and axillae shaved during bathing. Depending on the clients hair growth and
personal preference, daily shaving might be required.
– For clients taking anticoagulants or high doses of aspirin or for those who have low
platelet counts or bleeding disorders, use an electric razor. Before using it, make sure it
is in good working condition and will not harm the client. Check facility policy about using
a clients electric razor or a hospital-issued electric razor. Check the razor for frayed
cords or other electrical hazards.
– When using a disposable razor, be sure the clients skin is soft before beginning to shave
it. To accomplish this, place a warm washcloth over the clients face for a few seconds
before applying shaving cream. Softening the skin first helps prevent pulling, scraping, or
cutting the skin during shaving. When clients are unable to shave themselves, a nurse
will have to shave for them.
– To avoid causing discomfort and to reduce the risk of cutting the clients skin during
shaving, pull the skin taut and use long, firm strokes to shave the larger areas of the face
and short downward strokes to shave around the chin and lips. Shaving in the direction
of hair growth is also helpful. Clients who have tightly curled or kinky hair are at
increased risk of experiencing ingrown hair, so they need to be shaved close to the skin.
– If the client has a beard or mustache, they may need daily grooming. It is important to
keep these areas clean, since food particles and mucus can collect in the hair. Comb
and trim the clients beard and mustache as necessary. However, it is inappropriate to
shave a clients beard or mustache off without the permission to do so
Accepted practice:
– You will change bed linens after the clients bath, while the client is out of the bed sitting
in the chair or out of the room. You will also straighten the bed linens throughout the day
to remove any wrinkles and change them if you find them wet or soiled. Encourage
clients on bed rest to participate as much as possible, as this can help maintain their
strength, mobility, and come independence with activities of daily living
– It is ideal to change bed linens when the client is out of the bed. However, if the client is
too weak to get out of bed or restricted to bed rest, you will have to change the linens
while the client is in bed. Because this can be tiring for the client, be sure you are
organized before beginning this process. If the client is experiencing any pain,
administer a prescribed PRN analgesic about 30 to 60 minutes beforehand to help
control the pain and make the client as comfortable as possible while you change the
linens.
– When changing the linens on the client’s bed, you may not have to change all linens
each day. Typically you will change the bottom sheet, top sheet, and the pillowcase.
However, you can leave the same mattress pad, blanket, and bedspread in place if they
are not wet or soiled.
– Follow standard precautions by wearing gloves if the linens are soiled and by keeping
the linens away from your scrubs when placing them in the linen hamper. Also, avoid
shaking the linens since this can spread microorganisms in the air. If at any time during
the linen change the clean linens touch the floor, place them in the linen hamper and use
clean ones instead.
– Observing good body mechanics and client safety is also important when changing the
linens on the client’s bed. Be sure the bed is at a comfortable working height so that you
don’t have to bend or stretch over the mattress to remove the dirty linens or to put clean
ones on the bed. Also, make sure the side rails are up when changing an occupied bed
to keep the client from rolling out of bed and to give the client something to hold onto
while moving from side to side.
– Before beginning the process of changing the clients bed linens, be sure that you have
all of the necessary supplies. Try to plan ahead and bring only the linens you will use.
You cannot place any extra linens you bring into the client’s room back on the linen cart
until after they have been laundered.
– Depending on whether you are changing the bed linens for the current client or for a
client who will be admitted, leave the linens either in an open or a closed position. For a
closed bed, leave the top sheet and the bedspread at the top of the mattress under the
pillow until the client is admitted. For an open bed, fold back the top covers so that it is
easy for the client to get back into bed.
– In addition to an open or closed bed, you’ll prepare unoccupied beds for clients who will
be brought to the unit after surgery. With this type of bed, you won;’t tuck in or miter the
corners. Instead, you’ll fold them to the bottom third of the bed to make transferring the
client from the stretcher to the bed easier.
– After you have replaced the bed linens, lower the bed to its original position and make
sure the wheels are locked to keep the client from falling when getting in and out of the
bed. In addition, place the call light, bed controls, client-controlled analgesia button, and
any other devices the client needs within the client’s reach.
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