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B260: Fundamentals of Nursing
Scientific Knowledge Base
Physical hygiene is necessary for comfort,
safety, and well-being.
Ill patients require assistance with
personal hygiene.
Several factors influence a patient’s
hygiene practices, such as culture and age.
Good hygiene techniques promote normal
structure and function of tissues.
Apply knowledge of pathophysiology to
provide preventive hygiene care.
The Skin
• Functions include
– Protection, secretion, excretion,
temperature regulation, and
• Two layers
– Epidermis: shields underlying
– Dermis: contains bundles of
collagen, nerve fibers, blood
vessels, sweat glands, sebaceous
glands, and hair follicles
 Subcutaneous: tissue lies just
beneath the skin; contains blood
vessels, nerves, lymph, and loose
connective tissue filled with fat cells
The Feet, Hands, and Nails
• Feet, hands, and nails require special
attention to prevent infection.
• The hand in contrast to the foot is used
for manipulation rather than for
• The condition of a patient’s hands and
feet influences his or her ability to
perform hygiene care.
• The normal nail is transparent,
smooth, and convex, with a pink nail
bed and a white tip.
The Oral Cavity
• Cavity is lined with mucous membranes.
• Normal oral mucosa is light pink, soft, moist,
smooth, and without lesions.
• Medications, exposure to radiation, and mouth
breathing can impair salivary secretion.
• Xerostomia—dry mouth
• Gingivitis—inflammation of the gums
• Dental caries—tooth decay
• Growth, distribution, and pattern indicate
general health status.
• Hormonal changes, nutrition, emotional stress,
physical stress, aging, infection, and other
illnesses can affect the hair.
• Sun, chemicals, hair products, permanents, and
straightening and coloring agents can also
affect the hair.
Eyes, Ears, and Nose
• When hygiene care is provided, the eyes, ears,
and nose require careful attention.
• Clean the sensitive sensory tissues in a way that
prevents injury and discomfort for a patient,
such as by taking care to not get soap in his or
her eyes.
• The sense of smell is an important aid to
• Male
– Circumcised vs. uncircumcised
• Female
– Front to back
Nursing Knowledge Base
• Factors influence a patient’s personal hygiene.
• Use communication skills to promote the
therapeutic relationship.
• During hygiene, assess:
– Emotional status
– Health promotion practices
– Health care education needs
Factors Influencing Hygiene
Social patterns
Ethnic, social, and
family influences on
Dictate hygiene
hygiene patterns
Body image
A person’s subjective
concept of his or her Influences the type
body appearance
and extent of hygiene
practices used
Factors Influencing Hygiene
Health beliefs and Cultural variables
People from diverse
Motivation is the key
cultures practice
factor in hygiene.
different hygiene
Physical condition
May lack physical
Affects the patient’s energy and dexterity
ability to perform
to perform self-care
hygiene care
Factors Influencing Hygiene
• Developmental stage
– Skin (sensitive neonate skin,
active glands in puberty, thinning
and drying with age)
– Feet and nails (dry skin, systemic
disease footwear problems,
chronic foot problems)
– Mouth
• Teeth (teething, caries, gum disease,
– Hair (shaving, puberty, aging)
– Eyes, ears, nose
Critical Thinking
Integrate nursing knowledge.
Consider developmental and cultural
Think creatively.
Be nonjudgmental and confident.
Draw on your own experiences.
Rely on professional standards.
Nursing Process: Assessment
• Explore the patient’s viewpoint.
• Assess:
Self-Care Ability
Oral cavity
Hair and hair care
Use of sensory aids
Hygiene care
• Patients at risk for hygiene problems
Feet and Nails
Eyes, ears, and
Nursing Assessment
Nursing Process: Diagnosis
• Common diagnoses associated with hygiene:
– Activity intolerance
– Bathing self-care deficit
– Dressing self-care deficit
– Impaired physical mobility
– Impaired oral mucous membrane
– Ineffective health maintenance
– Risk for infection
• Use the patients’ actual alteration or the alteration for
which they are at risk.
Nursing Process: Planning
• Goals and outcomes
– Partner with the patient and family
– Measurable, achievable, individualized
• Set priorities based on assistance required, extent of
problems, nature of diagnoses
• Teamwork and collaboration
– Health care team members
– Family
– Community agencies
Use caring to reduce anxiety, promote comfort.
Administer meds for symptoms before hygiene.
Be alert for patient’s anxiety or fear
Assist and prepare patients to perform hygiene
as independently as possible.
Teach techniques and signs of problems.
Inform patients about community resources.
• Health promotion
– Make instructions relevant.
– Adapt instruction to patient’s facilities and
– Teach the patient ways to avoid injury.
– Reinforce infection control practices.
• Acute, restorative, and continuing care
– Hygiene measures vary by patient needs and
health care setting.
• Consider normal grooming
routines, and individualize care.
• Bathing and skin care
– Therapeutic: sitz, medicated
– Complete bed bath, shower
– Partial bed bath
• Bag baths
• Perineal care
• Back rub
• Foot and nail care
Bath Guidelines
Provide privacy.
Maintain safety.
Maintain warmth.
Promote independence.
Anticipate needs.
• Oral hygiene
– Brushing removes particles, plaque,
and bacteria; massages the gums; and
relieves unpleasant odors and tastes.
– Flossing removes tartar at the gum
– Rinsing removes particles and excess
• Patients with special needs: diabetes,
artificial airways, unconscious,
Care of Dentures
• Oral hygiene – Unconscious
– Turn patient’s head
towards you
– Place patient in semifowler’s
– Oral air way can be used to
hold mouth open
– Use a small brush or swab
to clean the mucous
membranes and teeth
– Use suctions to remove
secretions and fluid
– Use chap stick or lip
• Hair and scalp care
– Brushing and combing
• Distributes oil
• Prevents tangling, as does braiding
• Obtain permission before braiding or
• Procedures for head lice
– Shampooing
– Shaving
– Mustache and beard care
Shampooing Hair of Patient
Who Is Bed-Bound
• Care of the genitalia:
• 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.”
• Those patients who may need the
nurses assistance:
– Vaginal or urethral discharge
– Skin irritation
– Catheter
– Surgical dressings
– Incontinent of urine or feces
Peri-care: Female
• 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
Peri-care: Female
• 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
Peri-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
• Wash down shaft of penis toward the thighs
changing washcloth position with each stroke
• Wash scrotum – front to back
• Wash inner thighs
Peri-care: Male
• Rinse with clean wash cloth or peribottle using warm water in same
sequence as the wash
• Dry with clean towel in the same
• Replace foreskin, as appropriate
• Turn patient on side to wash anus from
front to back and dry
• Care of the eyes, ears, and
– Basic eye care
– Eyeglasses
– Contact lenses
– Artificial eyes
– Ear care
– Hearing aid care
– Nasal care
Hearing Aids: In the Canal
Hearing Aids: In the Ear
Hearing Aids: Behind the Ear
• Patient’s room environment
– Maintaining comfort: temperature, noise,
lighting, ventilation, odors
– Beds
• Features: raising, adjusting, side rails
• Clean, comfortable, and safe
– Bed making
• Occupied
• Unoccupied
Room Equipment
Foot Boots
Linen Care
Evaluate during and after each intervention.
Observe for changes in patient’s behavior.
Consider the patient’s perspective.
Often it takes time, repeated measures, and a
combination of interventions for improvement.
• Expected outcomes met?
• Patient’s expectations met?
• Ask questions to determine appropriate changes
to interventions.
Safety Guidelines
Communicate clearly with team members.
Incorporate patient’s priorities.
Move from the cleanest to less clean areas.
Use clean gloves for contact with nonintact skin,
mucous membranes, secretions, excretions, or blood.
• Test the temperature of water or solutions.
• Use principles of body mechanics and safe patient
• Be sensitive to the invasion of privacy.