Chapter 20 Personal Hygiene

Seatwork What are the purposes of good hygiene? 2 minutes to discuss as a table group… Good hygiene cleanses the skin and mucous membranes. The skin is the body’s first line of defense against disease, it must be intact to prevent microbes from entering the body. The mucous membranes of the mouth, genital area, and anus also must be clean and intact to prevent infection. Good hygiene also prevents body and breath odors. It is relaxing and increases circulation. Hygiene promotes comfort, safety, and health.

Seatwork What are the purposes of good hygiene? Good hygiene cleanses the skin and mucous membranes. The skin is the body’s first line of defense against disease, it must be intact to prevent microbes from entering the body. The mucous membranes of the mouth, genital area, and anus also must be clean and intact to prevent infection. Good hygiene also prevents body and breath odors. It is relaxing and increases circulation. Hygiene promotes comfort, safety, and health. Good hygiene cleanses the skin and mucous membranes. The skin is the body’s first line of defense against disease, it must be intact to prevent microbes from entering the body. The mucous membranes of the mouth, genital area, and anus also must be clean and intact to prevent infection. Good hygiene also prevents body and breath odors. It is relaxing and increases circulation. Hygiene promotes comfort, safety, and health.

Personal Hygiene Hygiene promotes comfort, safety, and health. Intact skin: Is the body’s first line of defense against disease Prevents microbes from entering the body and causing an infection Mucous membranes of the mouth, genital area, and anus must be clean and intact. Personal Hygiene See the Body Structure and Function Review Box on p. 321 in the Textbook.

Personal Hygiene (cont’d) Good hygiene: Cleanses the body Prevents body and breath odors Is relaxing Increases circulation Culture and personal choice affect hygiene. Many factors affect hygiene needs. The nurse uses the nursing process to meet the person’s hygiene needs. Follow the nurse’s directions and the care plan. Personal Hygiene (cont’d) Review the Caring About Culture: Personal Hygiene Box on p. 322 in the Textbook. Perspiration (sweating), elimination, vomiting, drainage from wounds or body openings, bedrest, and activity affect hygiene needs. Illness and aging changes can affect self-care abilities. Some people need help with hygiene. Review the Focus on Children and Older Persons: Personal Hygiene Box on p. 322 in the Textbook. Review the Focus on Communication: Personal Hygiene Box on p. 322 in the Textbook.

Daily Care You assist with hygiene whenever it is needed. Most people have hygiene routines and habits. Routine care is given during the day and evening. Early morning/AM care is given before breakfast. Morning care is given after breakfast. Afternoon care is done after lunch and before the evening meal. Evening/PM care is given in the evening at bedtime. You assist with hygiene whenever it is needed. Daily Care You must protect the person’s right to privacy and to personal choice. Night shift or day shift staff members give AM care. See p. 323 in the Textbook for a list of measures performed during AM care, morning care, afternoon care, and PM care.

Oral Hygiene Oral hygiene (mouth care) Flossing Keeps the mouth and teeth clean Prevents mouth odors and infections Increases comfort Makes food taste better Reduces the risk for cavities (dental caries) and periodontal disease Flossing Removes plaque and tartar from the teeth Removes food from between the teeth Oral Hygiene Periodontal disease (gum disease, pyorrhea) is an inflammation of tissues around the teeth. Plaque and tartar build up from poor oral hygiene. Plaque is a thin film that sticks to teeth. When plaque hardens, it is called tartar. Tartar build-up causes periodontal disease. The nurse, the speech/language pathologist, and the dietitian assess the person’s need for mouth care. If done once a day, bedtime is the best time to floss. Review the Focus on Children and Older Persons: Oral Hygiene Box on p. 323 in the Textbook. Review the Focus on Children and Older Persons: Flossing Box on p. 324 in the Textbook.

Oral Hygiene (cont’d) Are very weak Cannot move or use their arms Many people perform oral hygiene themselves. Others need help gathering and setting up equipment. You perform oral hygiene for persons who: Are very weak Cannot move or use their arms Are too confused to brush their teeth Oral Hygiene (cont’d) A toothbrush with soft bristles is best. Use only denture cleaning products for dentures. When using sponge swabs, check the foam pad to make sure it is tight on the stick. Review the Delegation Guidelines: Oral Hygiene Box on p. 324 in the Textbook. Review the Promoting Safety and Comfort: Oral Hygiene Box on p. 324 in the Textbook.

D&S Skill: Mouth Care- Brushing Teeth

Oral Hygiene (cont’d) Mouth care for the unconscious person Unconscious persons may have mouth dryness and crusting on the tongue and mucous membranes. The care plan tells you what cleaning agent to use. Use sponge swabs to apply the cleaning agent. Applying a lubricant to the lips after cleaning prevents cracking of the lips. Check the care plan. Oral Hygiene (cont’d) Oral hygiene keeps the mouth clean and moist. It also helps prevent infection.

Protect unconscious persons from choking and aspiration (breathing fluid, food, vomitus, or an object into the lungs). Position the person on one side with the head turned well to the side. Use only a small amount of fluid to clean the mouth. Do not insert dentures. Keep the person’s mouth open with a padded tongue blade. Always assume that unconscious persons can hear. Mouth care is given at least every 2 hours. Follow the nurse’s directions and the care plan. Oral Hygiene (cont’d) Aspiration can cause pneumonia and death. Dentures are not worn when the person is unconscious. Do not use your fingers to keep the person’s mouth open. Explain what you are doing step by step. Tell the person when you are done, when you are leaving the room, and when you will return. Review the Promoting Safety and Comfort: Mouth Care for the Unconscious Person Box on p. 328 in the Textbook.

D&S Skill: Mouth Care of the Comatose Resident

Oral Hygiene (cont’d) Denture care A denture is an artificial tooth or a set of artificial teeth. Full and partial dentures are common. Mouth care is given and dentures cleaned as often as natural teeth. Dentures are slippery when wet. To use a cleaning agent, follow the manufacturer’s instructions. Hot water causes dentures to lose their shape (warp). Remind patients and residents not to wrap dentures in tissues or napkins. You clean dentures for those who cannot do so. Oral Hygiene (cont’d) With full dentures, the person has no upper or no lower natural teeth. Dentures replace the upper or lower teeth. With a partial denture, the person has some natural teeth. The partial denture replaces the missing teeth. During cleaning, firmly hold dentures over a basin of water lined with a towel. If not worn after cleaning, store dentures in a container with cool water, or a denture-soaking solution. Review the Promoting Safety and Comfort: Denture Care Box on p. 329 in the Textbook.

Oral Hygiene (cont’d) Remove the upper denture by grasping it with the thumb and index finger. Use a piece of gauze to grasp the slippery denture, if needed. Brush the other surfaces of the denture with back-and-forth motions. (Note that the denture is held over the sink. The sink is filled half-way with water and is lined with a towel. Position the brush vertically to clean the inner surfaces of the denture. Use upward strokes. Brush the chewing surfaces with back-and-forth motions

D&S Skill: Denture Care

Bathing Bathing has the following benefits: It cleans the skin. It cleans the mucous membranes of the genital and anal areas. It is refreshing and relaxing. Circulation is stimulated and body parts exercised. Observations are made. You have time to talk to the person. Complete or partial baths, tub baths, or showers are given. Bathing Bathing removes microbes, dead skin, perspiration, and excess oils.

Bathing (cont’d) The bathing method depends on: The person’s condition Self-care abilities Personal choice The person’s choice of bath time is respected whenever possible. Bathing frequency is a personal matter. Bathing (cont’d) Personal choice, weather, activity, and illness affect bathing frequency. The rules for bed baths, showers, and tub baths are listed in Box 20-1 on p. 332 in the Textbook. Review the contents of Table 20-1 on p. 332 in the Textbook. Review the Focus on Children and Older Persons: Bathing Box on p. 333 in the Textbook. Review the Delegation Guidelines: Bathing Box on p. 333 in the Textbook. Review the Promoting Safety and Comfort: Bathing Box on p. 334 in the Textbook.

For a complete bed bath, you wash the person’s entire body in bed. Bed baths are usually needed by persons who are: Unconscious Paralyzed In casts or traction Weak from illness or surgery For a towel bath, an oversized towel is used. Bag baths are commercially prepared or prepared at the agency. Bathing (cont’d) You give complete bed baths to persons who cannot bathe themselves. Some people are embarrassed and fear exposure. Explain how you give the bath. Explain how you cover the body for privacy. The nurse and the care plan tell you when to use a towel bath. To give a towel bath, follow agency policy. Review the Focus on Children and Older Persons: Towel Baths Box on p. 338 in the Textbook. Follow the nurse’s directions and the manufacturer’s instructions for bag baths.

The partial bath involves bathing the face, hands, axillae (underarms), back, buttocks, and perineal area. Some persons bathe themselves in bed or at the sink. You assist as needed. Tub baths and showers Falls, burns, and chilling from water are risks. Safety is important. Protect the person’s privacy. Follow the nurse’s directions and the care plan. Bathing (cont’d) You give partial baths to persons who cannot bathe themselves. The rules for bathing in Box 20-1 on p. 332 in the Textbook apply to partial baths, tub baths, and showers. Follow the safety measures in Box 20-2 on p. 340 in the Textbook. Never let weak or unsteady persons stand in the shower. Review the Focus on Long-Term Care and Home Care: Tub Baths and Showers Box on p. 342 in the Textbook. Review the Delegation Guidelines: Tub Baths and Showers Box on p. 342 in the Textbook. Review the Promoting Safety and Comfort: Tub Baths and Showers Box on p. 342 in the Textbook. Review the Teamwork and Time Management: Tub Baths and Showers Box on p. 342 in the Textbook.

D&S Skill: Bed Bath- Whole Face and One Arm, Hand and Underarm

Back Massage (Back Rub) Relax muscles and stimulate circulation Given after baths and showers and with evening care Can be given after repositioning or to help the person relax Last 3 to 5 minutes Observe the skin before the massage. Lotion reduces friction during the massage. During the massage, use firm strokes. After the massage, apply some lotion to the elbows, knees, and heels. Back Massage (Back Rub) Look for breaks in the skin, bruises, reddened areas, and other signs of skin breakdown. To warm the lotion before applying it, do one of the following: Rub some lotion between your hands. Place the bottle in the bath water. Hold the bottle under warm water. During the massage, keep your hands in contact with the person’s skin. Review the Delegation Guidelines: The Back Massage Box on p. 344 in the Textbook. Review the Promoting Safety and Comfort: The Back Massage Box on p. 344 in the Textbook.

Perineal care (pericare) involves cleaning the genital and anal areas. Cleaning prevents infection and odors, and it promotes comfort. Perineal care is done: Daily during the bath Whenever the area is soiled with urine or feces Perineal Care The genital and anal areas provide a warm, moist, and dark place for microbes to grow.

Perineal Care (cont’d) Perineal care is very important for persons who: Have urinary catheters Have had rectal or genital surgery Are menstruating Are incontinent of urine or feces Are uncircumcised Perineal Care (cont’d) Being circumcised means that the fold of skin (foreskin) covering the glans of the penis was surgically removed. Being uncircumcised means that the person has foreskin covering the head of the penis.

Perineal Care (cont’d) The person does perineal care if able. This procedure embarrasses many people and staff. Standard Precautions, medical asepsis, and the Bloodborne Pathogen Standard are followed. When giving perineal care: Use warm water, not hot. Use washcloths, towelettes, cotton balls, or swabs according to agency policy. Rinse thoroughly. Pat dry after rinsing. Perineal Care (cont’d) Use terms the person understands. The term must be in good taste professionally. Work from the cleanest area to the dirtiest. This is commonly called cleaning from “front to back.” Review the Focus on Communication: Perineal Care Box on p. 347 in the Textbook. Review the Delegation Guidelines: Perineal Care Box on p. 347 in the Textbook. Review the Promoting Safety and Comfort: Perineal Care Box on p. 347 in the Textbook.

D&S Skill: Perineal Care Female

D&S Skill: Perineal Care Male with Changing a Soiled Brief

Reporting and Recording Report the following observations at once: Bleeding Signs of skin breakdown Discharge from the vagina or urinary tract Unusual odors Changes from prior observations Report and record the care given. If care is not recorded, it is assumed that care was not given. Reporting and Recording You make many observations while assisting with hygiene. Not recording observations and care can cause serious legal problems.