1. HYGIENE
Nur 102
Fall semester 2014/2015
Dr Khulood Shattnawi

2. HYGIENE hygiene: is the science of health & maintenance
Personal hygiene: is the self-care by which people attend to such functions such as bathing, toileting, general body hygiene, & grooming
Hygiene is highly personal matter determined by:
Individual values
Individual practices
Purpose : promote cleanliness, provide comfort and relaxation, improves self images, and promote healthy skin
Involves care of the skin, hair, nail, teeth, mouth, eye, ear, and perineal area

3. HYGIENEIC CARE
The type of hygienic care provided depends on the client’s ability, needs, and practices
Nurses commonly use the following terms to describe types of hygienic care
Early morning care: is provided to clients as they awaken in the morning. (e.g., providing urinal or bedpan, washing the face& hands, & giving oral care)

4. Morning care: is often provided after clients have breakfast, although it may be provided before breakfast( e.g., providing for elimination needs, a bath or shower, perineal care, back massages,& oral, nail, & hair care
Making client's bed is part of morning care
Hour of sleep (HS OR Afternoon care) care: is provided to clients before they retire for the night. It usually involves providing for elimination needs, washing face& hands, giving oral care,& giving back massage
As-needed care (prn): care is provided as required by the client
E.g., a client who is diaphoretic( sweating profusely) may need more frequent bathing& change of clothes & linen.

5. Factor Influencing Hygiene Read table (33-1) P.742
Culture
Religion
Environment and socioeconomic status
Developmental level
Health and energy
Personal references ( tub or shower, time of bathing)

6. Functions of the Skin Protection Body temperature regulation Sensation
Excretion
Maintenance of water and electrolyte balance
Vitamin D production and absorption

7. ASSESSING Assessment of the clients skin & hygiene practices includes:
Nursing health history: to determine
The client’s skin care practices: it enable the nurse to incorporate the client’s needs & preferences as much as possible in the plan of care
self care abilities: it determines the amount of nursing assistance & type of bath( e.g., bed, tub, shower) best suited for the client
Important considerations include:
The client balance for tub & shower
Activity tolerance (fatigue, pain)
Coordination

8. 4) vision
Appropriate joint range of motion
Adequate muscle strength
The client’s preferences
8) cognition & motivation
The client’s functional level (0→completely independent +4 →totally dependent)
read table (33-2) page (744) (definitions & descriptors for functional level)

9. Presence of past or current skin problems: (abrasion, excessive dryness, ammonia dermatitis, acne, erythema, hirsutism) alerts the nurse to specific nursing interventions or referrals the client may require
B- Physical Assessment:
It involves inspection & palpation
Preferable done when assisting in bathing& other hygienic care
The nurses collect data about (skin color, uniformity of color, texture, turgor, temperature, intactness, & lesions)

10. Common skin problems
Abrasion: superficial layers of the skin are scraped or rubbed away, area is reddened and may have localized bleeding or serous discharge
Excessive Dryness: skin may appear rough
Ammonia Dermatitis( Diaper rash): reacting of skin bacteria with urea in the urine. Skin become reddened and is sore
Acne: inflammatory condition with papules and pustules
Erythema: redness associated with a variety of conditions, such as rashes, exposure to sun and fever
Hirsutism: Excessive hair growth on face particularly in women

11. C- At risk client:
Limited joint mobility
Dehydration
On chemo or radio therapy
Immunosuppressant
Reduce sensation
Chronic disease
Excessive secreration
Malnourished
Limited sensory ability

12. Nursing diagnosis
Self care deficit ( for pt have problem performing hygienic care)
Bathing/hygiene
Dressing/grooming
Toileting
R\T weakness or tiredness
pain
cognitive and perceptual impairment
therapeutic procedure restraining mobility( cast, IVF)

13. Associated Diagnosis Deficit knowledge related to
lack of experience with skin condition( acne)& need to prevent 2nd infection
New therapeutic regimen to manage skin problems
Lack of experience in providing hygiene care to dependent person
Unfamiliarity with devices available to facilitate sitting on or rising from toilet
Situational low Self-Esteem related to
Visible skin problem( acne or alopecia)
Body odor
Risk for impaired skin integrity & impaired skin integrity

14. PLANNING:
In planning care, the nurse, if appropriate, the client and/or family set outcomes for each nursing diagnosis.
Goals:
To increase self care ability
To increase pt knowledge
To promote self esteem
To prevent complications associated with immobility
( bed ulcer)
The nurse then performs interventions & activities to achieve the client outcomes, such activities may includes:
Assisting dependent client with bathing, skin care, perineal care
Providing back massages to promote circulation
Instructing clients/families about appropriate hygienic practices & alternative methods of dressing
Demonstrating use of assistive equipment & adaptive activities

15. Planning in assisting client with personal hygiene includes consideration:
Client’s personal preferences( when & how to bath)
Client’s health
Limitations
The best time to give the care
The equipment, facilities, & personnel available
Assess client comfort with the gender of the care giver ( bathing is embarrassing and stressful to modest individuals ).

16. Implementation General guidelines for skin care:
An intact skin is the body’s first line defense
The degree to which the skin protect the underlying tissuees from injury depend on the general health of cells, the amount of Sc tissue and skin dryness
Moisture can result in increase bacterial growth and irritation
Body odors are caused by resident skin bacteria which acting in body secreration
Skin sensitivity to irritation and injury varies among individuals and in accordance with their health
Agent used for skin care have selective actions and purpose

17. IMPLEMENTING
Bathing
The purpose of bathing
To Remove accumulated oils, perspirations, dead skin cells, & some bacteria
To stimulate circulation
It produce sense of well-being (refreshing & relaxing& frequently improves morale, appearance,& self respect
It offers an excellent opportunity for the nurse to assess all clients

18. Two categories of baths are given to clients Cleaning baths
Complete bed bath: the nurse washes the entire body of a dependent client in the bed
Self-help bed bath: clients confined to bed are able to bath themselves with help from the nurse for washing the back & perhaps the feet
Partial bath (abbreviated bath): only the parts of the client's body that might cause discomfort or odor, if neglected are washed ( the face, hands, axillae, perineal area,& back
Bag bath: is an in-bed bath that use a presoaked disposable washcloths that contain no-rinse cleanser solution. The washcloths warmed up into the microwave before applying the bath.

19. Tub bath: are often preferred to bed baths because it is easier to wash &rinse in a tub also it is used for therapeutic baths . The amount of assistance the nurse offers depends on the abilities of the client
Sponge baths: are suggested for the newborn
Shower: for ambulatory clients
Temp. for bathing should be comfortably warm (43-46Cº)

20. Therapeutic baths: Requires a physician’s order. Temperature of water
Body surface to be treated
Type of medicated solutions to use
They are given for physical effects, such as to soothe irritated skin or to treat an area (e.g., perineum)
Medications may be placed in water
Generally taken in a tub one-third or one-half full (specific time 20-30min.) (temp C adults, 40.5C for infants)

21. Client teaching Dry skin:
Use cleansing cream to clean skin rather than soap
Use bath oil
Remove, rinse soap immediately from skin if used
Bath less frequently
Increase fluid intake
Humidify water
Use moisturizing cream that contain lanoline or petroleum jell

22. Skin rashes:
Keep area clean and dry
Relive itching by using lotion with careful
Avoid scratching the rash
Choose cotton clothes
Acne:
Wash face frequently with soap and hot water to remove oil and dirt
Avoid using oily cream
Avoid using cosmetics that block the sebaceous gland
Never squeeze the lesion