1. Chapter 20 Personal Hygiene
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. 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.
See the Body Structure and Function Review Box on p. 321 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Personal Hygiene (cont’d)
Good hygiene:
Cleanses the body
Prevents body and breath odors
Is relaxing
Increases circulation
Culture and personal choice affect hygiene.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Did you know?
In response to the popularity of Roman baths, the early Christian church frequently discouraged cleanliness.
Queen Isabella of Castile boasted that she had had only two baths in her life—at birth and before her marriage.
Colonial America’s leaders deemed bathing impure, since it promoted nudity, which could only lead to promiscuity.
Laws in Pennsylvania and Virginia either banned or limited bathing. For a time in Philadelphia, anyone who bathed more than once a month faced jail
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Did you know?
Although scholars point to advances in medical science; such as, vaccines and antibiotics, as the major factors in turning the tide against disease, the changes in personal and domestic hygiene should be given considerable credit for improvements in better health conditions.
Pasteurization and vaccines didn’t come along until the mortality decline was well established. But nearly 40 diseases are transmitted by feces, urine, and other secretions on contaminated hands or other objects. The greatest cause of fatal infant diarrhea came from mothers who went to the toilet, didn’t wash their hands and passed along intestinal bacteria to their babies.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Did you know?
Body odor is not caused by the human body or sweat itself. The skin has more than two million sweat glands, and the perspiration that comes from the abundant sweat glands is fundamentally clear and odorless.
Common skin flora, consisting of several kinds of benign bacteria, feed off the secretions and skin particles on the body and clothing. In the process of eating and eliminating waste, the bacteria cause the stench.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Daily Care 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 at bedtime (includes back massages).
You assist with hygiene whenever it is needed.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Oral Hygiene Oral hygiene (mouth care) – done with gloves on
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 (inflammation of the tissues around the teeth with red, swollen gums)
Flossing-done after brushing teeth
Removes plaque and tartar from the teeth
Removes food from between the teeth
Do at least at bedtime
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Brushing Teeth Brush is held at a 45 degree angle to the gums
Brush with short strokes
Teeth are brushed from the gum to the crown of the tooth
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Oral Hygiene (cont’d) Mouth care for the unconscious person
Unconscious persons may have mouth dryness and crusting on the tongue and mucous membranes.
If the person is on oxygen, may need more frequent mouth care due to dry mouth
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 keeps the mouth clean and moist. It also helps prevent infection.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. Oral Hygiene (cont’d)
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.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. Oral Hygiene (cont’d)
Denture care-stored in cool or warm water in denture cup
A denture is an artificial tooth or a set of artificial teeth.
They are expensive so handle with care!
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.
Remove dentures with a dry piece of gauze
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. 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 and concerns reported to the nurse
You have time to talk to the person.
Complete or partial baths, tub baths, or showers are given.
Complete bed baths are usually given 2 x week
Start with most clean (face) and finish with most dirty (perineum)
Re-clean if patient is incontinent
Maintain privacy throughout the bath!
Bathing removes microbes, dead skin, perspiration, and excess oils.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. Bathing (cont’d)
For a complete bed bath, you wash the person’s entire body in bed (ideal temp degrees Fahrenheit)
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 which is wet with a solution-water, cleaning, skin softening and drying agents.
Bag baths are 8-10 wash clothes in a bag with solution that does not need to be rinsed.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Bathing (cont’d)
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-always keep soap in dish
Protect the person’s privacy.
Pat the skin dry-don’t rub
Follow the nurse’s directions and the care plan.
Powder may be used to absorb moisture and prevent friction
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

16. 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.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

17. Perineal Care
Perineal care (pericare) involves cleaning the genital and anal areas.
Cleaning prevents infection and odors, and it promotes comfort.
Clean from front to back-or urethra to anus
Ensure the foreskin on the uncircumcised male resident is returned to the covered position
Penis is cleaned with circular motions starting at the meatus
Perineal care is done:
Daily during the bath
Whenever the area is soiled with urine or feces
Always wear gloves!
The genital and anal areas provide a warm, moist, and dark place for microbes to grow.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

18. 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
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

19. 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.
Start at the urethra
Rinse thoroughly.
Pat dry after rinsing.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

20. 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.
You make many observations while assisting with hygiene.
Not recording observations and care can cause serious legal problems.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.