Hygienic needs

NURSING PROCEDURES - HYGIENIC NEEDS

1. HYGIENIC NEEDS

2. HYGIENE Hygiene includes care of the skin, along with the hair, hands, feet, eyes, ears, nose, mouth, back, and perineum. This includes the bath, components of the bath, bed making, and assisting the patient in the use of the bed pan, urinal and bedside commode

3. IMPORTANCE OF HYGIENE AND CARE The bath stimulates circulation in the skin and underlying tissues; it cleans and refreshes, promoting health and comfort; it provides some exercise for the patient; and similar to the opportunities available in making the occupied patients bad, it provides excellent opportunities for observation of the patients physical and emotional condition and for patient- centered conversation to promote good interpersonal relationship

4. Type of Baths Complete Bed Bath Partial Bed Bath Hands, face, back, axilla, perineum Tub Bath Shower Therapeutic Bath Sitz, Medicated

5. S pecial bath Sitz bath Cool water tube bath Warm water tube bath Hot water tube bath

6. Sitz bath The sitz bath cleanses and aids in reducing inflammation of the perineal and anal areas. It is for patients who have undergone rectal or vaginal surgery or normal vaginal delivery patients The sitz bath also relieves discomfort from hemorrhoids or fissures. Water 110f. The sitz bath should last from 20 to 30 minutes.

7. Cool water tube bath The cool water bath is given to relieve tension or lower the body temperature care must be taken to prevent the patient from chilling. The water temperature is tepid, not cold

8. Hot water tub bath The hot water tub bath is given to assist in relieving muscle soreness and muscle spasm. The procedure is not recommended for patient. For adults water temperature should be 113 to 115 f

9. BED BATH PROCEDURE

10. Administering a bed bath or partial bath When the patient is either confined to bed, must conserve energy, or is helpless, the medical specialist may give the entire bath; however, the patient should do as much for himself as his conditions permit. All necessary equipment is provided and the areas the patient cannot reach are bathed for him. Each bed patient should have his back bathed and rubbed for him.

11. Definition A bath given to client who is in the bed

12. BED BATH/SPONGE BATH What is it? A bed bath cleans the skin and helps keep the skin free of infection. It helps to relax the person being bathed and help him feel better. Let the person wash himself as much as possible. You may only need to get the bath supplies ready and wash the person’s back. Or you may need to do most or all of the bath.

13. BEFORE A BED BATH Ex p lain what you are ab o ut t o do, even i f the patient is unconscious. Cle a r the area o f any obstacles s o that you c an move around freely. Ensure the ward is warm. Have all the equipment to hand so that you do not have to leave the patient during the procedure. The use of toiletries such as deodorants, cosmetics and perfume should be determined by the patient.

14. PURPOSE OF BED BATH Bathing is an important part of personal hygiene Bathing cleanses the skin makes the patient more comfortable It stimulates the circulation and relaxes the patient. It’s a good opportunity to serve the observe the client body and as well as communicate with the patient.

15. Purpose To prevent bacteria spreading on skin To clean the clients body To stimulate the circulation To improve general muscular tone and joint To make client comfort and help to induce sleep To observe skin condition and objective symptoms

16. Article required Basin (2) for without soap (1) with soap (1) Bucket (2): for clen hot water (1), for waste (1) Jug (1) Soap with soap dish (1) Sponge cloth (2): for wash with soap (1) for rinse (1) Face towel (1) Bath towel (2): for covering over makintosh (1) Gauze piece (1) Makintosh (1) Trolley (1) Thermometer (1) Old newspaper Paper bag

17. INDICATIONS Bed ridden patients Coma patients Major surgery Orthopedic patients with surgery Mentally ill patients Certain infections Patients with amputation surgery

18. COMPLETE BED BATH VS PARTIAL BED BATH Complete bed bath involves washing the entire body and partial bed bath involves washing the face, hand, leg, under arms, genitals/perineal area.

19. PROCED R E.. Gather necessary equipment. Wash your hands. Put on gloves. Explain what you are going to do. Provide privacy. Offer bedpan/urinal then empty, clean, and put it away. Remo v e g l oves and disca r d i n approp r ia t e conta i ne r . Wash hands. Put on clean gloves. Place client in supine position near the side of the bed nearest you. Un-tuck bed linens. Remove bedspread and blanket; fold and place on chair if reusing; otherwise, place in laundry basket.

20. Contd…. Cover top sheet with a large towel. Ask the client to hold the towel in place; if unable, tuck under client's shoulders. R e m ove t o p s h e et without disturbi n g the t o wel a n d place in laundry basket at bedside. Remove client's gown or pajamas. Fill bath basin 2/3 full of warm water (115o F). Check temperature with inner aspect of arm. Place a towel across the client's chest. Wet washcloth and squeeze out excess water. Make a washcloth mitt. Wash eyes first. Start at inner corner and work out. Use different area of washcloth for each eye. Don't dangle the ends of the washcloth.

21. Cont d… NOTE: DO NOT USE SOAP ON OR NEAR THE CLIENT'S EYES. Wash, rinse, and dry face, ears, nose, and mouth. NOTE: ASK THE CLIENT IF HE WANTS SOAP USED ON HIS FACE. Wash, rinse, and dry neck. Expose arm farther from you; place towel under arm up to axilla. If the client is able, place a basin of water on the bed and immerse client's hand in water and wash. Wash and rinse far shoulder, axilla, arm, and hand. Re m ove the ba s in and dry t h e clie n t ' s ar m , shoulde r , and hand. Repeat steps 21-23 with arm closer to you. The In-Home Aide may perform fingernail care at this time.

22. Contd… Place towel across chest. Wash and rinse chest and breasts while lifting towel. Dry skin thoroughly. Keep chest covered with towel. Wash, rinse, and dry abdomen. Change bath water in basin. Obtain a clean washcloth. Expose the farther leg; flex (bend) leg and place bath towel lengthwise under the leg up to the buttocks. Wash and rinse leg and foot. Dry leg, foot, and in between toes.

23. Contd.. Repeat steps 32-34 on leg nearer you; cover client with bath blanket. May perform toenail care at this time. Place the towel and washcloth in a laundry basket and get clean ones. Change bath water in basin. Obtain a clean washcloth. Ask or assist the client to turn on his side with back towards you. 135 Fold a towel over the client's side to expose his back and buttocks; place clean towel parallel to client's back.

24. Co n t d.. 40. Wash, rinse, and dry the client's back and buttocks. 41. Give backrub using warmed lotion. 42. Turn client to back; place clean towel under buttocks. 43. If client is able, provide wash cloth, soap, and towel and instruct him to wash and dry peri area. 44 . I f the c l i e nt i s unable, wa s h peri ar e a from fr o nt to back. 45. Place dirty linen in appropriate container. 46. Remove and dispose of gloves. Wash hands. 4 7. I f c l i e nt did own peri c a r e , provi d e f r e sh wat e r f or client to wash hands.

25. Contd… 48. Apply warmed lotion and deodorant as needed. 49. Put clean clothing on client without exposing him. 50. Remove, clean, and store equipment. Wash your hands. Make the client comfortable. Record observations and report anything unusual to nurse/supervisor.

26. ORAL HYGIENE

27. I N T R ODUCTION Certain patients are prone to oral problems because of lack of knowledge. Good oral hygiene includes daily stimulation of the gums and brushing of the teeth.

28. DEFINITION “Oral hygiene cleaning the teeth and the oral cavity of the patient. It includes the measures to prevent the spread of disease from mouth and increase the comfort of the patient.”

29. PURPOSES To maintain the healthy state of mouth, gums, teeth and lips. To remove food particles from and between the teeth. To stimulate appetite. To provide a sense of well-being. To remove dental plaque. To prevent sores and infection of the oral tissues.

30. To relieve discomfort resulting from halitosis and taste. To prevent gum inflammation and infection . To prevent the mucous membrane from becoming dry. To prevent sordes, which results in ulceration. To maintain the intactness and health of the lips and oral cavity. To prevent oral infections. To clean and moisten the membranes of the mouth and lips.

31. INDICATIONS

32. Seriously ill p a tie nt. Patients with f e ve r . P o s t o per a ti v e patients. U n c o nsci o us patients. Patients breathing through mouth. Pa ra lyzed patients. Patients with infections and disease of mouth. Patients under anesthesia .

33. ARTICLES - Articles needed for conscious patients- A tray containing the following articles- Face towel. Mackintosh with draw sheet or towel. Disposable gloves(clean). Toothbrush Toothpaste Log of tepid water. Emollients (liquid paraffins, coconut oil, boroglycerine Vaseline. Cotton applicator.

34. Articles needed for unconscious patients- Face towel. Mackintosh with draw sheet. Disposable gloves(clean) Artery forceps Dissecting forceps. Tongue depressor Mouth gag Potassium permanganate(1gm:5000ml) Gauze piece Emollients (liquid paraffins, coconut oil, boro glycerine Vaseline Cotton applicator

35. PROCEDURE STEPS- for conscious

36. For unconscious

37. Post procedural/ After procedural Apply emollient over the lips . Remove and dispose off equipment appropriately. Remove and discard the gloves. Remove kidney tray, mackintosh and towel. Make the patient comfortable. Tidy up the unit. In unconscious patient, if there is collection of secretions in mouth, apply suction. Take all the articles to treatment room. Discard the waste as per protocol of biomedical waste management and clean the articles with soap and water. Wash hands. Record the time and nature of treatment and condition of the mouth on nurse record. Document assessment of the teeth, tongue, gums, and oral cavity.

38. COMPLICATIONS OF NEGLECTED MOUTH CARE

39. LOCAL Complications GENERAL Complications Halitosis Stomatitis Pyorrhea Root abscess Tonsillitis Sinusitis Parotitis Glossitis Sordes and crust Adenitis Otitis media Inhalation pneumonia Nephritis Joint disease Rheumatic heart disease Loss of appetite

40. NAIL AND FOOT CARE

41. DEFINITION Nail cutting that one of nursing care and general care for personal hygiene is to cut nails on hands and foots

42. PURPOSE To keep nails clean To make neatness To prevent the clients skin from scratching To avoid infection caused by dirty nail

43. EQUIPMENTS / ARTICLES NAIL CUTTER GALLIPOT WITH WATER (FOR COTTON) KIDNEY TRAY SPONGE CLOTH MIDDLE TOWEL MACKINTOSH PLASTIC BOWL IN SMALL SIZE SOAP WITH SOAP DISH

44. HAIR CARE AND SHAMPOOING

45. Definition Hair washing defines that is one of general care provided to a client who cannot clean the hair by himself/ herself

46. Purpose To maintain personal hygiene of the client To increase circulation to the scalp and hair and promote growing of hair To make him/ her feel refreshed

47. Equipments / Articles required 1. Mackintosh(2): to prevent wet (1)to make Kelly pad (1) 2. Big towel(2): to cover mackintosh (1)to round the neck (1) 3. Middle towel (1) 4. Shampoo or soap (1) 5. Hair oil (1): if necessary 6. Brush, comb: (1) 7. Paper bag (2): for clean (1)for dirty (1) 8. Cotton boll with oil or non-refined cotton 9. Bucket (2): for hot water (1)for wasted water (1) 10. Plastic jug (1) 11. Clothpin or clips (2) 12. Steel Tray (1) 13. Kidney tray (1) 14. Cushion or pillow (1) 15. Clean cloth if necessary 16. Old newspaper 17. Trolley (1)

48. Procedure 1. Perform hand hygiene To prevents the spread of infection 2.Gather all equipments Organization facilitates accurate skill performance 3.Check the condition of client. Explain the purpose and the procedure to the client. Proper explanation may allay his/her anxiety and foster cooperation 4. Bring and set up all equipments to the bed-side To save the time and promote effective care 5. Help the client move his/her head towards edge of the bed and remove the pillow from the head. To arrange appropriate position with considering your body mechanics

49. 6.Put another pillow or a cushion under the bending knee. Make him/her comfortable position. Putting a pillow or a cushion could prevents from having some pain while the hair washing process 7. Setting mackintosh and towel to the client: 1) Place a mackintosh covered a big towel under the upwards from the client head to the shoulders of client 2) Have a big towel around his/her neck 3) Roll another mackintosh to make the shape of a funnel, by using the way to hold from both sides in a slanting way. The narrow end should be folded and put under the client‟s neck and the free end should be put into the bucket to drain for the waste water. 4) Put the folding mackintosh under the client‟ sneck . To prevent the sheet from soiling To prevent the cloth and the body from soling To induce water drainage

50. 8. Washing: Brush the hair. 2) Insert the cotton balls into the ears 3) Wet the hair by warm water and wash troughly 4) Apply soap or shampoo and massage the scalp well while washing the hair using fingernails 5) Rinse the hair and reapply shampoo for a second washing, if indicated 6) Rinse the hair thoroughly 7) Apply conditioner if requested or if the scalp appears dry To remove dandruff and fallen hairs, and make the hair easier washing To prevent water from entering into the ears

51. 9. Wrapping the hair: 1)Remove the cotton balls from the ears into the paper bag and mackintosh with the towel from the clients neck. 2) Wrap the hairs in the big towel which are used to cover the clients neck part . 10. Drying the hair: Wipe the face and neck if needed Dry the hair as quick as possible Massage the scalp with oil as required Comb the hair and arrange the hair according to the client‟s preference Make the client tidy and provide comfortable position To prevent him/her from becoming chilled To increase circulation of the scalp and promote sense of well-being To raise self-esteem

52. 11. Clean the equipments and replace them to proper place. Discard dirty. To prepare for the next procedure11. Perform hand hygiene To prevent the spread of infection 12. Document the condition of the scalp, hair and any abnormalities on the chart with your signature. Report any abnormalities to senior staff. Documentation provides coordination of care Giving signature maintains professionalaccountability

53. PERINEAL CARE

54. Definition Perineal care is bathing the genitalia and surrounding area. 

55. Purpose 1. To keep cleanliness and prevent from infection in perineal area 2. To make him/her comfortable

56. Articles required 1. Gloves( non- sterile) (1 pair) 2. Sponge cloth (1) 3. Basin with warm water (1) 4. Waterproof pad or gauze 5. Towels (1) 6. Mackintosh (1) 7. Soap with soap dish (1) 8. Toilet paper 9. Bed pan (1)

57. Procedure (without urinary catheter) 1. Gather all required equipments . Organization facilitates accurate skill performance 2. Explain the procedure to the client. Providing information fosters cooperation. 3. Perform hand hygiene and wear on gloves if available. To prevent the spread of infection 4. Close the door to the room and place the screen. To protect the clients privacy. 5.Raise the bed to a comfortable height if possible. Proper positioning prevents back strain.

58. 6. Preparation the position: 1) Uncover the clients perineal area. 2) Place a mackintosh and towel ( or waterproofpad ) under the clients hips.A towel or pad protects the bed. You can use thetowel to dry the clients perineal and rectal area 7. Cleanse the thighs and groin: 1) Make a mitt with the sponge cloth. 2) Cleanse the clients upper thighs and groin areawith soap and water. 3) Rinse and dry. 4) Wash the genital area next.

59. Female client ①Use a separate portion of the sponge towel foreach stroke ②Change sponge towel as necessary. ③Separate the labia and cleanse downward from the pubic to anal area. ④Wash between the labia including the urethral meatus and vaginal area. ⑤Rinse well and pat dry.

60. Male client 1.Gently grasp the client‟s penis. ②Cleanse in a circular motion moving from the tip of the penis backwards toward the pubic area ③In an uncircumcised male, carefully retract the fore skin prior to washing the penis. ④Return the foreskin to its former position. ⑤Wash, rinse, and dry the scrotum carefully. Cleanse from the pubis toward the anus to wash from a clean to a dirty area. Prevent contaminating the vaginal area and urinary meatus with organisms from the anus. Cleanse from the tip of the clients penis backward to prevent transferring organisms from the anus to the urethra. Secretions that collect under the foreskin can cause irritation and odor. Return the foreskin to its normal position to prevent injury to the tissue.

61. 8. Assist the client to turn on the side. Separate the clients buttocks and use toilet paper, if necessary, to remove fecal materials. Removing fecal material provides for easier cleaning. 9.Cleanse the anal area, rinse thoroughly, and dry with a towel. Change sponge towel as necessary. Keep the anal area clean to minimize the risk of skin irritation and breakdown. 10.Apply skin care products to the area according to need or doctors order. Lotions may be prescribed to treat skin irritation. 11. Return the client to a comfortable position. To provide for comfort and safety. 12. Remove gloves and perform hand hygiene. To prevent the spread of infection 13. Document the procedure, describing the clients skin condition. Sign the chart. To provide continuity of care Giving signature maintains professional accountability

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