Hygiene

1. Hygiene Assisting with Elimination Hygiene & Peri-care Mouth care, Hair care, & Shaving Backrub

2. Assisting with Elimination • Bedpans - metal or plastic • Regular versus fracture bedpan • Urinals - male to void. Urinals for females, but not common

3. Commode - toilet on wheels with a catch basin under seat. Be sure to lock wheels

4. Putting Someone on a Bedpan • Provide privacy - close door, pull curtain • Siderail up on opposite side • Supine or recumbent position • Raise buttocks or roll onto pan • Elevate HOB, raise near siderail, call light/toilet tissue, leave alone if able • Use gloves, remove pan opposite way, wipe genitals • I&O, specimens, discard, wash hands, lower bed

5. Hygiene • Maintaining personal hygiene is necessary for an individual’s health, comfort, safety, & sense of well-being • Consider the client’s normal grooming routine • Convey sensitivity & respect for the person’s personal beliefs & habits

6. Assess the client’s physical and cognitive status to determine specifically what aspects of hygiene can be performed independently, those that require some assistance, and those that require total assistance.

7. Bathe body parts when soiled - incontinent, wound drainage, diaphoresis • Long term care - bath day once/week, complete bath, otherwise a partial bath done daily • Also, an excellent opportunity to conduct physical assessment

8. Bathing • Complete bedbath - washing whole body in bed • Partial bedbath - face, hands, axillae, perineum (or peri-care) & a backrub • Tub bath - immersed in water. Do not leave unattended, disinfect tub following • Shower - standing or shower chair • Shampooing in bed - use a hair trough

9. Bag bath – contains several soft cotton cloths that are premoistened in a solution of no-rinse cleanser & emollient. Easy to use, reduced time bathing, patient comfort

10. Am care - ready for breakfast: void, wash face & hands, brush teeth/dentures in • Pm care - relax for the night: void, wash face & hands, brush teeth/take out dentures, straighten bed linens, backrub

11. Highlights of the Bedbath • Maintain safety, use siderails • Undress unaffected 1st; dress affected 1st • Bath blanket - for privacy & warmth • Include ROM • Washmitt - retains heat, broad surface area

12. Eyes 1st - inner to outer canthus • No soap on face • Wash farthest then nearest OR go around the bed • Long firm strokes distal to proximal • Wash, rinse, & dry • Change water when cold, dirty, soapy, after feet, before perineum • Gloves for mouth care & perineum • Use deodrant, makeup as per client’s wishes • Promote client independence

13. Peri-Care • Washing of the genitals or perineum • Incontinent clients need frequent peri-care due to risk of skin breakdown • No baby powder or cornstarch - no medicinal properties & can cake. Use vaseline or zincoxide instead

14. Procedure for peri-care • Explain in words they will understand, “wash between your legs” • Privacy, gloves, dorsal recumbent position, waterproof pad • Wash with warm water & soap, separate the labia of female as you clean, begin at tip of penis & move down the shaft in male; rinse & dry

15. Catheter Care • Clean perineum as per usual & down the first 5-10cm of the catheter away from the urethral meatus to remove encrustations. • No lotions or powders • Keep collection bag off the floor to avoid m.o., but below the level of the bladder to prevent reflux • Empty bag q8hr or when 1/2 full • Encourage fluids to flush out bladder

16. Changing an Attends • Do not refer to as a diaper!! • Peri-care done when changing the Attends • Check lines on outside - will change color when wet • Mark date & time on outside of Attends

17. Mouth Care • Structures in oral cavity must receive regular hygiene to remain healthy • Healthy teeth & mouth influence client’s ability to eat, swallow, digest, & even speak • In older adults, often neglected, however older adults have greatest tooth loss due to dental caries

18. Toothbrushing with a soft-bristle toothbrush daily, after each meal & at bedtime • Dental flossing eliminate bacteria, reduce plaque, & reduce bacteria & plaque near gum line • Mouth care q1-2hr may be needed in the unconscious, on O2, or mouth breathers. Secretions on tongue dry & leads to odor & stomatitis • Use K-basin, towel, & glass of water

19. Mouth Care on Unconscious Client • Depend on nurses for their oral care • At risk for an altered oral cavity - may not eat/drink by mouth, mouth breathers, on O2 therapy - all are drying to oral mucosa • Risk for aspiration - check gag reflex. May need suction apparatus at the bedside

20. Procedure for mouth care on an unconscious client • Sidelying with head turned towards mattress • Towel under head, emesis basin under chin, padded tongue depressor • Brush with toothbrush or toothettes moistened with diluted mouthwash • Suction if necessary • Water soluble jelly to the lips

21. Care of Dentures • Clean as often as regular teeth • Place cloth in bottom of sink, brush as you would teeth, rinse & return to client or store in cup of tepid water. • If left out of water, will dry & warp • Be sure denture cup is labeled • Should be removed atnight to give gums a rest & prevent buildup of bacteriaunderneath

22. Hair care • Hair & its cleanliness is important to a person’s body image • Use a hair trough in the bed. Place padding/towels under the client’s neck • Wash & rinse as per usual

23. Shaving • Men without beards usually shave daily • Never shave off a beard or moustache without client consent • Often electric razors are used - no chance of cutting the skin • In older adults, will need to pull skin taught & move in a downward direction

24. Backrub • Helps to relax muscles, decrease stress & anxiety, & stimulate circulation • Done as part of the bath and/or at bedtime • Use lotion - moisturizes & decreases friction on the skin. Alcohol used in the past, however is drying to the skin. • Warm lotion between your hands or under hot water

25. Technique for a Backrub • Long smooth flowing movements over the back to relax • Kneading motions to relax tight muscle groups • Circular motions to stimulate circulation to an area (esp. for bedridden clients) • Time required - 3-5min • Caution - do not massage over reddened areas, massage around to stimulate blood flow