King Saud University

College of Nursing
Medical surgical Nursing

Module 4 -122

:Prepared By
Lecturer/ Magda Bayoumi
:Definition of Hygiene

Hygiene is the science of health and its maintenance. Personal hygiene is the self-care by
which people attend to such functions as bathing, toileting, general body hygiene, and
.grooming
Hygiene is a highly personal matter determined by individual values and practices. It involves
care of skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal-genital areas
.
It is important for nurses to know exactly how much assistance a client needs for hygienic
care. Client may required help after urinating or defecating, after vomiting

Benefits

Cleansing the skin: removal of perspiration, some bacteria, sebum, and dead skin cells
.minimizes skin irritation and reduces the chance of infection

Stimulating circulation: muscle activity, warm water, and stroking extremities enhance
.circulation

Promoting range of motion (ROM): movement of extremities assists in maintaining joint

.function

Reducing body odors: secretions and excretions from axillae and perineal areas result in
.body odors that are eliminated by bathing

Improving self-image: promotes relaxation and feeling clean and comfortable. Care of hair
.and teeth enhances appearance and sense of well-being

:Common Skin Problems and related Intervention

.Dry skin: flaky, rough texture to skin, which may crack and become infected
Acne: inflammatory papulopustular skin eruption, usually involving bacterial breakdown of
.sebum, typically on face, neck, shoulders, and back
Hirsutism: excessive growth of body and facial hair, especially in women; may cause
.negative body image by giving women a male appearance
Skin rashes: skin eruption from overexposure to sun or moisture or from allergic reaction;
.(may be flat, raised, localized, or systemic; may be associated with pruritus (itching
Contact dermatitis: inflammation of skin characterized by abrupt onset with erythema,
pruritus, pain, and scaly, oozing lesions; usually results from contact with substance difficult
.to identify and eliminate

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 Abrasion: scraping or rubbing away of epidermis that results in localized bleeding and later
.weeping of serous fluid; easily infected

:Intervention
Bathe less frequently; rinse away all soap or use a waterless cleanser 
.rather than soap; increase fluid intake; use moisturizing lotion
Wash hair daily. Wash skin twice daily with warm water and soap to 
remove oils and cosmetics (if used.); cosmetics that can accumulate in pores
should be used sparingly. Topical antibiotics, if prescribed, may minimize
.problems
Shaving is safest method; electrolysis and laser permanently remove hair 
by destroying hair follicles; tweezing and bleaching are temporary measures;
depilatories may remove unwanted hair but may cause infection, rashes, or
.dermatitis
Wash thoroughly; apply antiseptic spray or lotion to prevent further 
.itching and aid in healing process; warm or cold soaks relieve inflammation
Identify and avoid contributing agents; provide linens rinsed and 
.sterilized to minimize irritation
Wash with mild soap and water; observe dressings for retained moisture, 
.which can increase risk of infection

:Types of hygienic care

Early morning care: is provided to clients as they awaken in the morning. The care consists
of providing a urinal or bedpan to the client confined to bed, washing face and hands, and
giving oral care, making bed is part of morning care Afternoon care: often
includes providing bedpan or urinal, washing the hands and face, assisting with oral care to
refresh clients
Hours of sleep (HS) care is provided to clients before they retire for the car, and giving back
.massage
As-needed (prn) care is provided as required by the client. For example, a client who is
diaphoretic (sweating profusely) may need more frequent bathing and a change of clothes and
. .linen
:Function of Skin
The skin is the largest organ of the body. It serves five major functions 1-
It protect underlying tissues from injury by preventing the passage of microorganisms (the
(body's first line of defense
It regulate body temperature -2
It secretes sebum, an oily substance that a) softens and lubricates the hair and skin. -3
B) prevents the hair from becoming brittle c) decrease water loss from the skin when the

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 external humidity is low. D) Lessens the amount of heat lost from the skin e) has a
. bactericidal (bacteria-killing) action
It transmits sensations through nerve receptors, which are sensitive to pain, temp, touch, -4
. and pressure
It produces and absorbs vitamin D in conjunction with ultraviolet rays from the sun -5

:General Guide line for skin care

intact, healthy skin is the body's first line of defense. Nurses need to ensure that all skin care-1
measures prevent injury and irritation. Scratching the skin with jewelry or long, sharp
fingernails must be avoided. Harsh rubbing or use of rough towels and washcloths can cause
tissue damage, particularly when skin is irritated or when circulation or sensation is
diminished. Bottom bed sheets are kept taut and free from wrinkles to reduce friction and
abrasion to the skin. Top bed linens are arranged to prevent undue pressure on the toes
The degree to which the skin protects the skin protects the underlying tissues from injury -2
depend on the general health of the cells, the amount of subcutaneous tissue, and dryness of
. the skin
Moisture in contact with the skin for more than a short time can result in increased -3
. bacterial growth and irritation. After a bath, the client's skin is dried carefully
Body odors are caused by resident skin bacteria acting on body recreations. Cleanliness is -4
. the best deodorant
Skin sensitivity to irritation and injury varies among individuals and in accordance with -5
.their health. Skin sensitivity is greater in infants, very young children, and older people
:Bathing


Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria. The
nurse can appreciate the quality of oil and dead skin cells produced when observing a
person after the removal of the cast that have been on for 6 weeks. Applications of oil
over several days are usually necessary to remove debris. Excessive bathing, however,
can interfere with the intended lubricating effect of sebum, causing dryness of the skin.
This an important consideration, especially for older adults who produce less sebum.

Bathing also produces a sense of well-being, it is refreshing and relaxing and frequently
improves morale, appearance, self respect.

Bathing offers an excellent opportunity for the nurse to assess all clients. The nurse can
observe the condition of the client's skin physical conditions such as sacral edema or
rashes.

:Bath Categories
Two categories of bath are given to clients: Cleaning and therapeutic
:Cleaning baths are given chiefly for hygiene purposes and include these types

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 
Complete bed bath: the nurse washes the entire body of dependent client in bed.

Self-help bed bath. Clients confined to bed are able to bathe themselves with help from
the nurse for washing the back and perhaps the feet

Partial bath (abbreviated bath). Only the parts of the client's body that might cause
discomfort or odor.

Towel bath. The towel bath is an-bed bath that uses a quick-drying solution containing
a disinfectant, a cleaning agent, and a softening agent mixed with water

Bag bath. The "bag bath" is an adaptation of the towel bath. The equipment needed is a
plastic bag, 10-12 washcloths, the solution and wash clothes are warmed in a
microwaves for 1 minute. each area of the body is cleaned with a different cloth and
then air dried because the body not rubbed dry. The emollient in the solution remains on
the skin.

Tub bath. The tub baths are often preferred to bed baths because it is easier to wash and
rinse in a tub. Tubs are also used for therapeutic baths. There are specially designed
tubs for dependent clients.

Shower: many ambulatory clients are able to use shower facilities and required only
minimal assistance from the nurse.

Therapeutic baths: are given for physical effects, such as to soothe irritated skin or treat area
(e.g; the perineum). Medications may be placed in the water. The client remains in the bath for
a designated time, often 20-30 minutes.
:Nursing Diagnosis
Bathing/Hygiene Self-Care Deficit is appropriate when the focus of care is helping the client
move toward independence in bathing. The client may be unable to wash body parts, to obtain
or have access to a water source, or to regulate water temperature or flow. Contributing factors
may include impaired physical mobility in which range of motion (ROM) or muscle strength
is limited or an alteration in mental state. Shortness of breath with activity or excessive fatigue
.when bathing may also be contributing factors
Risk for Impaired Skin Integrity should be considered when the client has reduced
sensation, immobility, impaired circulation, incontinence, inadequate nutrition, or fragile skin
.associated with advancing age
Impaired Skin Integrity is an appropriate diagnosis for the client who has actually
experienced a loss in skin integrity. Pressure ulcers, vascular ulcerations, and blistering are

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 .examples of impaired skin integrity
Impaired Oral Mucous Membrane is appropriate when mucous membranes are damaged,
such as by ulcerations, erythema, and irritation. Contributing factors may include sensory
changes (pain, burning, or numbness), decreased level of consciousness, medication side
.effects, or altered oral intake for any reason

Imbalanced Nutrition: Less Than Body Requirements should be considered when a client's
appetite and intake are diminished because of altered mucous membranes, and the aim is to
.increase oral intake by improving oral hygiene

Dressing/ Grooming Self-Care Deficit is appropriate when the focus is to improve a client's
.ability to provide self-care with oral hygiene or hair care

Disturbed Body Image is often appropriate when the client loses interest in grooming or
experiences hair loss. This should also be considered when the client displays a lack of
.interest in appearance, especially when medical treatment alters body appearance or function

Ineffective Health Maintenance is appropriate when client teaching related to foot care is the
.focus of care for a diabetic

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