NCM 100 SKILLS - HYGIENE & COMFORT

HYGIENE - describes activities involved in maintaining personal cleanliness and grooming.

• Personal hygiene contributes to our physical and psychological well - being.

• Activities of Daily Living (ADLs), such as taking a bath or shower, washing our hair, or brushing and flossing our
teeth promote comfort; improve self - image, and decrease infection and disease.
• Self - care in ADLs promotes increased activity, independence, and self - esteem.

FACTORS THAT INFLUENCE HYGIENE PRACTICES:

• Personal preferences - some people prefer a shower, others a bath. One person may shower in the morning,
whereas another bathes in the evening to relax before going to sleep.
• Culture and religion or spirituality - our cultural and family values and beliefs about hygiene form the foundation
for our beliefs as adults.
• Economic status or living environment - inadequate bathing facilities or lack of money for hygiene supplies can
influence how frequently a person bathes. E.g. homeless individuals or migrant workers, although they may value
cleanliness and grooming, might not have access to running water or soap with which to bathe.
• Developmental level - Parents and other caregivers perform hygiene care for infants and young children.
• Knowledge level - not everyone has the knowledge necessary to make appropriate decisions. E.g. some people
who are careful to brush their teeth daily may not know the importance of flossing.

FACTORS THAT AFFECT SELF - CARE ABILITY

• PAIN - severely limits the person's ability and motivation to perform hygiene and grooming.
• LIMITED MOBILITY-( e.g., from injury, weakness, surgery, prescribed bed rest, or pain)decreases the ability to
perform hygiene activities. (for example, a patient may be unable to bend over to wash her lower legs and feet, cut
her toenails or even raise her arms to wash and dry her hair.

NCM 100 SKILLS - HYGIENE & COMFORT

• SENSORY DEFICITS - diminish a person's ability to perform hygiene measures safely and independently. Safety
is a priority for patients with sensory deficits.
• COGNITIVE IMPAIRMENT - such as is found in patients with dementia, psychoses, Alzheimer's disease, or
traumatic brain injury, may make it impossible for the person to initiate his own grooming. The patient may be
unable to determine the need for hygiene, much less know how to accomplish related tasks. (for e.g. a patient with
advanced alzheimer's disease may actually forget how to care for himself and will need step - by - step direction.
• EMOTIONAL DISTURBANCES - may diminish a person's ability to perform hygiene measures. Patients
experiencing altered reality states, such as psychoses, delusions, or hallucinations, may dress inappropriately and
have poor hygiene practices. Some are unable to make decisions about " what to do next” when bathing,
dressing, and so on.

TYPES OF SCHEDULED HYGIENE CARE

• EARLY MORNING CARE - is provided soon after the patient awakens. It includes preparing the patient for
breakfast or other activities, such as diagnostic tests. You will, as needed, assist with toileting, washing the face
and hands, giving mouth care, and providing comfort measures.
• A.M.( morning) CARE - is hygiene care that occurs after breakfast. Depending on the patient's self - care ability,
you will assist with toileting, bathing, oral hygiene, skin care, hair care (incuding shaving if needed), dressing, and
positioning or helping the patient transfer to chair.
• P.M. (afternoon) CARE - consists of preparing patients to receive visitors of afternoon rest. You may assist
nonambulatory patients with toileting, hand washing, and oral care; straighten bed linens; reposition the patient;
and offer other comfort measures (e.g. pain medications)
• H.S. (hour of sleep)CARE - is given before the patient goes to sleep. In addition to the care given in the afternoon,
you should offer a back massage to help relax the patient. Also place within easy reach the call light, water glass,
urinal and anything else the patient may need during the night.

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 ANATOMY & PHYSIOLOGY OF THE SKIN

INTEGUMENTARY SYSTEM

Integumentary system consists of the skin, subcutaneous layer directly under the skin, the hair, nails, and the sweat and
sebaceous glands. The skin covers the internal structures of the body and protects them from the environment. It has two
distinct layers, the epidermis and the dermis.

The epidermis (the thicker, outer layer) consists of stratified squamous epithelial tissue composed of keratinized
(dead)cells which are fused to make the skin water proof. The epidermis continually sheds (desquamates) and is
completely replaced every 3 to 4 weeks. The epidermis contains melanin, a pigment that provides protection against the
ultraviolet rays of the sun and that, together with circulating blood, gives skin its color. The dermis (the thinner, second
layer) contains blood and lymphatic vessels, nerves, bases of hair follicles, and sebaceous and sweat glands.

FUNCTIONS OF THE SKIN

• Protection. Intact skin is the body's first line of defense against bacteria and other microorganisms that can enter
the body and cause infection. It also provides protection from thermal,chemical, and mechanical injury to
underlying tissues. Sebaceous glands secrete an oily substance called sebum, which helps to waterproof and
lubricate the skin and decrease bacterial growth.
• Sensation. The skin contains sensory organs or receptors for heat, cold, pressure, touch and pain.
• Regulation. The skin helps maintain fluid and electrolyte balance by preventing the escape of excess water and
electrolytes from the body. It helps to regulate body temperature through the processes of dilating and constricting
blood vessels and activating or inactivating sweat glands. Sweat glands, concentrated in the axillae and external
genitalia, excrete water in the form of perspiration; evaporation produces a cooling effect on the skin.
• Secretion/ excretion. The sweat glands secrete fatty acids and proteins and excrete nitrogenous wastes (urea),
sodium chloride, and water in perspiration.
• Vitamin D formation. The skin contains a form of cholesterol that on exposure to ultraviolet light from the sun is
exchanged to vitamin D. This is why vitamin D is sometimes referred to as "sunshine vitamin”.

NCM 100 SKILLS - HYGIENE & COMFORT

ASSESSMENT OF THE SKIN

SUBJECTIVE DATA

Ask the patients:

• Usual bathing and skin care practices and preferences

• Past and current skin problems, including their effect on the patient's life.
• Prescription and over - the - counter (OTC) or herbal remedies used to treat any skin problems.
• Allergic reactions to food, medications, plants, skin care products, or other substances

Factor Influencing Individual Hygienic Practices

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 Factor Variables

Culture North American culture places a high value on cleanliness. Many North Americans
bathe or shower once or twice a day, whereas people from some other cultures
bathe once a week. Some cultures consider privacy essential for bathing, whereas
others practice communal bathing. Body odor is offensive in some cultures and
accepted normal in others.

Religion Ceremonial washings are practiced by some religion

Environment
Finances may affect the availability f facilities for bathing. For example, homeless
people may not have warm water available; soap, shampoo, shaving lotion, and
deodorants may be too expensive for people who have limited resources.

Developmental
Level Children learn hygiene in home. Practices vary according to the individual's age; for
example, preschoolers can carry out most tasks independently with encouragement.

Health and
Energy Ill people may not have the motivation or energy to attend to hygiene. Some clients
who have neuromuscular impairments may be unable o perform hygienic care.

Personal Some people prefer a shower to tub bath. People have different preferences
Preferences regarding the time of bathing (e.g. morning versus evening)

SKIN CARE

General Guidelines for Skin Care :

1. An intact, healthy skin is the body's first line of defense

2. The degree to which the skin protects the underlying tissues from injury depends on the amount of subcutaneous

NCM 100 SKILLS - HYGIENE & COMFORT

tissue and the dryness of the skin.
3. Moisture in contact with the skin can result in increased bacterial growth and irritation.
4. Body odors are caused by resident skin bacteria acting on the body secretions. Cleanliness is the best deodorant.
5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health.
6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent, bath oil, cream, lotion,
powder, deodorant, and antiperspirant.

Common Skin Problem

Problem and Appearance Nursing Implication

Abrasion 1. Prone to infection; therefore, wound should be kept clean and

Superficial layers of the skin dry.
are scraped or rubbed away. 2. Do not wear rings or jewelry when providing care to avoid
Area is reddened and may causing abrasions to clients.
have localized bleeding or 3. Lift, do not pull, a client across a bed.
serous weeping. 4. Use two or more people for assistance.
Excessive Dryness Skin
can appear flaky and rough.
1. Prone to infection if the skin cracks; therefore, provide alcohol-
free lotions to moisturize the skin and prevent cracking.
2. Bathe client less frequently; use no soap, or use nonirritating
soap and limit its use. Rinse skin thoroughly because soap can
be irritating and drying.
3. Encourage increased fluid intake if health permits to prevent
dehydration.
Ammonia Dermatitis
(Diaper Rash) 1. Keep skin dry and clean by applying protective ointments
Caused by skin bacteria containing zinc oxide to areas at risk (e.g., buttocks and
reacting with urea in the perineum).
urine. The skin becomes 2. Boil an infant's diaper or wash them with an antibacterial
reddened and is sore. detergent to prevent infection. Rinse diapers well because
detergent is irritating to an infant's skin.
Acne
Inflammatory condition 1. Keep the skin clean to prevent secondary infection.

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 2. Treatment varies widely.
with papules and pustules.
Erythema
Redness associated with a 1. Wash area carefully to remove excess microorganisms.
variety of conditions, such as 2. Apply antiseptic spray or lotion to prevent itching, promote
rashes, exposure to sun, healing, and prevent skin breakdown.
elevated body temperature.

Hirsutism
Excessive hair on a person's 1. Remove unwanted hair by using depilatories, shaving,
body and face, particularly in electrolysis, or tweezing.
women. 2. Enhance client's self concept.

BATHING

• Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
• Excessive bathing, can interfere with the intended lubricating effect of sebum, causing dryness of the skin.
• Bathing stimulates circulation
• Bathing offers an excellent opportunity for the nurse to assess all clients.

CLEANING BATHS

Given chiefly for hygiene purposes and include these types:

• COMPLETE BED BATH- The nurse washes the entire body of a 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, if
neglected, are washed: the face, hands, axillae, perineal area and back.
• BAG BATH - This bath is a commercially prepared product that contains 10 to 12 presoaked disposable

NCM 100 SKILLS - HYGIENE & COMFORT

washcloths that contain no- rinse cleanser solution.
• TUB BATH - Tub baths are often preferred to bed baths because it is easier to wash and rinse in a tub.
• SHOWER - Many ambulatory clients are able to use shower facilities and require only minimal assistance from the
nurse.

BATHING A PATIENT

Bathing is an integral part of personal hygiene. The quality and extentof a patient's bath and the methods of
implementation depend largelyon the patient's physical capabilities, health and needed degree ofhygiene.

A complete bed bath is usually given to a patient who is totally dependent and requires complete hygiene.
Complete bed bath has beenfound to increase oxygen consumption in healthy men, thereforemaking it an extremely tiring
procedure for patients. It is the nurse'sresponsibility to assess whether the patient can tolerate a completebed bath. This
can be done by measuring vital signs before and afterthe bed bath.

A partial bed bath on the other hand involves bathing of only specific parts of the patient's body. These parts are
assumed to be potential sources of discomfort and odor if left unbathed. Aging patients are usually the ones who require
partial bed baths.In bathing a patient, it is imperative that the nurse assess the condition
of the patient's skin. It will aid in deter mining if the patient needs touse soap during the bath or if the patient needs a bath
on a dailybasis. This is done specifically to avoid drying the patient's skin.

Guidelines in the Provision of Bed Baths:

• Provide needed privacy
• Maintain patient safety
• Maintain room warmth
• Promote patient independence
• Anticipate patient needs
BATHING INFANTS

Special precautions should be taken when bathing infants. Bathinggreatly reduces infants' body temperature,
which makes it necessaryfor the nurse to keep the infant covered before performing the

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procedure. Warm water temperature should also be kept and the procedure should be done as quickly as possible.
Infant skin pH should also be taken into consideration, which is whyonly warm water is used during bed bath
after birth. In older infantshowever, gentle soap may be used as soiling increases, use of alkalinesoaps is however,
discouraged.

MATERIALS REQUIRED:
• Soap and water
• Bedpan
• Towels
• Washcloth
• Bathrobe
• Slippers
• Clean gown
PREPARATION:

PROCEDURE RATIONALE
1. Assess patient for activity and Provides data for determining patient's level of selfcare
musculoskeletal function tolerance. performance and type of bath to be administered.

Identifies level of assistance needed by patient to avoid

2. Review specific precautions (if any) regarding injury.
patient positioning/movement.
Promotes self-esteem through enhancement of patient
3. Explain to patient the procedure and ask for participation.
bathing preferences if any.
Reduces patient embarrassment by avoiding unnecessary
4. Provide needed comfort and privacy. exposure of patient's private body parts.

Organizes performance of procedure by making needed

5.Prepare necessary equipment/supplies materials accessible. Saves time and minimizes patient
discomfort.

N
C
BATHING PROCEDURE: M
COMPLETE/ PARTIAL BEDBATH 1
1. Offer patient bedpan, towel and washcloth. 0
Prevents interruptions during bathing. 0
2. Wash hands. S
KI
3. Wear disposable gloves if necessary. Reduces transmission of microorganisms. L
L
4. Assist patient to comfortable position, making Reduces risk for infection. S
sure that body alignment is maintained. Position -
patient on side of the bed closest to you and Protects nurse against back strain and provides easy H
place bed in high position. access to patient. Y
GI
5. Loosen top covers at bed's foot and place E
bath blanket over top sheet. Fold top sheet N
before removing from under blanket. Foldtop E
sheet if it is to be reused. Prevents soiling of linen.
6. Assist patient in removing gown.

7. Fill up to two thirds of washbasin with warm

water. Have patient test water's temperature. If
Provides full access to inner body parts during bath.
desired, put lotion's plastic container in bath
water to make it warm.
Prevents unnecessary chilling and burns. Warm water
enhancesmuscle relaxation and restores comfort. Bath
water makes lotionwarm.

8. If allowed, remove pillow and raise bed's head

30-45°. Put bath towel underneath patient's head. Anatomical alignment allows for easy access to ears,
Put second bath towel overpatient's chest. neck andnape. Towels catch water and soap droplets,
preventing soiling of linen and bath blanket.
9. To form mitt, fold washcloth around fingers of
hand. Wet mitt and wring thoroughly.

Loosely held washcloth does not hold water and heat as

comparedto a mitt. Prevents cold edges of towel from
touching patient.Avoids splashing.

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 PROCEDURE RATIONALE
10. Use plain war m water to wash patient's eyes. Ask if Soap may hurt patient's eyes. Use of
patient is wearing contact lenses. Different sections of mitt different sections minimizes cross contamination. Applying
should be usedin each eye. Clean eyes from inner to outer pressure on eye may result in injury.
canthus. Use a dampcloth to soak any crust on eyelid for 2-3
mins before trying toremove. Gently and thoroughly dry eye.

16. Move to other side of the bed and repeat steps previous
steps for other arm.

17. Check bath water's temperature and change if needed.

Soap and water traces may irritate patient's skin.

NCM 100 SKILLS - HYGIENE & COMFORT

Prevents water and soap from spilling onto linen.

Removal of debris and bacteria occurs when soap lowers

11. Wash, rinse and thoroughly dry patient's cheeks, surface tension and during friction. Circulation is stimulated
forehead, nose, neck and ears. by long firm strokes. Normal range of motion is exercised
by arm elevation during exposure of axillar area.
12. Remove bath blanket from patient's arm. Put bath towel
underarm. Move to other side of the bed to wash arm. Wetness causes skin irritation. Use of deodorants prevents
bacterial growth. Talcum powder minimizes sweating.
13. Use soap and water to bathe patient's ar m using long,
firm strokes from distal to proximal areas. Raise and support Soaking promotes circulation through vasodilation, it also
patient's armabove head (if applicable) while washing axilla. loosens dirt, callouses and cuticles. Remnants of soap and
water causewetness which harbors bacterial growth and
skin breakdown.
14. Thoroughly rinse and dry arm and axilla. If desired, apply
deodorant or talcum powder.
Facilitates circulation and restores patient comfort. Prevents
transmission of infection from other side of patient's body.
15. Lay folded bath towel (half folded) beside patient. Put
basin on towel and immerse patient's hand in water. Soak Prevents accidental burns.
hand from 3-5mins before proceeding to wash hand and
fingernails. Removehand from basin and dry thoroughly.

18. Cover patient's chest with bath towel and fold blanket
down toumbilicus. Use long, firm strokes with mitted hand in
bathingpatient's chest. For female patient, wash skinfolds
under breasts.
Prevents unnecessary exposure of body patient's private body
parts. Restores warmth and comfort.

6
Patient's chest should be kept covered between washing and Prevents unnecessary exposure of patient's private parts.
rinsing.

19. Put bath towel (lengthwise) over patient's chest and Supporting the joints prevents musculoskeletal strain. Towel
abdomen. Blanket should be folded down to above patient's prevents soiling of linen. Allowing patient to hold leg facilitates
pubic region. assessment of leg strength.

20. Lift bath towel and bathe patient's abdomen using mitted
hand. Stroke from side to side, keeping patient's abdomen
coveredthroughout the process. Dry thoroughly. Soaking promotes circulation through vasodilation, it also
loosens dirt, callouses and cuticles. Remnants of soap and
21. Assist patient in putting on clean gown/pajama top. water causewetness which harbors bacterial growth and skin
breakdown.
22. Cover patient's chest and abdomen with bath blanket's
top. Fold blanket toward midline to expose patient's leg. Enhances circulation.
Patient's perineumshould be covered.

23. Position your arm under patient's leg to bend patient's leg
at knee. Slightly elevate leg from mattress and put bath towel Moisture harbors bacterial growth especially in skinfolds which
under leg (lengthwise). Instruct patient to hold leg still. Place may contain sediments. These sites are prone to irritation and
basin onbath towel and secure it next to the foot to be washed. tissue breakdown. Lotion provides sufficient moisture to
condition skin.
24.Soak patient's feet after bathing (if allowed).
Facilitates circulation and restores patient comfort. Prevents
transmission of infection from other side of patient's body.

Restores warmth and observes hygiene.

25. Using long, firm strokes, wash patient from ankle to knee
and from knee to thigh (if allowed). Dry thoroughly.
Provides easy access to back portion of patient's body for
26. Wash patient's foot, ensuring to clean between toes. cleaning. Towel prevents soiling of linen.
Clean and clip nails as needed. Dry well and apply lotion to dry
skin. Avoidmassaging reddened areas of patient's skin. Ensures unnecessary exposure of patient's private parts. Back
rub promotes circulation and promotes comfort.
27. Move to other side of the bed and repeat steps for
patient's other leg and foot.
Reduces patient embarrassment by preventing unnecessary
exposure of patient's private parts.
28. Cover patient with bath blanket and change bath water.

NCM 100 SKILLS - HYGIENE & COMFORT

29. Assist client to establishing a prone/side-lying position.
Put towel (lengthwise) along patient's side. Provides sufficient moisture to condition skin.
30. Slide bath blanket over shoulders and thigh to keep Promotes body image and enhances self-esteem.
patient draped.Using long, firm strokes, wash, rinse and dry
back from neck tobuttocks. Give patient a back rub. Removes creases on linen that might cause pressure
sores. Restores comfort and promotes rest.
31. Assist patient in establishing a supine position. Use towel
to cover patient's chest and upper extremities. Expose only Reduces transmission of microorganisms.
patient's genitalia. Wash, rinse and dry perineum.

32. Apply body lotion/oil to patient if so desired.

RATIONALE
33. Assist client in dressing and comb patient's hair.
Ensures patient safety during performance of procedure.
34. Remake patient's bed.
Patient's state of readiness for procedure is ensured.

35. Put soiled linens in laundry bag. Clean and store bathing
equipment. Wash hands.

TUB BATH/ SHOWER:

PROCEDURE
1. Assess patient condition and review precautionary orders.

2. Schedule use of tub/shower.

Prevents unnecessary exposure of body patient's private body

parts.

Moisture harbors bacterial growth especially in skinfolds which

may contain sediments. These sites are prone to irritation
andtissue breakdown.

Promotes body image and enhances patient selfesteem.

Restores patient comfort.

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3. Check cleanliness of tub/shower; if applicable utilize
cleaning techniques as per institution's policy. Put a rubber Minimizes risk for contamination and ensures
mat on tub/shower bottom. safety.

4. Prepare all hygienic aids, toiletries and linen.

5. Have patient wear bath robe and slippers and assist in Robe and slippers facilitate easy exposure of patient's body
going to bathroom (if needed). during procedure. Avoids unnecessary exposure of patient's
privateparts during ambulation of patient to bathroom.
Promotes warmth and comfort.

6. Fill tub halfway with warm water. Have patient test water Prevents accidental burns. Use of oil may cause accidental
andadjust temperature if necessary. Instruct client on the use slipping and fall when patient is in tub.
of hotand cold faucet. Warn patient against use of oil inside
tub.

7. Tell client to remain in tub for not more than 20 mins. Warm water promotes vasodilation. Prolonged stay may
cause dizziness.

8. Return to bathroom when patient calls. Promotes independence and enhances self-esteem.
Leaving patient provides privacy.

9. Drain tub completely before patient attempts to get out. Ensures patient safety.
Place towel on patient's shoulder and assist as deemed
necessary.

10. Assist patient in dressing as needed. Promotes independence and enhances self-esteem

11. Assist patient to room and in establishing comfortable Restores patient comfort.
position.

12. Wash hands. Reduces transmission of microorganisms.

13. Observe patient's skin especially areas previously soiled, Evaluates effectiveness of procedure.
reddenedor showing any sign of breakdown. Ask patient to
rate level ofcomfort.

14. Record procedure accurately. Record patient's skin Documentation facilitates communication with other health

NCM 100 SKILLS - HYGIENE & COMFORT

condition and significant findings if any. Report any alteration team members. Serves as future reference for nursing
in patient's skinintegrity. care. May also serve for legal purposes.
Provides easy access to equipment/supplies. Saves time.

EAR CARE

Nursing Interventions
• Cleanse the pinna with moist wash cloth
• Remove visible cerumen by retracting the ears downward. If this is ineffective, irrigate the ear as ordered.
• Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen. These can rupture the tympanic
membrane or traumatize the ear canal. Cotton- tipped applicators can push wax into the ear canal, which can cause
blockage.

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EYE CARE

Nursing Interventions
• Cleanse the eyes from the inner cantus to the outer cantus. Use a new cotton ball for each wipe. To prevent
contamination of the nasolacrimal ducts.
• If the client is comatose, cover the ayes with sterile moist compresses. To prevent dryness and irritation of the cornea.
• Eyeglass should be cleaned with warm water and soap; dried with soft tissue.
• Clean contact lens as directed by the manufacturer
• To remove artificial eyes, wear clean gloves, depress the client's lower eyelid.
• Hold the artificial eye with thumb and index finger
• Clean the artificial eye with warm normal saline, then place in a container with water or saline solution.
• Avoid rubbing the eyes. This may cause infection.
• Maintain adequate lighting when reading.
• Avoid regular use of eye drops
• If dirt/ foreign bodies get into eyes, clean them with copious, clean, tepid water as an emergency treatment.
NOSE CARE

Nursing Interventions
• Clean nasal secretions by blowing the nose gently into the soft tissue.
• Both nares should be open when blowing the nose to prevent forcing debris into the middle ear, via Eustachian tube.
• May use cotton tipped applicator moistened with saline or water to remove encrusted, dried secretions. Insert only up
to cotton tip.

ORAL CAVITY CARE

Measures to Prevent Tooth Decay

• Brush the teeth thoroughly after meals and at bedtime.

• Floss the teeth daily.
• Ensure adequate intake of food rich in calcium, phosphorous, Vit. A, C and D and fluoride.

NCM 100 SKILLS - HYGIENE & COMFORT

• Avoid sweet foods and drinks between meals
• Eat coarse, fibrous foods (cleansing foods) such as fresh fruits ant raw vegetables.
• Have dental check up every 6 months.
• Have topical fluoride applications as prescribed by the dentists.

Brushing and Flossing the Teeth

Purposes

1. To remove food particles from around and between the teeth.

2. To remove dental plaque.
3. To enhance the client's feelings of well- being
4. To prevent sordes and infection of the oral tissues.

Nursing Interventions When Providing Oral Care for Conscious Patient

• Inform the client and explain purpose of the procedure.

• Provide privacy.
• Assist in sitting or side-lying position.
• Place towel under the client's chin.
• Moisten bristles of toothbrush and apply dentifrice.
• Hold kidney basin under the chin.
• Allow the client to brush his teeth, if possible.
• Use downward strokes fro upper front teeth; upward strokes for lower front teeth; back and forth strokes for the biting
surfaces of the teeth; and hold the brush against the teeth with bristles at 45 degrees angle to penetrate and clean
under the gingival margins.
• Rinse the mouth with adequate amount of water. Floss the teeth.
• Keep the client comfortable.
• Do after-care of the equipment and articles.
• Document relevant data.

For Unconscious Client

• Place in side-lying position to prevent aspiration.

• Have suction apparatus readily available.
• Use padded tongue blade to open the mouth.
• Brush teeth and gums, using toothbrush or soft sponge-ended swab.

9
 • Apply thin layer of petroleum jelly to lips to prevent drying or cracking.

Note: Lemon glycerin swabs can be drying to the oral mucosa if used for extended periods.

Care of Artificial Dentures

• Wear gloves when handling and cleansing dentures.

• Place a washcloth in a basin or bowl of sink when brushing dentures to prevent damage if the dentures are dropped.
• Store the dentures in a container with water.

Common Problems of the Mouth

1. Plaque. An invisible soft film of bacteria, saliva, epithelial cells and leukocytes that adhere to the enamel surface of the
teeth.
2. Tatar. A visible, hard deposit of plaque and bacteria that forms at the gum lines.
3. Halitosis. Bad breath.
4. Glossitis. Inflammation of the tongue.
5. Gingivitis. Inflammation of the gums.
6. Stomatitis. Inflammation and dryness of oral mucosa.
7. Parotitis. Inflammation of the parotid salivary glands (mumps).
8. Sordes. Accumulation of foul matter (food, microorganisms, and epithelial elements) on the gums and teeth.
9. Periodontal disease. Gums appear spongy and bleeding (pyorrhea).
10. Cheilosis. Cracking of the lips.
11. Dental Caries. Teeth have darkened area, may be painful (cavities).

PROVIDING ORAL CARE: BRUSHING AND FLOSSING

Purpose

- Decreases microorganisms in mouth and on teeth

NCM 100 SKILLS - HYGIENE & COMFORT

- Reduces the risk of cavities and mouth disease
- Decreases buildup of food residue on teeth
- Improves appetite and taste of food
- Promotes comfort
- Stimulates circulation to the oral tissues, tongue, and gums
- Improves appearance and self-esteem

Equipment

• Soft toothbrush
• Toothpaste
• Toothettes or swabs
• Emesis basin
• Nonsterile gloves
• Towel or linen saver and washcloth
• Cup of water
• Mouthwash (alcohol-free)
• Dental floss (optional)
• Suction and catheter (if client is unconscious)

Assessment

Assessment should focus on the following:

• Client's desire and need for oral care
• Client's usual routine for oral hygiene (method, frequency)
• Client's knowledge of purpose and procedure.
• Client's ability to understand and follow instructions (e.g. to expectorate instead of swallowing mouthwash and
toothpaste)
• Presence of dentures
• Status of palate, floor of mouth, throat, cheeks, tongue, gums, and teeth (e.g. presence of lesions, cavities).
Special Considerations in Planning and Implementation

General
Use a soft toothbrush or toothette for client receiving anticoagulant therapy. Dilute mouthwash for clients with oral lesions or
sensitive oral tissues.

Geriatric

1
0
 Use extra care when performing oral care for elderly clients because they often have problems with loose teeth due
to retracting gums. Good oral care may promote appetite.

End-of-life Care
Pay special attention to the mouth and mucous membranes in clients who are mouth breathers to ensure that mucous
membranes remain moist. Good grooming contributes to a sense of well-being and peace. It also portrays to family
members a sense of caring.

Cost-Cutting Tip
Encourage client to perform as much oral care as possible and encourage family members to assist, when
necessary.

Implementation

Action Rationale

1. Perform hand hygiene and organize equipment. • Reduces microorganism transfer; promotes
2. Explain Procedure to client. efficiency.
3. Lower side rail and position client in one of the
following positions: supine at an angle greater
• Reduces anxiety; promotes compliance.
than 45 degrees (if not contraindicated), side- • Decreases risk of aspiration; promotes
lying position, or prone with head turned to side. drainage of mouthwash from mouth.
4. Don gloves.
5. Drape towel under client's neck and assist client
to rinse mouth with water.
If Client Can Perform Self-Care • Prevents exposure to body fluids.
6. Assist the client in brushing teeth:
• Provide a glass of water, toothbrush, and • Prevents secretions from wetting or soiling
toothpaste. bedclothes; facilitates removal of
• Moisten the toothbrush with water and apply secretions.
toothpaste to brush.
• Allow client to brush teeth, and instruct on • Gives client necessary equipment.
proper technique.
7. Assist the client in cleansing the oral cavity:
• Provides mouthwash soaked Toothette, or Promotes self-care.
apply as appropriate.
N
• Encourage client to swab inner cheeks, lips, C
tongue, and gums, or perform these actions Freshens mouth.
for client, if needed. M
1
• Instruct client to rinse with mouthwash and Decreases microorganism growth in 0
expectorate. mouth. 0
• Instruct client to rinse and expectorate any S
excess water.
KI
Freshens mouth. L
If Client Cannot Perform Own Care
6. Perform oral care on the client: L
Removes residue. S
• Prepare toothbrush as above.
-
• Apply brush to back teeth and brush inside, H
top, and outside of teeth. Brush from back to Y
front, using an up-and- down motion. Repeat GI
these steps, brushing teeth on opposite side E
of mouth. - Permits cleaning back and sides of teeth. N
• Allow client to expectorate or suction excess E
secretions.
• Instruct client to clench teeth together, or
grasp the mandible and brush outside of front
lower teeth to upper teeth; brush the outside
of the front and side teeth. - Removes toothpaste and oral
• Open mouth and brush top and insides of secretions.
teeth.
• Rinse toothbrush and brush tongue. - Exposes front teeth for brushing.

• Rinse toothbrush and brush teeth again.

• If use of dental floss is desired, provide care
at this time.
7. Cleanse the oral cavity:
• Swab inner cheeks, lips, tongue, and gums. - Decreases microorganisms living in the
• Irrigate mouth with mouthwash suction mouth.
excess fluid. - Removes residual toothpaste.
• Rinse with water and suction excess. - Cleans between teeth.

Decreases microorganism growth in

mouth.
Freshens oral cavity.

Removes residue.

If Client is Unconscious

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6. Provides oral care: - Cleans teeth.
• Brush teeth with toothbrush and
toothpaste as described above in step
6 in providing care for clients who can't
provide their own care. Removes water and avoids pooling.
• Irrigate mouth with small amounts of
water, suctioning constantly.
7. Cleanse the oral cavity: - Decreases microorganism growth in
• Swab mouth with Toothette moistened mouth.
with mouthwash. Begin with inside of
cheeks and lips; proceed to swab
tongue and gums.
• Rinse and suction excess toothpaste,
mouthwash, water, and secretions.
• Wipe lips with wet washcloth. - Removes any residue.
• Apply petroleum jelly or mineral oil to - Moisturizes lips.
lips.
8. Discard soiled materials; restore supplies in - Promotes clean environment.
proper place.
9. Remove gloves and perform hand hygiene. - Reduces transfer of microorganisms.
10. Position client for comfort with call button within
reach. - Promotes safety, comfort, and
communication.

Documentation

The following should be noted on the client's chart:

• Amount of care done by client.
• Client's response to activity
• Condition of oral cavity and lips

PERFORMING DENTURE CARE

NCM 100 SKILLS - HYGIENE & COMFORT

Purpose

- Decreases microorganisms in mouth and on dentures.

- Deceases buildup of food residue on teeth or dentures.
- Improves appetite and taste of food.
- Promotes comfort.
- Stimulates circulation to oral tissue, tongue, and gums.
- Improves appearance and self-esteem.

Equipment

• Denture brush
• Denture cream
• Denture cup
• Denture cleanser
• Emesis basin
• Nonsterile gloves
• Towel or linen saver and washcloth
• Cup of warm water

Assessment

Assessment should focus on the following:

• Client's desire and need for oral care.
• Client's usual routine for oral hygiene and denture care (method, frequency).
• Client's knowledge of purpose and procedure
• Client's ability to understand and follow instructions
• Status of palate, floor of mouth, throat, cheeks, tongue, gums (e.g. presence of lesions).
Special Considerations in Planning and Implementation

Geriatric
Elderly clients often wear dentures. Assess their mouth for irrigation from poorly fitting dentures.

Cost-cutting Tip
Encourage client to perform as much oral care as possible and encourage family members to assist,
when necessary.

Implementation

Action Rationale

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1. Perform hand hygiene and organize supplies. - Reduces microorganism transfer; promotes
2. Explain procedure to client and encourage efficiency.
participation, if able. - Promotes compliance.
3. Don gloves.
4. Assist client with denture removal: - Prevents contact with body secretions.
• Fill denture cup halfway with cool water and
add denture cleanser per manufacturer's - Prepares cleansing solution.
instructions.
• Give the client a glass of water. Instruct the
client to take a sip. Ask the client to hold - Prevents dentures from breaking during
water in mouth and "float" dentures loose. removal.
• Allow client to remove dentures, or gently
rock dentures back and forth until they are
free from gums. - Breaks seal created with dentures.
• To remove, lift bottom dentures up and pull
top dentures down.
• Place dentures in denture cup to soak. (If a - Prevents undue pressure and injury to oral
denture cup is unavailable, use emesis basin membranes.
or other receptacle and label clearly). - Facilitates removal of microorganisms.
5. Assist client with cleansing of oral cavity:
• Provide a mouthwash-soaked Toothette.
• Encourage client to swab inner cheeks, lips,
tongue, and gums.
• Instruct client to swirl mouthwash in mouth Freshens mouth.
and expectorate. Follow with water, as Decreases microorganism growth in
desired. mouth.
6. Cleanse dentures: Removes any residue.
• Apply denture cleaner and brush using the
technique.
• Thoroughly rinse paste from dentures with
cool water.
7. Reinsert dentures: - Facilitates removal of microorganisms.
• Apply denture cream to gum side of denture
plate. - Removes cleaner and debris.
• Insert upper plate and press firmly to gums.
Repeat with lower plate.

NCM 100 SKILLS - HYGIENE & COMFORT

8. Apply petroleum jelly or mineral oil to client's lips. - Facilitates adherence.
9. Remove towel from client's chest Discard soiled
materials. - Adheres dentures to the gums.
10. Remove gloves and perform hand hygiene.
- Maintains skin integrity of lips.
11. Position client for comfort, with side rails raised
and call light within reach. - Maintains clean environment.
12. Place personal hygiene items in client's drawer
or on bedside table. - Prevents transmission of
microorganisms.
- Promotes comfort, safety, and
communication.
- Provides an orderly environment.

Documentation

The following should be noted on the client's chart:

• Amount of care done by client.
• Client's response to activity.
• Condition of oral cavity and lips.

HAIR CARE

• The appearance of the hair may reflect a person's sense of well-being and health status.
• Brushing and combing the hair stimulate circulation of blood in the scalp; distribute the oil along
the hair shaft; help to arrange the hair.

Hair shampoo

Purposes

1. To stimulate the circulation of the blood in the scalp through massage.

2. To clean the hair and improve the client's sense of well-being.

Nursing Interventions during Hair Shampoo

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 • Determine if the institution requires doctor's order for hair shampoo.
• Place client diagonally in bed.
• Remove pins from hair. Comb and brush hair thoroughly. This is to remove tangles.
• Place Kelly pad under the head, with neck hyper extended.
• The trough of the Kelly pad should be directed to a pail. To prevent spillage of the water onto the
floor.
• Cover the eyes with wash cloth. To protect them from irritation.
• Plug the ears with cotton balls. To prevent entry of the water into the external auditory canal.
• Apply small amount of shampoo.
• Massage the scalp with the fat pads of the fingers and make a rich lather.
• Massage promotes circulation on the scalp. Rich lather ensures through cleansing of the hair.
• Rinse the hair thoroughly. Soap residue in hair may cause irritation of the scalp and may dry hair.
• Dry the hair thoroughly.
• Keep he client comfortable.
• Do after-care of equipment and articles.
• Make relevant documentation.

Common Hair and Scalp Problems

1. Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus (seborrheic dermatitis).
2. Alopecia. Lair loss or baldness.
3. Pediculosis. Infestation with lice.

• Padiculosiscapitis is head louse

• Pediculosiscorporis is body louse
• Pediculosis pubis is crab louse

- The usual treatment for pediculosis is gamma benzene hexachloride (Kwell), which comes
in lotion, cream and shampoo. Pubic lice are difficult to remove, so the shampoo may be applied
and left on 12 to 24 hours.

- Linens and clothing used by clients should be washed in hot water.

NCM 100 SKILLS - HYGIENE & COMFORT

4. Scabies. Contagious skin infestation by the itch mite. The characteristic of the lesion is the burrow
produced by the female mite as it penetrates the skin. The burrows are short, wavy, brown, or black
threadlike lesions.
5. Hirsutism. Excessive growth of body hair.

FOOT CARE

• Wash the feet daily, and dry them well especially the interdigital spaces.
• Use warm water for foot soak, to soften the nails and loosen debris under them. Caution: soaking
the feet of diabetic clients is no longer encouraged because excessive moisture can contribute to
skin breakdown.
• Use cream or lotion to moisten the skin and soften calluses.
• Use deodorant sprays or foot powder to prevent or control unpleasant odor
• File toe nails straight across. To prevent nail splitting and tissue injury around nail.
• Change socks or stocking daily.
• Wear comfortable, well-fitted pair of shoes
• Do not go bare footed
• Exercise the feet to improve circulation
• Avoid using constricting clothing or round garters which may decrease circulation
• Avoid crossing the legs
• Avoid self-treatment for corns or calluses

Common Foot Problems

1. Callus. Painless, flat, thickened epidermis, a mass of keratotic material. Often caused by
pressure from the shoe on bony prominence.
2. Corn. Keratosis caused by friction and pressure from a shoe. It commonly affects the fourth and
fifth toe. It appears circular and raised.
3. Unpleasant odors. This results from perspiration and its interaction with microorganism.
4. Plantar warts. Caused by virus papova-virus hominis . They appear on the sole of the foot and
are moderately contagious. They are painful and make walking difficult.

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 5. Fissures. Caused by dryness and cracking of the skin.
6. Tineapedis. Characterized by scaling and cracking of the skin, particularly between the toes, caused by a
fungus. There may be blisters, (also Athlete's foot, ringworm of the foot.)
7. Ingrown Toenail. Inward growth of the nail, causing trauma into soft tissues. It is usually due to trimming the
lateral edges of the toenails.

NAIL CARE

• Trim nails straight across, or follow the contour of the fingers.

• File nails to have smooth edges.
• Do not trim nails at the lateral corners to prevent ingrowns.

• Diabetic clients are advised against cutting hangnails or cuticles.

• Ingrown is also called unguis incarnate.
• Separation of the nail from the nail bed is onycholysis.

• Inflammation of the skin fold at the nail margin is paronychia.

PERFORMING FOOT AND NAIL CARE

Foot and nail care is also a part of total hygiene and therefore should be done routinely.
Softening of the cuticles is done by soaking, cleansing and drying, nail trimming usually follows.
It is the duty of the nurse to teach the patient and family about the proper method for nail
cleaning and trimming. Methods to avoid infection should also be stressed. Care should also be
taken for patients who have diabetes mellitus as they are prone to foot infection due to poor
circulation.
The nurse should be observant for changes, which may indicate peripheral neuropathy and
vascular insufficiency. The nurse is encouraged to teach the patient the following guidelines for
proper foot and nail care:

NCM 100 SKILLS - HYGIENE & COMFORT

• Daily inspection of feet
• Thorough examination of the feet of patients with diabetes
• mellitus.
• Daily washing of the feet using lukewarm water.
• Avoid cutting corns/calluses and the use of commercial removers.
• Application of unscented foot powder to perspiring feet.
• Application of lanolin or baby oil to dry portions of the feet.
• For diabetic patients, toenails should be filed straight across and
• square. Avoid the use of scissors/clippers.
• Consult physician before application of medication for athlete's foot.
• Avoid wearing elastic stockings.
• Wear clean socks.
• Avoid walking barefooted.
• Make sure shoes are properly fitted.
• Avoid wearing new shoes for extended period of time.
• Exercise regularly to promote circulation.
• Avoid the application of hot water bottles or heating pads.

MATERIALS:
• Disposable bath mat
ee
• Orange stick
• Nail clipper
• Nail file
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• Washcloth
• Disposable gloves

PROCEDURE:
PROCEDURE RATIONALE
1. Check patient's fingers, toes, feet and nails. Assessment findings identify level of hygiene required.
2. Examine circulation to toes, feet and
Alteration in circulation affects nail and skin
integrity.

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fingers of patient. shoes/foot- wear.

3. Assess patient's walking gait. There are factors that ncrease susceptibility to nail
problem (i.e.,age). Older adults may have poor
vision and coordination and other degenerative
4. For female patients, ask if they use nail polish conditions.
and polish remover frequently.
Identifies level of assistance needed by patient.
5. Assess type of footwear that patient wears.
Improves patient's understanding of procedure.
Promotes cooperation.
6. Assess patient's risk for foot/nail problems.
Some patients may be prone to skin breakdown and
infection,thus a medical order is required.

Reduces transmission of microorganisms.

7. Assess ability of patient to care for nails/feet.
Organizes working environment and saves time.
8. Explain procedure to patient.
Reduces patient embarrassment.

9. If institution policy requires, obtain physician's Makes patient comfortable while feet are soaked in
order for cutting patient's nails. basin. Mat protects feet from being soiled.

10. Wash hands.

Thickened epidermal layers and nails are softened
11. Prepare necessary equipment. by warm water. Promotes circulation and reduces
inflammation of skin.
12. Provide needed privacy.
Patient may have muscular difficulty in positioning
13. Have ambulatory patient sit on bedside chair. feet. Assistance protects patient from injuries.
Put disposable bath mat on floor under patient's
feet.
Thickened epidermal layers and nails are softened
14. Fill washbasin with warm water and check by warm water. Promotes circulation and reduces
temperature. inflammation of skin.

NCM 100 SKILLS - HYGIENE & COMFORT

Thickened epidermal layers and nails are softened
15. Put basin on bath mat or towel and assist by warm water. Promotes circulation and reduces
patient in placing feet inflammation of skin.
in basin.
This is typical period of time it takes for corns,
16. Fill emesis basin with warm water and place calluses, cuticlesand nails to soften.
basin on paper towels on overbed table.
Orange stick reaches inner corners of nails,
removing dirt and grime. Drying helps prevent
17. Have patient place fingers in emesis basin. microorganisms from thriving in nails.

Prevents accidental cutting of skin.

18. Soak patient's feet and fingernails for 1020

mins (if not contraindicated). Rewarm water after 10 Reaches cuticles and prepares them for cutting.
mins.

19. Use orange stick to gently clean under Reduces transmission of microorganisms.
patient's fingernails while fingers are immersed.
Remove basin and dry patient's fingers thoroughly. Facilitates removal of dry skin.

20. Clip patient's fingernails straight across. Use a

nail file to shape patient's nails. Orange stick reaches inner corners of nails,
removing dirt andgrime. Drying helps prevent
21. Use orange stick to gently push patient's microorganisms from thriving in nails.
cuticles back.

22. Wear disposable gloves.

23. Use a washcloth to scrub calloused areas of

patient's feet.

24. Use orange stick to gently clean under

patient's toe nails. Remove patient's feet from basin
and dry thoroughly.

Unnatural gait of limping are signs of painful

disorders.

Excessive dryness can be caused by these

products.

Nail and foot problems may be caused by ill- fitted

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25. In clipping toenails, follow procedures for Prevents dryness and tissue breakdown.
clipping fingernails. Avoid filing toenails' corners.

26. Apply lotion to patient's hands and feet and Prevents transmission of microorganisms. Allows
assist patient to a comfortable position. for easy location of equipment in the future.

27. Remove and dispose of gloves properly. Clean Reduces spread of infection.
and restore equipment for future use.
Evaluates effectiveness of procedure.
28. Dispose of soiled linens properly. Wash hands.
Determines patient's ability to carry out procedure.
29. Examine patient's nails and surrounding areas.
Compares assessment findings prior to
30. Ask patient to explain/demonstrate nail care. performance of procedure.

31. Observe patient's walking gait after procedure. Documentation facilitates communication with other
Prevents accidental cutting of skin. health team
32. Record and report procedure.

NCM 100 SKILLS - HYGIENE & COMFORT

PERINEAL- GENITAL CARE

Purposes of Perineal-Genital Care

1. To remove normal perineal secretions and odor.

2. To prevent infection.
3. To promote comfort.

Nursing Intervention during Perineal- Genital Care

• Inform the client and explain purpose of the procedure.

• Provide privacy. To maintain client dignity.
• Position and drape the client as follows:
o Female: dorsal recumbent position; drape the client diagonally.
o Male: supine position
o For female clients, use forceps to hold cotton balls for cleansing the perineum. o For male
clients, wear clean gloves.

For Female Clients

1. Use anterior to posterior (front to back) stroke to prevent contamination of urethral meatus and
vagina with microorganisms from the anus.
2. Use one cotton ball for each stroke.
3. Cleanse perineum with soap/ antiseptic solution. Include the inner thigh.
4. Rinse the area with copious amount of water. To remove soap adequately and prevent irritation of
the perineal area.
5. Dry perineum thoroughly. Moisture supports microbial growth.

For Male Clients

1. Wash and dry penis using firm strokes, to prevent erection of the penis.
2. Use circular motion, from the tip of glans penis towards the penile shaft.

1
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3. If the client is uncircumcised, retract the prepuce (foreskin). This is to remove smegma that collects
under the foreskin and facilitates bacterial growth.
4. Wash and dry the scrotum and buttocks.

• For post-delivery or menstruating females, apply a perineal pad as needed from front to back. This
prevents contamination of urethra and vagina from anal area.
• Keep the client comfortable
• Do the after-care of equipment and article
• Document relevant data

PROVIDING PERINEAL CARE

Perineal care is a part of a complete bed bath. Patients who require perineal care are those who are
deemed to be most susceptible to infection (i.e., uncircumcised males, patients with indwelling
catheters or those recovering from genital/rectal surgery). Perineal care, being of a personal nature
requires a nurse to allow independent patients to do it for themselves. Patients practicing self-care are
prone to overlook problems such as vaginal discharge or skin irritation. It is the nurse's responsibility
to be alert and on the lookout for such problems.

Materials :
• Soap and water
• Towel
• Blanket
• Gloves
• Underpad/toilet tissue
• Washbasin

PROCEDURE: RATIONALE

NCM 100 SKILLS - HYGIENE & COMFORT

PROCEDURE Secretions in the skin of the genitalia prevents
1. Assess patient's risk for developing genital, transmission of microorganisms.
urinary tract or reproductive tract infections.
Self-care promotes patient independence and self-
2. Assess patient's cognitive/musculoskeletal worth. If patient is capable, allow him/her to carry
function. out the procedure.

Extent of perineal care varies in accordance with

3. Assess genitalia for inflammation, skin degree of infection or inflammation.
breakdown or infection.
Enhances patient understanding, cooperation and
4. Assess patient's knowledge of the importance of lessens anxiety.
perineal hygiene. Explain to client purpose and
nature of procedure.
Organizes working environment, saves time and
5. Prepare needed equipment/supplies. provides easy access to materials needed.

Prevents unnecessary exposure of patient's private

6. Provide needed privacy. parts and reduces patient embarrassment.

Prevents back strains on the part of the nurse.

Towel prevents soiling of linen. Bath blanket
provides needed privacy.
7. Position bed to comfortable working position.
Put towel (lengthwise) alongside of patient. Use a
bath blanket to keep patient covered. Reduces transmission of microorganisms.

8. Wear disposable gloves. Ensures asepsis. Reduces transmission of

microorganisms.
9. Remove any fecal matter using a fold of
underpad/toilet tissue. Cleanse patient's buttocks
and anus, washing beginning from front
to back. Dry area thoroughly. If gloves become
soiled, change them.
Provides easy access to patient's perineal area
10. Expose patient's genital area by raising while ensuring privacy.

1
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 patient's gown. Diamond drape patient. Fill
washbasin with warm water.
Provides easy access to equipment/supplies.
11. Put washbasin and toilet tissue on over bed
table.

• PROVISION OF PERINEAL CARE FEMALE

PERINEAL CARE:

PROCEDURE RATIONALE
1. Assist patient to establishing dorsal recumbent Exposes patient's perineum for flushing.
position. Assist patient in flexing knees and
spreading legs.

2. Fold bath blanket's lower corner up between Prevents spread of infection. Wet areas
patient's legs onto the abdomen. Thoroughly wash harbor microorganisms.
and dry patient's upper thighs.

3. Wash patient's labia majora, using nondominant

hand to gently retract labia from thigh. Use Microorganisms thrive in between skinfolds.
dominant hand to wash skinfolds. Wipe beginning Direction of wiping prevents contamination of
from perineum to rectum. Repeat procedure on genitalia.
opposite side using a different section of the
washcloth.
Thoroughly rinse and dry area.

4. Using non-dominant hand, separate labia and

expose urethral meatus and vaginal orifice. Use
Use of different sections prevents
one smooth stroke to wash downward from pubic
contamination. Drying area prevents skin
area to rectum. Use different sections of the
breakdown.
washcloth for each stroke. Clean labia minora,
clitoris and vaginal orifice thoroughly.

5. If patient uses a bedpan, pour warm water over

perineal area use front-to-back method in
thoroughly drying perineal area. N
Warm water promotes circulation and restores C
comfort. Running water flushes away soap and M
microorganisms. It is more effective than wiping. 1
0
Prevents unnecessary exposure of patient's
0
6. Fold bath blanket's corner back between private parts.
S
patient's legs and over perineum. Have patient KI
lower legs and establish comfortable position. L
L
S
-
H
• MALE PERINEAL CARE: PROCEDURE Y
GI
PROCEDURE E
1. Assist patient in establishing supine position and RATIONALE N
note any difficulty in mobility. Provides access to male genitalia. E
2. Fold bath blanket's top half below patient's penis.
Wash and dry patient's upper thighs. Protects surrounding skin from contamination by
penile secretions. Provides patient privacy for the
duration of the whole procedure.

3. Raise patient's penis gently and put bath towel Prevents pooling of moisture in the inguinal area.
underneath it. Grasp penis' shaft gently. For Proper handling prevents erection. Foreskin is
uncircumcised patient, retract foreskin. cleared of accumulated secretions and
Perform procedure at a later time if patient has an microorganisms.
erection.

4. Begin washing at the tip of patient's penis at

urethral meatus. Use a circular motion, cleansing
of washing

begin from

contamina
ted part to

microorga
spreadof
direction

from meatus outward. Dispose ofwashcloth and

cleanest

nisms to

urethra.

repeat procedure using clean cloth until penis is

to the

avoid
must

most
The

clean. Gently rinse and dry area.

the

the

5. Return foreskin to natural position.

Local edema might result from constriction of blood

6. Use gentle but firm downward strokes in vessels.
washing shaft of penis. Rinse and dry penis
thoroughly. Ask patient to slightly spread Washing direction prevents erection. Accumulated
secretions are removed.

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 legs apart.
7. Cleanse scrotum gently, lifting carefully and washing Prevents unnecessary exposure of patient's private parts.
underlying skin folds. Rinse and dry thoroughly.

8. Fold bath blanket over patient's perineum and assist Prevents spread of infection.
patient to side-lying position. Cleanse patient's anal area.
Restores patient comfort.
9. Remove and properly dispose of gloves.

10. Assist patient to establishing a comfortable position Reduces transmission of microorganisms.

and coverwith sheet.

11. Dispose of all used equipment and soiled linen. Evaluates effectiveness of procedure and determines
needed intervention.
12. Examine surface of patient's external genitalia and
surrounding area.

Determines presence of any infection.

13. Observe for abnormal drainage from patient's genitalia.

Documentation facilitates communication with other health
14. Record and report procedure. team members. Serves as future reference for nursing care.
Scrotal tissue is sensitive to pain. Application of excessive May also serve for legal purposes.
pressure must be avoided.

THERAPEUTIC MASSAGE

NCM 100 SKILLS - HYGIENE & COMFORT

(Providing Back Care)

Purpose

- Promotes comfort
- Stimulates circulation
- Relieves muscle tension
- Facilitates therapeutic interaction

Equipment

• Lotion
• Soap
• Towel
• Washcloth
• Warm water
• Gloves, if the client's or nurse's skin is broken or if the client has an infectious skin disorder.

Assessment

Assessment should focus on the following:

• Client's desire for back rub
• Client's knowledge of purpose of back rub
• Blood pressure and pulse rate and rhythm, if there is a history of cardiac or vascular problems.
• Respiratory rate, if there is a history of respiratory problems
• Skin and bony prominences
• Client's ability to tolerate prone or lateral position.
• Client's allergy to ingredients of lotion.
Special considerations in Planning and Implementation

General
Use the client's preferred substance for the back rub. Some clients may prefer baby oil or powder rather than lotion.
Powder should be used sparingly, to avoid inhalation of powder. Use only light pressure for clients with back disorders; a
doctor's order is required for a back rub for these clients.

Geriatric
As their skin is drier, use baby oil or oil-based lotion for the skin of elderly clients. The skin of elderly clients is thinner,
so avoid vigorous massage.

End-of-Life Care

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 Offer back rubs more often, when possible and desired. Comfort is a priority in end-of- life care. If opportunity exists,
allow more time to do back rub and allow client time to verbalize concerns. Transcultural
Ascertain the client's desire for a back rub to avoid misunderstanding: some individuals may consider a back rub as
gender-sensitive. Individuals from various cultures, especially males, may consider a back rub as an invasion of personal
space. Use of various oils / substances on the body may have specific meaning in various cultures. Communicate with
client to clarify desire before use.

Cost-Cutting Tip
Teach family members back care techniques and encourage them to perform care.

Delegation
Generally, back care may be delegated to unlicensed assistive personnel. However, the care of clients with back
problems or those who need special positioning may require additional instruction or supervision. Instruct assistive
personnel to report unusual findings. It is the nurse's responsibility to assess the skin and the effects of back care.
Implementation 15. Lightly rub toward neck and shoulders, and then back
down toward buttocks for several strokes (using
Action lighter pressure and moving laterally with each
1. Explain procedure to client. stroke).
2. Maintain a quiet, relaxing atmosphere (temperature at 16. Remove excessive lotion with towel.
a comfortable setting, lighting dim, room neat, noise Rationale
eliminated, door closed). - Promotes relaxation and compliance.
3. Wash hands and organize equipment. - Promotes relaxation.

4. Warm lotion by running bottle under warm water or

placing bottle in a basin of warm water.
5. Place client in prone or side-lying position. - Reduces microorganism transfer; promotes efficiency.
- Prevents discomfort and muscle spasms caused by
cold lotion and hands.
6. Drape with sheet or bath blanket.
7. Wash back with soap and water; rinse and dry - Provides easy access to back while maintaining a
thoroughly. Use long, firm strokes. comfortable, relaxing position.
8. Pour lotion into hands and rub hands together. - Provides warmth and privacy.
9. Encourage client to take slow, deep breaths as you - Removes dirt and perspiration; stimulates circulation.
begin. - Distributes lotion clearly.

NCM 100 SKILLS - HYGIENE & COMFORT

10. Place palms of hands on sacrococcygeal
area. Once you have placed your hands on the - Facilitates relaxation.
client's back, don't remove them until you have
completed the back rub. - Facilitates circulation via upward message.
Provides maximum soothing effect through
continuous contact with skin. Effective back rubs have
been associated with increased oxygen saturation, so
11. Make long, firm strokes up the center of the back maximum time for effect is important.
moving toward shoulders, and back down toward - Stimulates circulation and release of muscle tension
buttocks, covering the lateral area of the back. Repeat moving toward shoulders, and back down toward
this step several times. It may be helpful to imagine a buttocks, covering the lateral areas of the back.
large heart on the client's back to accomplish this Repeat this step several times. It may be helpful to
step. imagine large heart on the client's back to accomplish
this step.
12. Move hands up the center of the back toward the neck - Releases tension in neck muscles and promotes
and rub nape of neck with fingers; continue rubbing relaxation.
outward across shoulders.
13. Move hands down to scapulae and massage in a
circular motion over both scapulae for several - Stimulates circulation around pressure points.
seconds.

14. Move hands down to buttocks and massage in a - Stimulates circulation around pressure points.
figure-eight motion over the buttocks; continue this
step for several seconds. - Ends back rub with a calming, therapeutic effect.
17. Reposition client and replace covers. Reduces risk of skin breakdown and bacterial
growth from excessive moisture.
18. Raise side rails and place call light within reach. Promotes comfort and provides warmth.
Facilitates communication; promotes

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 safety.

Documentation

The following should be noted on the client's chart:

• Client's response to back rub and ability to tolerate procedure.
• Condition of skin and bony prominences.
• Blood pressure, pulse and respirations before and after procedure, if applicable.
• Any abnormalities or problems encountered.

ADMINISTERING A SITZ BATH

Purpose

- Promotes perineal and anorectal healing.

- Reduces local inflammation and discomfort.

Equipment

• Clean bathtub filled with enough warm water to cover buttocks (or portable sitz tub, if available).
• Peri-care equipment
• Bath towel
• Bath thermometer, if available
• Bathroom mat
• Gown
• Small footstool
• Nonsterile gloves

Assessment

Assessment should focus on the following:

• Baseline vital signs
• Appearance and condition of treatment area
• Client's knowledge of benefits of sitz bath
• Client's inability to remain unattended in bathtub (e.g. confusion, weakness)

NCM 100 SKILLS - HYGIENE & COMFORT

• Status of pain
Special Considerations in Planning and Implementation

General
Avoid sitz bath during initial phase (first 12 to 24 hours), as they may contribute to post-trauma swelling. Inflatable
rings or cushions are generally discouraged because they can cause stretching and tension on perineal or anorectal
tissue, which impairs wound healing. Schedule the procedure for a time when ther client can be checked frequently. If
client cannot remain alone, plan to remain with client or find someone to do so.

Pediatric
Do not leave children unattended during this procedure.

Geriatric
Vasodilatation from exposure to warm could cause severe changes in blood pressure and cardiac function in elderly
clients with compromised cardiovascular status. The duration and temperature of the sitz bath might need to be
deceased, and clients must be watched closely for adverse reactions.

Transcultural
Discuss therapy with client and relay any objections to physician. Adhere to cultural preferences regarding same-sex
or opposite sex care providers; family member should be instructed on procedure for sitz bath if preferred by client.

Delegation
Generally, this procedure may be delegated to unlicensed assistive personnel. Stress the importance of monitoring water
temperature before contact with client's skin.

Implementation
Action Provides privacy.
1. Explain procedure to client.
2. Perform hand hygiene, organize equipment, and put
on gloves.
3. Check temperature of water with thermometer; water
should 40.5°C to 43°C (105°F to 110°F). If
thermometer is unavailable, test water with your wrist
(water should be warm).
4. Assist client to bathroom and close door. Proceed to
step 5 for a tub or toilet sitz bath.
Rationale
- Promotes relaxation and compliance.
- Reduces microorganism transfer; promotes efficiency.
Prevents skin damage from high water temperature.

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For Tub Sitz Bath - Prevents complications from falling or unusual
5. Place rubber ring at bottom of tub and place bathmat reaction to therapy.
on floor.
6. Assist client into tub, using footstool if necessary.
7. Ascertain client's stability in the tub. Proceed to step 8.
- Allows client to sit in the water.
For Portable Sitz Bath Using Toilet Insert
5. Prepare the equipment:
• Raise the toilet seat and place the basin on the rim - Promotes comfort and vasodilation; prevents leakage.
of the toilet bowl. Fill with warm water.
• Fill water bag with warm water (40.5°C to 43°C - Higher heights may cause the water to leave the bag
[105°F to 110°F]).Prime tubing and close the too quickly, creating a flow that is too forceful.
clamp. - Ensures that water is properly directed toward injured
• Hang the bag at approximately shoulder height. area and prevents spillage.

• Thread the tubing through the back of the basin - Allows client to adjust to comfort level.
and secure the tubing in the slot in the bottom of
the basin.
6. After the client is seated on the basin, demonstrate - Promotes warmth and privacy.
how to unclamp tubing to begin and adjust water flow.
7. Cover the client's lap with a towel or bath blanket. - Prevents complications from or unusual reaction to
8. Assess client's reaction to the treatment: therapy.
• Observe facial expressions and body motions for
signs of discomfort.
• Ask if heat is too high.
• Watch for dizziness, faintness, profuse
diaphoresis.
• Note any rapid increase or irregularity of pulse.
9. Instruct client on use of call light, and place light within - Allows communication and immediate response to
reach. emergency.
10. Check client every 15 to 20 minutes. - Allows assessment of unusual reactions
11. After 15 to 20 minutes, help client out of the tub or up - Terminates treatment.
from the toilet.
12. Assist client with drying and dressing, then place
linens in hamper. - Prevents chilling.
13. Return client to room or bed. - Promotes comfort.
14. Remove equipment and clean tub or sitz basin. - Reduces microorganism transfer to others using tub or
15. Remove gloves and perform hand hygiene. basin.

NCM 100 SKILLS - HYGIENE & COMFORT

- Prevents accidental falls.
- Reduces microorganism transfer.
- Prevents accidental injury.
Documentation

The following should be noted on the client's chart:

• Appearance of treatment area before and after treatment.
• Type of sitzbath used (tub or potable)
• Any unusual reactions to treatment, such as profuse diaphoresis, faintness, dizziness, palpitations, or pulse
changes.
• Duration of pain
• Client's reaction to treatment.

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