Nursing Skills

Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

NURSING SKILLS
Hygiene
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N

HYGIENE
The science of health.
Promotes cleanliness, provides for comfort and relaxation,
improves self-image, promotes healthy skin.
Is a basic need for a clients well-being and self esteem and
also necessary for infection control.
Hygiene practices are highly individualized and can be
influenced by clients culture, socio-economic status,
religion, developmental level, health status and personal
preference.
The nurse must be knowledgeable about these factors to
provide individualized client care, meeting hygiene needs
by providing care that the client alone cannot or should not
provide.
The nurse should also encourage the client to meet personal
hygiene when possible.

Equipments:
Tray with: soap, comb, toothpaste and toothbrush
Basin
Pitcher of warm water
Clean gown
Bath towel
Kidney basin
Bed screen PRN
Procedure:
1. Prepare equipment and arrange them within reach of
patient.
2. Loosen top sheet at the foot remove patients gown.
3. Screen the bed, provide privacy.
4. Bathe the face, hands and axilla as in giving a
cleansing bath.
5. Place on client gown, change PRN
6. Clean teeth, brush or comb hair.
7. Serve bedpan and follow with external douche.
8. Loosen bottom sheet, brush away crumbs and
straighten it.
9. Remove pillow and change pillow case; change other
linens PRN.
10. Replace pillow and place client in a comfortable
position ready for breakfast.
11. Gather and bring all used articles to utility room of
CSR.
12. Wash and clean equipment and return clients
belonging to bedside stand.
13. Record time and type of care given and condition of
the client.

Afternoon Care

Cultural Considerations and Hygiene

Some cultures do not permit women to immerse their

bodies in water during menstruation for fear they will
drown.
In North America, people typically bathe daily and use
deodorants.
In Europe, many people do not bathe daily or use
deodorants.

Factors Influencing Personal Hygiene

Culture

Socioeconomic class

Spiritual practices

Developmental and knowledge level

Health state

Personal preference

Ensure patients comfort after lunch:

Offer assistance with toileting, handwashing, oral care

Straighten bed linens

Help patients with mobility to reposition themselves

Evening Care
The care given to client after evening meal and
bedtime medication.
Purposes:
To refresh the client
Give comfort to the client in preparation for sleep

Morning Care

The care given to a client in the early morning prior to

serving breakfast.
Purposes:
To refresh the client
To prepare client for breakfast
General Consideration:
Client should be encouraged to help themselves if
condition permits.
Client who is critically ill and debilitated must be
given assistance. No over exertion should be allowed.
When a large number of clients are to be morning
cared, a systematic procedure for distributing and
collecting water used for washing should be devised
according to facilities available.
Foundations of Nursing
Hygiene

General Considerations:
Assist the client according to his condition
Observe the skin and report any reddening or
developing decubitus ulcer.
Equipments:
Tray with: soap, comb, toothpaste and toothbrush
Basin
Pitcher of warm water
Clean gown
Bath towel
Kidney basin
Bed screen PRN
Procedure:
1. Arrange equipment on bedside within reach of the
client.
2. Screen the bed
3. If the client is strong, washing of hands. Brushing of
teeth may be done by himself.
Abejo

Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Loosen the top sheet at foot part of bed and remove

gown.
Turn the client to side. Expose back and place towel
beneath it on the bed.
Rub and massage the back, hips and other pressure
areas with alcohol using gentle soothing strokes.
Dry and apply talcum powder.
Offer bedpan and follow it with external douche.
Loosen bottom sheets. Remove crumbs and straighten
it.
Turn pillow
Adjust height of backrest to clients comfort.
Turn off light except for the night light.
Place call light or bell within reach of client.
Remove all used articles. Wash, clean and return to
proper places.
Record time care was given, procedure done and
significant observation.

BATHING

General Information:
a.
b.
c.

d.

e.

f.
g.

The nurse provides cleansing or therapeutic baths.

Cleansing bath include a complete bed bath, a partial
bed bath and a tub bath or shower.
A complete bed bath consists of washing a dependent
clients entire body in bed; a complete bed bath with
assistance involves helping the client to wash.
A partial bed bath consists of or buttocks that may
cause discomfort or odor if le washing only parts of
the clients body such as feet ft unwashed.
A tub bath or shower provides a more thorough
cleansing than a bed bath; the amount of nursing
assistance is determined by the clients age and health
and safety consideration.
A therapeutic bath is ordered by a physician for a
specific purpose.
Therapeutic baths include:
Sitz bath to reduce inflammation and clean
the perineal area.
Tepid sponge bath to reduce fever.
Medicated tub bath to relieve skin
irritation.

BED SHAMPOOING

It is the washing of the hair with the patient in bed

Purposes:
To maintain cleanliness and provide comfort
To refresh the patient
To wash the hair after application of a pediculocide.
General Considerations:
Be sure the procedure is ordered by the physician.
Be certain that the patient is not febrile or within
normal body temperature.
See to it that the patient is comfortably placed in
position.
Arrange the Kelly pad so as to llow the free flow of
water from the head.
Protect the patient from chilling and falling.
Observe principles of body mechanics

Foundations of Nursing
Hygiene

Equipments:
Inflated Kelly pad
Face towel
Newspaper
Cotton balls
Soap or hair shampoo
Pitcher of hot water
Bath towel
Rubber protector
Bed screen
Preparation:
Gather all needed articles.
Identify the client
Introduced yourself
Inform the patient about the procedure
Provide privacy
Close the window and door, turn off air conditioning
unit or electric fan if any.
Arrange all needed materials within reach, line a chair
or table with newspaper or a piece of rubber where the
basin will be placed.
Lower the back and the knee rests depending on the
condition of the patient.
Prepare the water at the desired temperature.
Procedures:
1. Loosen and fold the top sheet down to the waistline or
replace with a bath blanket.
2. Remove the pillow and bring the patients head close
to the edge of the bed by placing her diagonally across
the bed.
3. Line a pillow with a rubber protector and bath towel
and place it under the patients neck and shoulder so
that the head is slightly incline.
4. Remove pins, ribbons from the hair and comb the hair
5. Cover the eyes with a folded towel.
6. Plug the ear with cotton balls.
7. Moisten the hair thoroughly then pour the soap
solution or liquid shampoo slowly on the scalp and
hair while the other hand tries to spread it.
8. Massage the scalp with the ball of your finger not the
nails.
9. Rinse, repeat process until the hair is thoroughly
cleansed, taking care to avoid undue jagging or
frequent turning of the head.
10. Use cold water, whenever required for final rinse.
11. Squeeze off the excess water from the hair.
12. Remove the eye cover or ear plug.
13. With one hand raise the head with the other, remove
the Kelly pad and drop it to the pail. Then wrap the
hair with the bath towel under the head and readjust
the pillow.
14. Dry the hair well then comb it.
15. Move back the patient to the center of the bed. Leave
the rubber protector until the hair is completely dry.
16. Arrange the bed linen and make the patient
comfortable.
17. Leave the unit in order.
18. Discard soiled linen in the hamper. Clean used
equipment and keep in their proper places.
19. Document the time of procedure, reaction of the
patient and abnormality noted

BED BATH
A bath given to a patient on bed
Purposes:
To cleanse, refresh and give comfort the patient who
must remain in bed.
To stimulate circulation and aid in elimination.
To provide for an opportunity to inspect the patients
body for any signs of abnormality.
Abejo

Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

To help the patient have some form of movement and

exercise.
To provide for an opportunity for nurse-patient
interaction.

General Consideration:
Avoid unnecessary exposure and chilling.
Expose, wash, rinse and dry only a part of
the body at one time.
Avoid draft
Use correct temperature of water.
Observe the patients body closely for physical signs
such as rashes, swelling, discoloration, sore, burns etc.
Give special attention to the following body areas;
behind the ears, axilla, under the breast, umbilicus,
pubic region, groin and spaces between the fingers and
toes.
Do the bath quickly but unhurriedly, use even, smooth
but firm strokes.
Use adequate amount of water and change as
frequently as necessary.
If possible, do such procedure as vaginal douche,
enema, shampoo, oral care etc. before bath.
Equipments:
Pitcher of water
Bath basin
Bath towel
Face towel
Soap in soap dish
Talcum powder
Deodorant
Rubbing alcohol
Gown
Bed screen
Linen for changing
Rubber sheet or news paper
Preparation:
Gather all needed articles.
Identify the client
Introduced yourself
Inform the patient about the procedure
Provide privacy
Adjust the temperature and ventilation of the room
Remove unnecessary articles on the bed and clear up
the work area.
Arrange all needed materials within reach, line a chair
or table with newspaper or a piece of rubber where the
basin will be placed.
Lower the back and the knee rests depending on the
condition of the patient.
Offer the bedpan or urinal as desired.
Procedure:
1. Loosen the sheet, this may be replaced by a bath
blanket.
2. Assist the patient to the side of the bed for
convenience and ease in working.
3. Remove patients clothing under cover of the sheet or
blanket.
4. Fill the basin with one half t two-thirds full of
comfortably warm water.
5. Wrap the washcloth around the palm and fingers to
form a mitten
Making a bath mitt: Rectangular method:

Lay your hand on the washcloth and fold one side over
your hand;

Fold the second side over your hand;

Fold the top of the cloth down; and

Tuck it under the folded side against your palm to

secure the mitt.

Foundations of Nursing
Hygiene

6.
7.

Apply soap
Start cleaning the eyes, wipe from inner to outer
canthus. Using circular strokes, bathe the face, neck
and ears.

Eye Care
Cleanse the eyes from inner canthus to the outer
canthus. Use a new cotton ball for each wipe.
If the client is comatose, cover the eyes with
sterile moist compresses. To prevent dryness and
irritation of cornea.
Health Teachings
Eyeglass should be cleansed with warm water
and soap, dried with soft tissue.
Clean contact lens as directed by the
manufacturer.
Hold the artificial eye with thumb and index
finger. Clean the artificial eye with warm normal
saline, the place in a container with water or
saline solution.
Avoid rubbing the eyes.
Maintain adequate lighting when reading
Avoid regular use of eyedrops
If dirt or foreign bodies get into the eyes, clean
them with copious, clean, tepid water as
emergency treatment
Ear Care
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 or toothpicks to remove
cerumen these can rupture the tympanic
membrane or traumatize the ear canal.
Nose Care
Clean nasal secretion by blowing the nose gently
into soft tissue.
Both nares should be open when blowing the
nose to prevent forcing debris into the middle ear
via the Eustachian tube.
May use cotton-tipped applicator moistened with
saline or water to remove encrusted, dried
secretions. Insert only up to cotton tip.

Abejo

Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

8.
9.
10.
11.

12.
13.

14.

15.
16.

17.

Rinse the area two or three times; then put it dry with
the towel.
Spread the towel lengthwise under the father arm.
Soap, rinse and dry, paying particular attention to the
axilla and using long firm strokes.
Place the basin on the towel near the edge of the bed
and wash the hands in water paying special attention
to the nails.
Do the same with the nearer arm.
Spread the towel over the chest and abdomen. Wash,
rinse and dry, giving special attention to the area
beneath the breast and the umbilicus. Change water
Assists the patient to turn to his/her side with the back
towards the nurse and spread the bath towel on the bed
close to the body.
Expose the entire back. Then soap, rinse and dry from
the nape.
Rub the back with alcohol, lotion or powder
(depending on the condition of the skin ) followed by
talcum powder.
Expose the thigh, leg and foot on the far side, draping
of the top sheet or blanket around the groin.

18. Flex the knees and spread the bath towel under the
entire leg. Soap, rinse and dry up to the ankle giving
particular attention to the inguinal and popliteal areas.
19. Place the basin on the towel between the legs. Lift
father foot with the heel in the palm of your hand and
lower it slowly into the water, with the leg resting on
the bend of your elbow. Soap, rinse and dry well
between the toes.
20. Repeat the procedure on the other leg.
21. Clean the pubic and perineal areas. If the patient is a
female, finish with external douche or perineal
flushing. If the basin is big enough both feet may be
washed at the same time.
22. Put on the new gown
23. Assist with hair care
24. Discard dirty linens into hamper, clean and return used
equipment and leave the unit in order
25. Document relevant information

Tapotement, in here the little finger side of each

hands is used in a sharp hacking movement on the
back. Care must be taken with this type of rub to not
hurt the patient. Also called tapping.

Petrissage, is a large pinch of the skin, subcutaneous

tissue and muscle quickly done. The pinches are taken
first up the vertebral column and then over the entire
back.

Procedure:
1.
2.

Back Rub
3.
The backrub is a massage of the back with two chief
objectives:
a. To relax and relieve muscle tension.
b. To stimulate blood circulation to the tissues and
muscles.

4.
5.

Types of Techniques that can be used in Back Rub

Effleurage, is a smooth, long stroke, moving the

hands up and down the back. The hands are moved
lightly down the sides of the back, maintaining contact
with the skin but moved firmly up the back

Foundations of Nursing
Hygiene

6.
7.

Help client to side-lying or prone position.

Expose back, shoulder, upper arms and sacral area.
Cover remainder of the body with bath blanket. This
prevent unnecessary exposure and chilling while
maintaining dignity.
Wash hands in warm water. Warm lotion by holding
container under running water. Warm hands and lotion
prevent startle response and muscle tension from cold
hands and lotion.
Pour small amount of lotion into palms. Lubricating
palms reduces friction on skin during massage.
Massage sacral area with circular motion. Move hands
upwards to shoulder, massaging over scalpulae in
smooth, firm strokes. Without removing hands from
skin, continue in smooth strokes to upper arms and
down sides of back to iliac crest. Continue for 3 to 5
minutes.
Continuous, firm strokes promote relaxation and
stimulate circulation.
Use petrissage over shoulders and gluteal area and
tapotement up and down the spine.

Abejo