Hygiene and Comfort

 Factor Influencing Individual Hygienic Practices

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 Preferences	Some people prefer a shower to tub bath. People have different 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 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 Superficial layers of the skin are scraped or rubbed away. Area is reddened and may have localized bleeding or serous weeping.	Prone to infection; therefore, wound should be kept clean and dry. Do not wear rings or jewelry when providing care to avoid causing abrasions to clients. Lift, do not pull, a client across a bed. Use two or more people for assistance.
Excessive Dryness Skin can appear flaky and rough.	Prone to infection if the skin cracks; therefore, provide alcohol-free lotions to moisturize the skin and prevent cracking. 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. Encourage increased fluid intake if health permits to prevent dehydration.
Ammonia Dermatitis (Diaper Rash) Caused by skin bacteria reacting with urea in the urine. The skin becomes reddened and is sore.	Keep skin dry and clean by applying protective ointments containing zinc oxide to areas at risk (e.g., buttocks and perineum). Boil an infant’s diaper or wash them with an antibacterial detergent to prevent infection. Rinse diapers well because detergent is irritating to an infant’s skin.
Acne Inflammatory condition with papules and pustules.	Keep the skin clean to prevent secondary infection. Treatment varies widely.
Erythema Redness associated with a variety of conditions, such as rashes, exposure to sun, elevated body temperature.	Wash area carefully to remove excess microorganisms. Apply antiseptic spray or lotion to prevent itching, promote healing, and prevent skin breakdown.
Hirsutism Excessive hair on a person’s body and face, particularly in women.	Remove unwanted hair by using depilatories, shaving, electrolysis, or tweezing. 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 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.

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.

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.