1. Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 1
Equipments:
Tray with: soap, comb, toothpaste and toothbrush
Basin
Pitcher of warm water
Clean gown
Bath towel
Kidney basin
Bed screen PRN
NURSING SKILLS
Procedure:
Hygiene 1. Prepare equipment and arrange them within reach of
patient.
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N
2. Loosen top sheet at the foot remove patient’s gown.
3. Screen the bed, provide privacy.
4. Bathe the face, hands and axilla as in giving a
cleansing bath.
HYGIENE 5. Place on client gown, change PRN
6. Clean teeth, brush or comb hair.
7. Serve bedpan and follow with external douche.
The science of health. 8. Loosen bottom sheet, brush away crumbs and
Promotes cleanliness, provides for comfort and relaxation, straighten it.
improves self-image, promotes healthy skin. 9. Remove pillow and change pillow case; change other
Is a basic need for a client’s well-being and self esteem and linens PRN.
also necessary for infection control. 10. Replace pillow and place client in a comfortable
Hygiene practices are highly individualized and can be position ready for breakfast.
influenced by client’s culture, socio-economic status, 11. Gather and bring all used articles to utility room of
religion, developmental level, health status and personal CSR.
preference. 12. Wash and clean equipment and return client’s
The nurse must be knowledgeable about these factors to belonging to bedside stand.
provide individualized client care, meeting hygiene needs 13. Record time and type of care given and condition of
by providing care that the client alone cannot or should not the client.
provide.
The nurse should also encourage the client to meet personal
hygiene when possible.
Afternoon Care
Cultural Considerations and Hygiene
Some cultures do not permit women to immerse their
bodies in water during menstruation for fear they will Ensure patient’s comfort after lunch:
drown. • Offer assistance with toileting, handwashing, oral care
In North America, people typically bathe daily and use • Straighten bed linens
deodorants. • Help patients with mobility to reposition themselves
In Europe, many people do not bathe daily or use
deodorants.
Factors Influencing Personal Hygiene
• Culture Evening Care
• Socioeconomic class
• Spiritual practices
• Developmental and knowledge level
• Health state The care given to client after evening meal and
• Personal preference bedtime medication.
Purposes:
To refresh the client
Give comfort to the client in preparation for sleep
Morning Care
General Considerations:
Assist the client according to his condition
Observe the skin and report any reddening or
developing decubitus ulcer.
The care given to a client in the early morning prior to
serving breakfast.
Equipments:
Tray with: soap, comb, toothpaste and toothbrush
Purposes:
Basin
To refresh the client
Pitcher of warm water
To prepare client for breakfast
Clean gown
Bath towel
General Consideration:
Kidney basin
Client should be encouraged to help themselves if
Bed screen PRN
condition permits.
Client who is critically ill and debilitated must be
given assistance. No over exertion should be allowed. Procedure:
1. Arrange equipment on bedside within reach of the
When a large number of client’s are to be morning
client.
cared, a systematic procedure for distributing and
2. Screen the bed
collecting water used for washing should be devised
3. If the client is strong, washing of hands. Brushing of
according to facilities available.
teeth may be done by himself.
Foundations of Nursing Abejo
Hygiene
2. Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 2
4. Loosen the top sheet at foot part of bed and remove Equipments:
gown. Inflated Kelly pad
5. Turn the client to side. Expose back and place towel Face towel
beneath it on the bed. Newspaper
6. Rub and massage the back, hips and other pressure Cotton balls
areas with alcohol using gentle soothing strokes. Soap or hair shampoo
7. Dry and apply talcum powder. Pitcher of hot water
8. Offer bedpan and follow it with external douche. Bath towel
9. Loosen bottom sheets. Remove crumbs and straighten Rubber protector
it. Bed screen
10. Turn pillow
11. Adjust height of backrest to client’s comfort. Preparation:
12. Turn off light except for the night light. Gather all needed articles.
13. Place call light or bell within reach of client. Identify the client
14. Remove all used articles. Wash, clean and return to Introduced yourself
proper places. Inform the patient about the procedure
15. Record time care was given, procedure done and Provide privacy
significant observation. 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.
BATHING Lower the back and the knee rests depending on the
condition of the patient.
Prepare the water at the desired temperature.
General Information: Procedures:
1. Loosen and fold the top sheet down to the waistline or
a. The nurse provides cleansing or therapeutic baths. replace with a bath blanket.
b. Cleansing bath include a complete bed bath, a partial 2. Remove the pillow and bring the patient’s head close
bed bath and a tub bath or shower. to the edge of the bed by placing her diagonally across
c. A complete bed bath consists of washing a dependent the bed.
client’s entire body in bed; a complete bed bath with 3. Line a pillow with a rubber protector and bath towel
assistance involves helping the client to wash. and place it under the patient’s neck and shoulder so
d. A partial bed bath consists of or buttocks that may that the head is slightly incline.
cause discomfort or odor if le washing only parts of 4. Remove pins, ribbons from the hair and comb the hair
the client’s body such as feet ft unwashed. 5. Cover the eyes with a folded towel.
e. A tub bath or shower provides a more thorough 6. Plug the ear with cotton balls.
cleansing than a bed bath; the amount of nursing 7. Moisten the hair thoroughly then pour the soap
assistance is determined by the client’s age and health solution or liquid shampoo slowly on the scalp and
and safety consideration. hair while the other hand tries to spread it.
f. A therapeutic bath is ordered by a physician for a 8. Massage the scalp with the ball of your finger not the
specific purpose. nails.
g. Therapeutic baths include: 9. Rinse, repeat process until the hair is thoroughly
Sitz bath – to reduce inflammation and clean cleansed, taking care to avoid undue jagging or
the perineal area. frequent turning of the head.
Tepid sponge bath – to reduce fever. 10. Use cold water, whenever required for final rinse.
Medicated tub bath – to relieve skin 11. Squeeze off the excess water from the hair.
irritation. 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.
BED SHAMPOOING 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.
It is the washing of the hair with the patient in bed 17. Leave the unit in order.
18. Discard soiled linen in the hamper. Clean used
Purposes: equipment and keep in their proper places.
To maintain cleanliness and provide comfort 19. Document the time of procedure, reaction of the
To refresh the patient patient and abnormality noted
To wash the hair after application of a pediculocide.
General Considerations:
Be sure the procedure is ordered by the physician. BED BATH
Be certain that the patient is not febrile or within
normal body temperature.
See to it that the patient is comfortably placed in
position. A bath given to a patient on bed
Arrange the Kelly pad so as to llow the free flow of
water from the head. Purposes:
Protect the patient from chilling and falling. To cleanse, refresh and give comfort the patient who
Observe principles of body mechanics must remain in bed.
To stimulate circulation and aid in elimination.
To provide for an opportunity to inspect the patient’s
body for any signs of abnormality.
Foundations of Nursing Abejo
Hygiene
3. Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 3
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 patient’s 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, 6. Apply soap
pubic region, groin and spaces between the fingers and 7. Start cleaning the eyes, wipe from inner to outer
toes. canthus. Using circular strokes, bathe the face, neck
Do the bath quickly but unhurriedly, use even, smooth and ears.
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 Eye Care
Linen for changing Cleanse the eyes from inner canthus to the outer
Rubber sheet or news paper canthus. Use a new cotton ball for each wipe.
If the client is comatose, cover the eyes with
Preparation: sterile moist compresses. To prevent dryness and
Gather all needed articles. irritation of cornea.
Identify the client
Introduced yourself Health Teachings
Inform the patient about the procedure Eyeglass should be cleansed with warm water
Provide privacy and soap, dried with soft tissue.
Adjust the temperature and ventilation of the room Clean contact lens as directed by the
Remove unnecessary articles on the bed and clear up manufacturer.
the work area. Hold the artificial eye with thumb and index
Arrange all needed materials within reach, line a chair finger. Clean the artificial eye with warm normal
or table with newspaper or a piece of rubber where the saline, the place in a container with water or
basin will be placed. saline solution.
Lower the back and the knee rests depending on the Avoid rubbing the eyes.
condition of the patient. Maintain adequate lighting when reading
Offer the bedpan or urinal as desired. Avoid regular use of eyedrops
If dirt or foreign bodies get into the eyes, clean
Procedure: them with copious, clean, tepid water as
1. Loosen the sheet, this may be replaced by a bath emergency treatment
blanket.
2. Assist the patient to the side of the bed for Ear Care
convenience and ease in working.
Cleanse the pinna with moist wash cloth
3. Remove patient’s clothing under cover of the sheet or
Remove visible cerumen by retracting the ears
blanket.
downward. If this is ineffective, irrigate the ear
4. Fill the basin with one half t two-thirds full of
as ordered.
comfortably warm water.
5. Wrap the washcloth around the palm and fingers to Do not use bobby pins or toothpicks to remove
form a mitten cerumen these can rupture the tympanic
membrane or traumatize the ear canal.
Making a bath mitt: Rectangular method:
• Lay your hand on the washcloth and fold one side over Nose Care
your hand; Clean nasal secretion by blowing the nose gently
• Fold the second side over your hand; into soft tissue.
• Fold the top of the cloth down; and Both nares should be open when blowing the
• Tuck it under the folded side against your palm to nose to prevent forcing debris into the middle ear
secure the mitt. 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.
Foundations of Nursing Abejo
Hygiene
4. Nursing Skills
Hygiene
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 4
8. Rinse the area two or three times; then put it dry with
the towel.
9. Spread the towel lengthwise under the father arm.
10. Soap, rinse and dry, paying particular attention to the
axilla and using long firm strokes.
11. Place the basin on the towel near the edge of the bed
and wash the hands in water paying special attention
to the nails.
12. Do the same with the nearer arm.
13. 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 Tapotement, in here the little finger side of each
14. Assists the patient to turn to his/her side with the back hands is used in a sharp hacking movement on the
towards the nurse and spread the bath towel on the bed back. Care must be taken with this type of rub to not
close to the body. hurt the patient. Also called tapping.
15. Expose the entire back. Then soap, rinse and dry from
the nape.
16. Rub the back with alcohol, lotion or powder
(depending on the condition of the skin ) followed by
talcum powder.
17. Expose the thigh, leg and foot on the far side, draping
of the top sheet or blanket around the groin.
Petrissage, is a large pinch of the skin, subcutaneous
tissue and muscle quickly done. The pinches are taken
18. Flex the knees and spread the bath towel under the first up the vertebral column and then over the entire
entire leg. Soap, rinse and dry up to the ankle giving back.
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
Procedure:
1. Help client to side-lying or prone position.
2. Expose back, shoulder, upper arms and sacral area.
Cover remainder of the body with bath blanket. This
prevent unnecessary exposure and chilling while
Back Rub maintaining dignity.
3. 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
The backrub is a massage of the back with two chief hands and lotion.
objectives: 4. Pour small amount of lotion into palms. Lubricating
a. To relax and relieve muscle tension. palms reduces friction on skin during massage.
b. To stimulate blood circulation to the tissues and 5. Massage sacral area with circular motion. Move hands
muscles. upwards to shoulder, massaging over scalpulae in
smooth, firm strokes. Without removing hands from
Types of Techniques that can be used in Back Rub skin, continue in smooth strokes to upper arms and
down sides of back to iliac crest. Continue for 3 to 5
Effleurage, is a smooth, long stroke, moving the minutes.
hands up and down the back. The hands are moved 6. Continuous, firm strokes promote relaxation and
lightly down the sides of the back, maintaining contact stimulate circulation.
with the skin but moved firmly up the back 7. Use petrissage over shoulders and gluteal area and
tapotement up and down the spine.
Foundations of Nursing Abejo
Hygiene