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1. Chapter11.4
Basic Human Needs:
Hygiene
Introduction
Hygiene isthe science of healthandits maintenance.Maintenance andpromotionof hygieneis
veryimportantaspectof humanphysiological needs.Manykindsof disease orillnesscanbe prevented
by maintainingpersonal hygiene.If hygiene ispromotedandmaintained,the individualhasa feelingof
comfort,well being,safetyandself confidence.
Personal hygiene isa self-care bywhichpeople attendtosuchas functionsasbathing,toileting,
general bodyhygieneandgrooming.Hygiene isdeterminedbyindividual valuesandpractices.It
involvesthe care of skin,hair,nails,teeth,oral andnasal cavities,eyeandperineal areas.
AnatomyandPhysiologyof the Skin
• It isthe largestorgan of the body.
• The functionsof the skinare as follows:
- It isthe firstline of defense againstinjuryandmicroorganisms.
- It maintainsbodytemperature.
- It issecretoryorgan.It secretessebum, anoilysubstanceswhichlubricatesthe hair
and the skin;preventsthe hairfrom becomingbrittle;decreaseswaterlossfrom
the skin;lessensthe amountof heatlostfromthe skinand has bactericidal action.
- It isa sensoryorgan.Ithas numerousnerve receptorswhichare sensitive topain,
temperature,touch andpressure.
- It producesandabsorbsvitaminD throughthe actionof ultravioletraysfromthe sun
whichactivate vitaminDprecursorpresentinthe skin.
Two Typesof SweatGlands
1. Apocrine glands
• Theyare primarilylocatedinthe axillaandanogenitalareas
• Theybegintofunctionatpubertyunderthe influenceof androgen.
• The secretionof these glandsisodorless,butmaybecome musky/unpleasant
whenacteduponby microorganisms.
2. Eccrine glands
• Theyare foundprimarilyonthe palmsof the hands,the solesof the feetand
forehead.
• The sweattheyproduce coolsthe bodythroughevaporation.
• The sweatiscomposedof water,sodium, potassium,chloride,glucose,urea
and lactate.

2. Common Problems of the Skin
1. Abrasion
• Superficial layers of the skin are scraped or rubbed away.
• The area appears red, with localized bleeding or serous weeping.
Nursing Interventions
• Keep the wound clean and dry to prevent infection.
• Lift instead of sliding, pulling or pushing the client in bed.
• Do notwear jewelries when performing procedures to the client.
2. Excessive dryness
• Skin is scaly and rough.
Nursing Interventions
• Encourage to increase fluidintake.Thisismosteffectivemeasure torelievedryness of the
skin.
• Apply cream or lotion to moisturize the skin and prevent cracking.
• Avoid use of alcohol on the skin.
• Bathe the client less frequently, rinse skin thoroughly.
3. Acne
• Aninflammatoryconditionof the skin which of the skin which of the skin which occurs in
and around sebaceous glands.
• Characterized by papules, pustules and comedones ( black heads).
Nursing Interventions
• Encourage daily bath.
• Keep the skin clean and dry.
• Adequate rest, sleep and exercise.
• Have exposure to natural sunlight.
• Avoid foods with high carbohydrate and fat content
E.g. chocolates, nuts and colas.
• Reduce emotional stress and anxiety.
• Avoid picking or squeezing of pimples.
• Use of medications as prescribed:
▪ topical ointment
▪ systemic antibiotics
▪ estrogen with progesterone
Hygienic Measures
Skin Care

3. 4. Erythema
• Rednessof the skinwhichmaybe associatedwithrashes,exposure to sun, elevated body
temperature.
Nursing Interventions
• Wash skin thoroughly to minimize microorganisms.
• Apply antiseptic spray or lotion to relieve pruritus.
• Promote healing and prevent impairment of the skin integrity.
5. Hirsutism
• Excessive growth of the hair among women.
Nursing Interventions
• Shave excessive hair growth
• Use depilatory cream
• Enhance client`s self concept
6. Hyperhidrosis is excessive perspiration.
7. Bromhidrosis is foul-smelling perspiration.
8. Vitiligo are patches of hypopigmented skin caused by destruction of melanocytes in the
area.
A. Primary Skin Lesion
• Macule. A flat,circumscribedareaof colorwithno elevationof itssurface;1mmto 1 cm
e.g.freckle,flatnevi (moles).
• Patch. Same as macule butlarger than1 cm e.g.port wine birthmark.
• Papule. A circumscribed,solidelevationof skin;lessthan1cm, e.g.
warts,acne.
• Plaque. Same as papule butlargerthan 1 cm , e.g.eczema.
• Nodule. A solidmassthat extends deeperintothe dermisthanthatof a papule,e.g.
pigmentednevi.
• Tumon. A solidmasslargerthan a nodule,e.g.epithelioma.
• Vesicle. A circumscribedelevationcontainingserousfluidorblood;lessthan1 cm, e.g.
blister,chickenpox.
• Bulla.A large fluid-filledsac.
• Pustuie. A vesicle orbullafilledwithpus,e.g.acne vulgaris,impetigo.
• Wheal. A relativelyreddened,elevated,localizedcollectionof edemafluid;irregularin
shape,e.g.mosquitobite.
• Cyst. Elevated,thick-walledlesioncontainingfluidorsemisolidmatter.
• Telangiectasia. Dilatedcapillary;fineredlines,e.g.livercirrhosis.
Types of Skin Lesion

4. • Petechiae. Pinpointredspots.
B. Secondary Skin Lesions
• Scale. Thickened epidermal cells that take off. E.g. dandruff, psoriasis.
• Crust. Dried serum or pus on the skin surface. E.g. impetigo.
• Fissure. A deep linear crack. E.g. athlete’s foot.
• Erosion. Loss of all or part of the epidermis. Appears moist demarcated depressed area.
E.g. ruptured chicken pox vesicle.
• Excoriation. A superficial linear or hollowed out crushed area exposing dermis. E.g.
scratch.
• Atrophy. A decrease in the volume of epidermis. E.g. striae, aged skin.
• Scar. A formation of connective tissue. E.g. healed wound.
• Ulcer. An excavation extending into the dermis or below. E.g. decubitus ulcer.
• Lichenification. Epidermal thickeningresultinginelevatedplaque with accentuated skin
markings. Results from repeated rubbing or scratching. E.g. chronic atopic dermatitis.
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. Bodyodors are causedbyresidentskinbacteriaactingonthe bodysecretions.Cleanlinessis
the best deodorant.
5. Skin sensitivity to irritation and injury varies among individuals and accordance with their
health.
6. Agentsusedforskincare have selective actionsandpurposes.E.g.soap,detergent,bathoil,
cream, lotion, powder, deodorant and antiperspirant.
Methods of Bathing
• Tub bath
• Stand-up shower
• Sit-down shower with shower chair.
• Bed bath
Clientswhosufferdizziness,weaknessormental confusionshouldnotbe allowedtotake stand-
up showers.Obese clientsmayfinditdifficulttomaneuverintoa bathtuband mightriskfalling.
For these clients,asit-downshowerchairmaybe more appropriate.

5. Purposes of Bed Bath
1. To remove microorganisms, body secretions and excretions and dead skin cells.
2. To improve circulation.
3. To promote relaxation and comfort.
4. To prevent or eliminate body odors and promote self-esteem.
5. To promote sense of well-being.
6. To assess the client’s skin and body parts.
7. To provide activity and exercise.
Nursing Interventions During Bed Bath
• Inform the client and explain purpose of the procedure.
• Provide privacy by closing curtains around bed or shut room door. This is to maintain client’s
dignity.
• Close windows and doors to prevent drafts.
• Turn-ff electric fan or air conditioning unit prevent chills.
• Encourage to void before start of the procedure. To ensure comfort.
• Place the bed in flat position, if admissible. To facilitate movement and change of position.
• Move the client to one side of the bed. To prevent overreaching and prevent muscle strain.
• Remove the patient’sgrown.Coveruptoshoulderlevel withthe topsheetorbath blanket. To
provide comfort, warmth and privacy.
• Use warm water (110 – 115ᵒF).
• Make bath mitt with the washcloth and prevent water from dripping on client.
• Wash the body parts as follows:
a. Eyes, face, ears, neck
b. Farther arm
c. Nearer arm
d. Hands
e. Chest and abdomen
f. Farther leg
g. Nearer leg
h. Feet
i. Back and buttocks
j. Perineum ( “finishing the bath”)
• Exposure, wash and dry one body part a time. To promote privacy and prevent chills.
• Rinse off soap thoroughly. To prevent skin irritation.
• May apply cream, lotion or powder on the skin.
• Change gown. Do bed making.
• Do after-care of equipment and articles.
• Document relevant data.
Special Nursing Considerations When Bathing a Client in Bed
1. Cleanse eye with water only, wiping from inner to outer canthus. Use separate corner of mitt
for each eye.
Rationale:Washingeye frominner to outer canthus prevents secretions from entering
Bed Bath

6. and irritating nasolacrimal ducts. Using separate corner for each eye prevents transfer of
microorganisms from one eye to the other.
2. Determine if clientwouldlike touse soaponthe face.Considerindividualpreferences.
Rational: Soap can be drying especially to the face. Some clients use special cleansing
solution for their faces.
3. Wash, rinse and dry the arms and legs using long, firm strokes from distal to proximal areas.
Rationale: Stroking from distal to proximal areas stimulates venous blood return.
4. Assess bath water temperature and change water as necessary.
Rationale: to ensure warm temperature of water for comfort. Changing water as
necessary ensures cleanliness of the water used for bathing the client.
Back Rub
The Backrub is a massage of the back with two chief objectives: to relax and relieve
muscle tension and to stimulate blood circulation to the tissues and muscles.
Types of Techniques that can be Used in Back Rub
• Effleurage. Is a smooth, long stoke, 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 are moved
firmly up the back.
• Tapotement.In here the little side of each hand 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 the over the entire back. It is called
kneading.
Nursing Interview in back Rub
• Help client to side-lying or prone position.
• Expose back, shoulders, upper arms and sacral area. Cover remainder of the body with bath
blanket. This prevents unnecessary exposure and chilling while maintaining dignity.
• Wash hands in warm water. Warm lotion by holding container under running warm water.
Warm handsand lotionpreventstartle response andmuscle tensionfromcoldhandsandlotion.
• Poor small amount of lotion into palms. Lubricating palms reduces friction on skin during
massage.
• Massage sacral area withcircularmotion. Move hands upwards to shoulders, 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 tapoitement up and down the spine.
To ensure asepsis, always wash from clean areas to dirty areas when possible.

7. • End massage withlong,continuous,strokingmovements. Stroking is the most relaxing of the
massage movements.
Purposes of Perineal-Genital Care:
1. To remove normal perineal secretionsandodor.
2. To preventinfection.
3. To promote comfort.
Nursing Interventions During Perineal-Genital Care
• Informthe clientandexplainpurpose of the procedure.
• Provide privacy.Tomaintainclientdignity.
• Position anddrape the clientasfollows:
- Female :dorsal recumbentposition;drape the clientdiagonally.
- Male:supine position.
- For female clients,use forceupstoholdcottonballsforcleansingthe
perineum.
- For male clients,wearcleangloves.
• For female clients
a. Use anteriortoposterior(fronttoback) stoke to preventcontaminationof
urethral meatus andvaginawithmicroorganismsfromthe anus.
b. Use one cottonball for eachstroke.
c. Cleanse perineumwithsoap/antisepticsolution.Includethe innerthigh.
d. Rinse the areawithcopiousamountof water.To remove soapadequeately
and preventirritationof the perineal area.
e. Dry perineumthoroughly.Moisture supportsmicrobialgrowth.
• For male clients
a. Wash and drypenisusingfirmstrokes,topreventerectionof the penis.
b. Use circularmotion,fromthe tipof glanspenistowardsthe penileshaft.
c. If the clientisuncircumcised,retractthe prepuce (foreskin).Thisisto
remove smegmathatcollectsunderthe foreskinandfacilitatesbacterial
growth.
d. Wash and drythe scrotumand buttocks.
• For post-deliveryormenstruatingfemales,applyaperineal padasneededfromfront
to back. Thispreventscontaminationof urethraandvaginafromanal area.
• Keepthe clientcomfortable
• Do the after-care of equipmentandarticles
• Documentrelevantdata
Perineal-Genital Care

8. • Washthe feetdaily,anddrythemwell especiallythe interdigitalspaces.
• Use warm waterfor footsoak,to softenthe nailsandloosendebrisunderthem.
Caution:soakingthe feetof diabeticclientsisnolongerencouragedbecause excessive
moisture cancontribute toskinbreakdown.
• Use cream or lotiontomoistenthe skinandsoftencalluses.
• Use deodorantspraysor footpowderto prevent orcontrol unpleasantodor.
• File toenailsstraightacross.Topreventnail splittingandtissue injuryaroundnail.
• Change socksor stockingdaily.
• Wearcomfortable,well-fittedpairof shoes
• Do notgo barefooted.
• Exercise the feettoimprove circulation
• Avoidusingconstrictingclothingorroundgarterswhichmaydecrease circulation.
• Avoidcrossingthe legs.
• Avoidself-treatmentforcornsor calluses.
Common Foot Problems
1. Callus.Painless,flat,thickenedepidermis,amassof keratoticmaterial.Often
causedby pressure fromthe shoe onbonyprominence.
2. Corn. Keratosis causedbyfrictionandpressure fromashoe.It commonlyaffectsthe
fourthand fifthtoe.Itappearscircularand raised.
3. Unpleasantodors. Thisresultsfromperspirationanditsinteractionwith
microorganisms.
4. Plantar warts. Causedbyviruspapova-virushominis.Theyappearonthe sole of the
footand are moderatelycontagious.Theyare painful andmake walkingdifficult.
5. Fissures.Causedbydrynessandcrackingof the skin.
6. Tinea pedis.Characterizedbyscalingandcrackingof the skin,particularlybetween
the toes,causedby a fungus.There maybe blisters.(AlsoAthlete’sfoot,ringworm
of the foot) .
7. Ingrown Toenail.Inwardgrowthof the nail,causingtraumaintosoft tissues.Itis
usuallydue totrimmingthe lateral edgesof the toenails.
• Trimnailsstraightacross,or follow the contourof the fingers.
• File nailstohave smoothedges.
• Do nottrim nailsat the lateral cornersto preventingrown.
• Diabeticclientsare advisedagainstcuttinghangnailsorcuticles.
• Ingrownisalsocalled unguisincarnatu.
• Separationof the nail fromthe nailbedisonycholysis.
Foot Care
Nail Care

9. • Inflammationof the skinfoldatthe nail marginis paronychia.
Measures to Prevent Tooth Decay
• Brushthe teeththoroughlyaftermealsand ata bedtime.
• Flossthe teethdaily.
• Ensure adequate intake of foodrichincalcium, phosphorus,VitaminA,CandD and
fluoride.
• Avoidsweetfoodsanddrinksbetweenmeals.
• Eat coarse,fibrousfoods( cleansingfoods) suchasfreshfruitsandraw vegetables.
• Have dental checkup every6 moths.
• Have topical fluoride applicantsasprescribedbythe dentists.
Brushing and Flossing the Teeth
Purposes
a. To remove foodparticlesfromaroundandbetweenthe teeth.
b. To remove dental plaque.
c. To enhance the client’sfeelingsof well-being.
d. To preventsordesandinfectionof the oral tissues.
Nursing Interventions When Providing Oral Care
• Informthe clientandexplainpurpose of the procedure.
• Provide privacy.
• Assistinsittingorside-lyingposition.
• Place towel underthe client’schin.
• Moistenbristlesof toothbrushandapplydentrifice.
• Holdkidneybasinunderthe chin.
• Allowthe clienttobrushhisteeth,if possible.
• Use downwardstrokesforupperfrontteeth;upwardstrokesfor lowerfrontteeth;
back and forthstrokesforthe bitingsurfacesof the teeth;andholdthe brush against
the teethwithbristlesat45 degreesangle topenetrateandcleanunderthe gingival
margins.
• Rinse the mouthwithadequate amountof water.Flossthe teeth.
• Keepthe clientcomfortable.
• Do after-care of equipmentandarticles.
• Documentrelevantdata.
For unconscious Client:
• Place inside – lyingpositiontopreventaspiration.
• Have suctionapparatusreadilyavailable.
• Use paddedtongue blade toopenthe mouth.
• Brushteethandgums,usingtoothbrushor softsponge – endedswab.
Mouth Care

10. • Applythinlayerof petroleumjellytolipstopreventdryingorcracking.
Note:Lemonglycerinswabscanbe dryingto the oral mucosaif usedfor extended
periods.
Care of Artificial Dentures
• Weargloveswhenhandlingandcleansingdentures.
• Place a washclothina basinor bowl of the sinkwhenbrushingdenturestoprevent
damage if the denturesare dropped.
• Store the denturesina containerwith water.
Common Problems of the Mouth
1. Plaque.An invisiblesoftfilmof bacteria,saliva,epithelial cellsandleukocytesthat
adhere tothe enamel surface of the teeth.
2. Tartar. A visible,harddepositof plaque andbacteriathatformsat the gum lines.
3. Halitosis.Bad breath.
4. Glossitis.Inflammationof the tongue.
5. Gingivitis.Inflammationof the gums.
6. Stomatitis. Inflammation anddrynessof the oral mucosa.
7. Parotitis. Inflammationof the parotidsalivaryglands(mumps).
8. Sordes.Accumulationof foul matter(food,microorganisms,andepithelial
elements) onthe gumsandteeth.
9. Perlodontal disease. Gumsappearspongyand bleeding(pyorrhea).
10. Cheilosis.Crackingof the lips.
11. Dental caries.Teethhave darkenedarea,maybe painful (cavities).
• The appearance of the hair may reflectaperson’ssense of wellbeingandhealth
status.
• Brushingandcombingthe hairstimulate circulationof bloodinthe scalp;distribute
the oil alongthe hair shaft;helptoarrange the hair.
Purposes
a. To stimulate the circulationof the bloodinthe scalpthroughmassage.
b. To cleanthe hair and improve the client’ssense of well-being.
Nursing Interventions During Hair Shampoo.
• Determine if the institutionrequiresdoctor’sorderforhairshampoo.
Hair Care
Hair Shampoo

11. • Place clientdiagonallyinbed.
• Remove pinsfromhair.Combandbrushhair thoroughly.Thisistoremove tangles.
• Place Kellypadunderthe head,withneckhyperextended.
• The trough of the Kellypadshouldbe directedtoa pail.Topreventspillageof water
ontothe floor.
• Coverthe eyeswithwashcloth.Toprotect themfromirritation.
• Plugthe earswithcotton balls.Toprevententryof waterintothe external auditory
canal.
• Applysmall amountof shampoo.
• Massage the scalp withthe fatpadsof the fingersandmake a richlather.Massage
promotescirculationinthe scalp.Richlatherensuresthroughcleansingof the hair.
• Rinse the hairthoroughly.Soapresidue inhairmaycause irritationof the scalp and
may dryhair.
• Dry the hair thoroughly.
• Keepthe clientcomfortable.
• Do after-care of equipmentandarticles.
• Make relevantdocumentation.
Common Hair and Scalp Problems
1. Dandruff. Is a chronicdiffuse scalingof the scalp,withpruritus(seborrheic
dermatitis).
2. Alopecia.Hair lossor baldness.
3. Pediculosis.Infestationwithlice.
a. Pediculosiscapitisisheadlouse.
b. Pediculosiscorporisisbodylouse.
c. Pediculosispubisiscrablouse.
4. Scabies.Contagiousskininfestationbythe itchmite.The characteristicof the lesion
isthe burrowproducedbythe female mite asitpenetrate the skin.The burrowsare
short,wavybrownor blackthreadlike lesions.
5. Hirsutism. Excessive growthof bodyhair.
• The usual treatmentforpediculosisis gammabenzenehexachloride(Kwell),
whichcomesinlotion,creamandshampoo.Pubiclice are difficulttoremove,so
the shampoomay be appliedandleftonfor12 to 24 hours.
• Linensandclothingsusedbyclientsshouldbe washedinhotwater.

12. Nursing Interventions
• Cleanse the eyesfromthe innercanthustothe outercanthus.Use a new cotton ball
for eachwipe.Topreventcontaminationof the nasolacrimalducts.
• If the clientiscomatose,coverthe eyeswithsterilemoistcompresses.Toprevent
drynessandirritationof the cornea.
• Eyeglassshouldbe cleansedwithwarmwaterandsoap;driedwithsofttissue.
• Cleancontactlensas directedbythe manufacturer.
• To remove artificial eyes,wearcleangloves,depressthe client’slowereyelid.
• Holdthe artificial eye withwarmnormal saline,thenplace inacontainerwithwateror
saline solution.
• Avoidrubbingthe eyes.Thismaycause infection.
• Maintain adequate lightningwhenreading.
• Avoidregularuse of eyedrops.
• If dirt/foreignbodiesgetintothe eyes,cleanthemwithcopious,cleartepidwateras
an emergencytreatment.
Nursing Interventions
• Cleanse the pinnawithmoistwashcloth.
• Remove visiblecerumenbyretractingthe earsdownward.If thisisineffective,irrigate
the ear as ordered.
• Do notuse bobbypins,toothpicksorcotton-tippedapplicatorstoremove cerumen.
These can rupture the tympanicmembrane ortraumatize the earcanal.Cotton - -tipped
applicatorscan pushwax intothe ear canal,whichcan cause blockage.
Nursing Interventions
• Cleannasal secretionsbyblowingthe nose gentlyintosofttissue.
• Bothnares shouldbe openwhenblowingthe nose topreventforcingdebrisintothe
middle ear,viathe Eustachiantube.
• May use cotton-tippedapplicatormoistenedwithsaline orwatertoremove
encrusted,driedsecretions.Insertonlyuptocottontip.
Eye Care
Ear Care
Nose Care