After completing the chapter, you will be able to accomplish the following:

1. Assist with a shower or tub bath.
2. Provide a bed bath.
3. Assist with oral care.
4. Provide oral care for a dependent patient.
5. Provide denture care.
6. Remove contact lenses.
7. Shampoo a patient's hair in bed.
8. Assist with shaving.
9. Provide nail care.
10. Make an unoccupied bed.
11. Make an occupied bed.

• Assessment
• Clinical decision making/clinical judgment
• Comfort
• Functional ability
• Safety

• personal hygiene
• gingivitis
• caries
• plaque
• tartar
• dysphagia
• pediculosis

Personal hygiene involves measures for maintaining a minimal level of personal cleanliness and grooming that promotes physical and psychological well-being. Personal hygiene practices vary widely among people. The time of day one bathes, how often a person shampoos his or her hair, and how often a person changes their bed linens are very individualized choices.

People who are well ordinarily are responsible for their own hygiene. In some cases, the nurse may provide teaching to assist a well person to develop personal hygiene habits they may lack. Acute and chronic illness, hospitalization, and institutionalization may make it necessary to modify hygiene practices. In these situations, the nurse helps the patient to continue sound hygiene practices and can teach the patient and family members/caregivers, when necessary, about hygiene. When assisting with basic hygiene, it is important to respect individual patient preferences and provide only the care those patients cannot, or should not, provide for themselves. Patient care flow sheets are documentation tools used to record routine aspects of nursing care and are often used to document hygiene-related interventions. Figure 7-1 shows an example of a patient care flow sheet that is part of an electronic health record.

This chapter covers skills that the nurse needs to promote hygiene, including bathing, skin care, oral care, removing dentures and contact lenses, shampooing hair, shaving, and changing bed linens. Fundamentals Review 7-1 outlines general skin care principles.

1. Before Denasia's hair is washed, assess the situation. Assess the patient's hygiene preferences: frequency, time of day, and type of shampoo products. Assess for any physical activity limitations. Assess the patient's ability to get out of bed to have her hair washed. If the prescribed interventions allow it and the patient is physically able to wash her hair in the shower, the patient may prefer to do so. Otherwise, the shampoo could take place at the sink, if available. If the patient cannot tolerate being out of bed or is not allowed to do so, or a sink is not available, perform a bed shampoo. Assess for any activity or positioning limitations. Inspect the patient's scalp for any cuts, lesions, or bumps. Note any flaking, drying, or excessive oiliness. Find out if Denasia would prefer a family member/caregiver to shampoo her hair. If shampooing in bed, a shampoo cap can be used. Otherwise, use a shampoo board or tray, shampoo, and water.
2. Before removing Ms. Vortex's contacts assess the following: Assess both eyes for contact lenses, because some people wear them in only one eye. Determine the type of contact lenses worn. Assess eyes for any redness or drainage, which may indicate an eye infection or an allergic response. Assess for any eye injury. If an injury is present, notify the health care team about the presence of the contact lens. Do not try to remove the contact lens in this situation due to the risk for additional eye injury.
3. Assess the patient's oral hygiene preferences: frequency, time of day, and type of hygiene products. Assess for any physical activity limitations. Assess the patient's ability to perform own care. Determine if the IV site can be covered with water-protecting material, such as a glove or plastic wrap, to allow Mr. Sheen the ability to care for his dentures. Explore the possibility of discontinuing the IV infusion for a short period of time to keep the IV tubing from interfering with oral hygiene. If this is a possibility, review facility policy and determine the need for clearance from the health care team to implement this option. Encourage Mr. Sheen to do as much as he can; offer assistance, as needed. Patients are often afraid they will damage the IV or hurt themselves. Reinforce the fact that normal range of motion and activity are acceptable and should not interfere with the IV infusion.