Providing for a patient's hygiene is probably the
most basic of all nursing care activities, but it is undoubtedly one of the
most important. Not only is it a provision for the patient's physical needs;
it also contributes immeasurably to the patient's feeling of emotional
3-2. PURPOSE OF THE PATIENT'S DAILY BATH
Removal of bacteria from the skin.
Confinement in bed increases perspiration, and
bacterial growth is stimulated by moisture.
Skin irritation from hospital bed linens may
result in skin breakdown and subsequent infection.
Relaxation effect on the patient.
Stimulation of blood circulation to the skin,
respirations, and elimination.
Maintenance of joint mobility.
Improvement of the patient's self-image and
emotional and mental well-being.
Providing the nurse with an opportunity for
health teaching and assessment.
Providing the nurse with an opportunity to give
the patient psychological support.
PHYSICAL CONDITIONS WHICH ENCOURAGE SKIN
BREAKDOWN IN A PATIENT WHO IS CONFINED TO BED
Continuous pressure over any body part impairs circulation to that part and can cause breakdown and eventual
If the patient is unable to control the bladder or bowel functions, skin breakdown is likely to occur due
to the presence of moisture and bacteria on the skin.
An emaciated patient may be prone to skin breakdown over bony prominence (heels, elbows, and coccyx).
An obese patient may have many skin folds where perspiration and bacteria may contribute to skin breakdown.
Changes. An older person's skin is very thin and inelastic. The sweat and oil glands are less
active. Thin, dry skin is more susceptible to pressure areas and skin breakdown.
Any Disease or
Condition that Affects Circulation. Any disease or condition that affects circulation can encourage
skin breakdown in a patient who is confined to bed.
NURSING INTERVENTION TO PREVENT SKIN
The time of the patient's bath or back massage
is the most logical time to thoroughly observe the patient's skin for pressure
At the first sign of redness, the area should
be washed with soap and water and rubbed with lotion; measures should then be
taken to keep the patient off the reddened area.
Report any signs of pressure to the charge
Keep sheets under the patient clean, smooth,
and tight to help eliminate skin irritation.
Ensure adequate nutrition and fluid intake,
according to physician's orders.
Every effort should be made to keep urine and
feces off the patient's skin, washing the skin with soap and water and keeping
the buttocks and genital area dry (lotion or powder may be used depending upon the
patient's skin type) when the patient is incontinent.
Obese patients may need assistance washing and
drying areas under skin folds (groin, buttocks, under breasts, and so
For the patient with very dry skin, various
bath oils may be added to the bath water.
TIMING OF PATIENT HYGIENE PROCEDURES
A patient's bath may be given at any time,
according to the patient's needs, but certain routines are generally followed on a ward.
The procedure followed in the morning affects
the patient's comfort throughout the day.
Each morning before breakfast, the patient
should be assisted to the bathroom, or a bedpan or urinal should be
provided, according to the patient's activity level.
The patient is then given the opportunity to
wash his/her hands and face and brush his/her teeth. The bed linen is
straightened, and the overbed table is cleaned in preparation for the breakfast tray.
After breakfast, the patient has a complete
bath (type is dependent upon the patient's condition and mobility), mouth care,
a change of clothing, and a back massage.
Bed linens are changed; and the unit is
cleaned and straightened to provide a comfortable and safe environment for the
The care the patient receives at the end of
the day greatly influences the patient's level of relaxation and ability to
An opportunity is provided for elimination;
the patient's hands and face are washed; the teeth are brushed; a back rub is
Bed linens are straightened; the patient's
unit is straightened to ensure comfort and safety. It is important that there are
no items, which the patient could slip on, or fall over, such as chairs or linens, on the
PROVIDING FOR SELECTED PATIENT NEEDS WHILE
BATHING A PATIENT
The bed may be in the high position during the
patient's bed bath, but should be placed in the low position upon
The side rails should be up after the
patient's bath for the patient who is confined to the bed.
The patient's call light should be within easy
reach to prevent the need to reach for it and risk falling out of bed and to
provide easy access in case of pain or distress.
Fire safety in the patient care area calls for
the following rules:
Always wash your hands before entering and
upon leaving the patient's room.
Respect for the patient's privacy decreases
the patient's emotional discomfort during personal care.
Keep the door to the patient's room closed.
Pull the curtains around the unit and drape
the patient's body during care.
Allow the patient to complete as much personal
care as possible; self-care is appropriate and provides additional
Ensure a comfortable temperature in the
Close any windows and the door to the
patient's room to prevent drafts and chilling.
Drape the patient appropriately during the
For a bedside bath, maintain bath water
between 110oF and 115oF; change the water as it cools and/or gets soapy.
SIGNIFICANT NURSING OBSERVATIONS DURING THE
Observe the skin under good, natural light.
Any abnormal skin condition should be
described as to its location, color, and size and how it feels to the patient.
The following skin observations should be
checked upon admission and daily thereafter:
Odor. May be caused by sweat secreted by the
sweat glands; by abnormal conditions, such as infection or kidney
disease; or by bodily discharges (urine, feces) that need to be cleaned.
Texture. Smooth and elastic or dry and rough;
nutritional deficiencies can influence skin texture.
Color. Reddened areas that could indicate
pressure, cyanosis (bluish tinge) or jaundice (yellowish tinge).
Temperature. Hot skin could mean fever; cold
skin could mean poor circulation.
Sensitivity. Pain, tenderness, itching, or
Swelling (edema). Stretched or tight
appearing; usually begins in the ankles or legs or any other dependent part;
may be associated with injury.
Skin lesions. Rashes, growths, or breaks in
Observations may begin at the head (scalp) and
proceed to the feet in a systematic manner.
Problems in this area may be related to the
patient's present problems.
The time of the patient's bath may be a good
time to find out more about the patient's psychosocial needs.
Remember that the patient's nonverbal
communication may tell you much about the way he/she is feeling.
BASIC PRINCIPLES OF MOUTH CARE
Provide oral care of the teeth, gums, and
Remove offensive odors and food debris.
Promote patient comfort and a feeling of
Preserve the integrity and hydration of the
oral mucosa and lips.
Alleviate pain and discomfort, thereby
enhancing oral intake.
Oral hygiene should be performed before
breakfast, after each meal, and at bedtime.
Oral hygiene is especially important for
patients receiving oxygen therapy, patients who have nasogastric tubes, and
patients who are NPO. Their oral mucosa dries out much faster than normal due to
You should provide for patient privacy during
the procedure, as this is an extremely personal procedure for most patients.
Oral care for the unconscious patient should
be performed at least every four hours.
Lipstick, chap stick, or vaseline may be
applied to the lips to keep them from drying out.
Nursing observations for the patient's mouth should be recorded in the clinical record, noting such
Swelling of gums.
Unusual mouth odor.
Effect of brushing the teeth. Note if there is
bleeding when you brush the patient's gums and teeth.
Many patients are sensitive or embarrassed
about wearing dentures; therefore, the patient's privacy should
be respected when the dentures are cleaned.
Dentures must be handled carefully; they are
fragile and expensive, and the patient is handicapped without them.
If the dentures are left out of the mouth for
any period of time, place them in a covered opaque container with the
patient's name on the container.
Dentures must be kept in water to preserve
their fit and general quality; the color may change if they become dry.
You may avoid breaking the dentures while
cleaning them by holding them over a basin of water with a
washcloth folded in the bottom.
Dentures are brushed in the same way as
natural teeth; be sure to rinse them well.
The denture cup should be labeled with the
patient's name and room number.
Never use hot water to rinse the dentures as
it could warp them; use cool or lukewarm water.
The patient's gums and soft tissues should be
cared for at least twice per day while the dentures are out of the mouth; a
soft-bristled toothbrush, swab, or gauze-covered tongue blade dipped in mouthwash
should be used to cleanse the gums, tongue, and soft tissues.
Patients With Mouth
Complications. The following problems are common in patients receiving chemotherapy and radiation
Observe the patient's mouth frequently for the
amount of bleeding present and the specific areas.
Do not floss the patient's teeth; use a Water-pik®.
Brush the teeth and clean the mouth using one
of the following methods:
1 Brush the teeth carefully with a very soft
2 Wrap a tongue blade with a gauze sponge
saturated with a prescribed solution; carefully swab the teeth and
mouth. Do not use lemon/glycerine swabs or commercial mouthwash because they contain
alcohol, which causes burning.
Observe the patient's mouth for appearance,
integrity, and general condition.
Wear clean gloves during the procedure.
Obtain a culture, if ordered.
Do not floss the teeth if the mouth is
irritated or painful.
Assist the patient with brushing the teeth and
cleaning the mouth, using a soft toothbrush or a gauze-padded tongue
Rinse the mouth with water and the prescribed
solution, if ordered.
Ulcerations, to include stomatitis.
Basic procedure for the patient with an
infection should be followed.
If the patient's mouth is extremely painful,
rinsing the mouth with a local anesthetic, as prescribed by a physician,
may be necessary.
Mouthwash and other solutions which contain
alcohol should not be used for the patient with ulcerations as they are
frequently very painful.
Oral care should be performed at least every
Oral suctioning may be required for the
unconscious patient to prevent aspiration.
A soft toothbrush or gauze-padded tongue blade
may be used to clean the teeth and mouth.
The patient should be positioned in the
lateral position with the head turned toward the side to provide for drainage and
to prevent aspiration.