Editing Fundamentals of Nursing (section)

== Hygiene and personal care ==

Hygiene meets a physiologic need and, equally, a psychological one. Loss of the ability to bathe and groom independently is one of the most common sources of shame in hospitalized patients. Provide privacy, keep the patient covered except for the area being washed, and ask about personal and cultural preferences.

=== Bathing ===

* Test water temperature; approximately 43 to 46 degrees Celsius (110 to 115 degrees Fahrenheit) is a typical range for bathing, and it should always be verified against the patient's own tolerance. Older adults and patients with neuropathy or diabetes have reduced thermal sensation and are at high risk for burns.
* Wash from clean to dirty and from head to toe, saving the perineum for last.
* '''Eyes:''' wash from the inner canthus to the outer canthus using a separate portion of the washcloth for each eye, to avoid transferring organisms into the lacrimal duct or between eyes.
* '''Perineal care:''' clean from front to back. For an uncircumcised male, retract the foreskin, clean, and always return it to its natural position to prevent paraphimosis.
* Use gentle patting to dry, especially in skin folds and between the toes. Apply moisturizer to dry skin but not between the toes.
* Raise the side rails when leaving the bedside, and never leave a weak patient unattended in a tub or shower.

=== Oral care ===

Brush teeth twice daily and floss daily. For a patient who is unconscious or has an impaired gag reflex, place the patient in a side lying position with the head turned to the side, use minimal fluid, keep suction immediately available, and never place fingers in the mouth without a bite block. Dentures are removed, cleaned over a basin lined with a washcloth or filled with water to cushion a drop, and stored in a labeled container with water or denture solution. Avoid lemon glycerin swabs and alcohol based mouthwash, which dry and irritate the mucosa.

=== Foot and nail care ===

For a patient with diabetes or peripheral vascular disease: inspect the feet daily including between the toes and the soles, wash with lukewarm water and mild soap, dry thoroughly between the toes, do not soak the feet, do not use heating pads or hot water bottles, cut toenails straight across only if permitted by policy, and refer thickened nails, calluses, and corns to a podiatrist. Never allow the patient to walk barefoot. In many facilities nail trimming for patients with diabetes requires a provider order or podiatry referral.

=== Hair, shaving, and eyes ===

Shampooing may be done with a basin, an inflatable trough, or a no rinse cap. Use an electric razor for any patient with a bleeding risk, including patients on anticoagulants or with a low platelet count. For an unconscious patient, instill artificial tears as prescribed and consider protective shields, because the blink reflex may be absent and corneal drying can occur.