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Hygiene King Saud University College of Nursing Medical surgical Nursing Module

VIEWS: 135 PAGES: 14

									King Saud University
College of Nursing
Medical surgical Nursing

Module 4 -122




Prepared By:
                lecturer/ Magda Bayoumi
Definition of Hygiene:
 Hygiene is the science of health and its maintenance. Personal hygiene is the self-care by
which people attend to such functions as bathing, toileting, general body hygiene, and
grooming.
Hygiene is a highly personal matter determined by individual values and practices. It
involves care of skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal-genital
areas                                                                                              .

It is important for nurses to know exactly how much assistance a client needs for hygienic
care. Client may required help after urinating or defecating, after vomiting
                                                     .
Types of hygienic care:
Early morning care: is provided to clients as they awaken in the morning. The care consists
of providing a urinal or bedpan to the client confined to bed, washing face and hands, and
giving oral care, making bed is part of morning care                                      .
 Afternoon care: often includes providing bedpan or urinal, washing the hands and face,
assisting with oral care to refresh clients                                               .


Hours of sleep (HS) care is provided to clients before they retire for the car, and giving back
massage.
As-needed (prn) care is provided as required by the client. Foe example, a client who is
diaphoretic (sweating profusely) may need more frequent bathing and a change of clothes
                                                                   and linen.
Function of Skin:
    The skin is the largest organ of the body. It serves five major functions
 1- It protect underlying tissues from injury by preventing the passage of microorganisms (the
          body's first line of defense)                                .
2- It regulate body temperature
3- It secretes sebum, an oily substance that a) softens and lubricates the hair and skin. B)
prevents the hair from becoming brittle c) decrease water loss from the skin when the
external humidity is low. D) Lessens the amount of heat lost from the skin e) has a
                                                  bactericidal (bacteria-killing) action.
4- It transmits sensations through nerve receptors, which are sensitive to pain, temp, touch,
                  and pressure                         .
5- it produces and absorbs vitamin D in conjunction with ultraviolet rays from the sun

General Guide line for skin care:
1-intact, healthy skin is the body's first line of defense. Nurses need to ensure that all skin
care measures prevent injury and irritation. Scratching the skin with jewelry or long, sharp
fingernails must be avoided. Harsh rubbing or use of rough towels and washcloths can cause
tissue damage, particularly when skin is irritated or when circulation or sensation is
diminished. Bottom bed sheets are kept taut and free from wrinkles to reduce friction and
abrasion to the skin. Top bed linens are arranged to prevent undue pressure on the toes
  2- The degree to which the skin protects the skin protects the underlying tissues from injury
depend on the general health of the cells, the amount of subcutaneous tissue, and dryness of
   the skin                                                                          .
 3- Moisture in contact with the skin for more than a short time can result in increased
bacterial growth and irritation. After a bath, the client's skin is dried carefully            .


Lecturer/ Magda Bayoumi                          2
 4- Body odors are caused by resident skin bacteria acting on body recreations. Cleanliness is
     the best deodorant                            .
  5- Skin sensitivity to irritation and injury varies among individuals and in accordance with
their health. Skin sensitivity is greater in infants, very young children, and older people.

Bathing:

      Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
       The nurse can appreciate the quality of oil and dead skin cells produced when
       observing a person after the removal of the cast that have been on for 6 weeks.
       Applications of oil over several days are usually necessary to remove debris.
       Excessive bathing, however, can interfere with the intended lubricating effect of
       sebum, causing dryness of the skin. This an important consideration, especially for
       older adults who produce less sebum.
      Bathing also produces a sense of well-being, it is refreshing and relaxing and
       frequently improves morale, appearance, self respect.
      Bathing offers an excellent opportunity for the nurse to assess all clients. The nurse
       can observe the condition of the client's skin physical conditions such as sacral edema
       or rashes.

 Bath Categories:
Two categories of bath are given to clients: Cleaning and therapeutic
          Cleaning baths are given chiefly for hygiene purposes and include these types:

      Complete bed bath: the nurse washes the entire body of dependent client in bed.
      Self-help bed bath. Clients confined to bed are able to bathe themselves with help
       from the nurse for washing the back and perhaps the feet
      Partial bath (abbreviated bath). Only the parts of the client's body that might cause
       discomfort or odor.
      Towel bath. The towel bath is an-bed bath that uses a quick-drying solution
       containing a disinfectant, a cleaning agent, and a softening agent mixed with water
      Bag bath. The "bag bath" is an adaptation of the towel bath. The equipment needed is
       a plastic bag, 10-12 washcloths, the solution and wash clothes are warmed in a
       microwaves for 1 minute. each area of the body is cleaned with a different cloth and
       then air dried because the body not rubbed dry. The emollient in the solution remains
       on the skin.
      Tub bath. The tub baths are often preferred to bed baths because it is easier to wash
       and rinse in a tub. Tubs are also used for therapeutic baths. There are specially
       designed tubs for dependent clients.
      Shower: many ambulatory clients are able to use shower facilities and required only
       minimal assistance from the nurse.

Therapeutic baths: are given for physical effects, such as to soothe irritated skin or treat area
(e.g; the perineum). Medications may be placed in the water. The client remains in the bath
for a designated time, often 20-30 minutes.




Lecturer/ Magda Bayoumi                        3
Nursing Process: Bathing and Skin Care
ASSESSMENT
Assess:
 Condition of the skin (color, texture and turgor, presence of pigmented spots,
  temperature} lesions} excoriations} and abrasions)
 Fatigue
 Presence of pain and need for adjunctive measures (e.g., an analgesic) before the
  bath
 Range of motion of the joints and any other aspect of health that may affect the
  client's bathing process
• Need for use of disposable gloves during the bath

PLANNING
The nurse often delegates the skill of bathing to certified nursing assistant

IMPLEMENTATION:
Equipment
 Basin or sink with warm water (between 43 and 46°C)
 Soap and soap dish
 Linens: bath blanket, two bath towels, washcloth, clean gown or pajamas or clothes
  as needed, additional bed linen and towels, if required
 Gloves, if appropriate (e.g., giving perineal care)
 Personal hygiene articles (e.g., deodorant, powder,
  lotions)
 Shaving equipment for male clients
 Table for bathing equipment
 Laundry hamper

Preparation
Before bathing a client, determine:
 (1) The purpose and type of bath the client needs;
(2) Self-care ability of the client;
(3) Any movement or positioning precautions specific to the client;
(4) Other care the client may be receiving, such as physical therapy or x-rays, in order
to coordinate all aspects of health care and prevent unnecessary fatigue;
(5) Client's comfort level with being bathed by someone else; and
(6) Necessary bath equipment and linens.




Lecturer/ Magda Bayoumi                      4
Performance
1-Explain to the client what you are going to do, why it is necessary, and how he or she
can cooperate. Discuss with the client the plan for bathing and explain any unfamiliar
procedures to the client.
 2. Wash hands and observe other appropriate infection control procedures.
 3. Provide for client privacy by drawing the curtains around the bed or closing the
    door to the room. Some agencies provide signs indicating the need for privacy.
    Hygiene is a personal matter.
 4. Prepare the client and the environment.
     Invite a family member or significant other to participate if desired.
     Close windows and doors to ensure the room is a comfortable temperature. Air
      currents increase loss of heat from the body by convection.
     Offer the client a bedpan or urinal or ask whether the client wishes to use the toilet
      or commode. Warm water and activity can stimulate the need to void. The client will be more
      comfortable after voiding, and voiding before cleaning the perineum is advisable.
     Encourage the client to perform as much personal self-care as possible. This
      promotes independence, exercise, and self-esteem.
     During the bath, assess each area of the skin carefully.
For a Bed Bath
5- Prepare the bed and position the client appropriately.
     Position the bed at a comfortable working height. Lower side rail on the side close
      to you. Keep the other side rail UP. Assist the client to move near you. This avoids
      undue reaching and straining and promotes good body mechanics.
     Place bath blanket over top sheet. Remove the top sheet from under the bath
      blanket by starting at client's shoulders and moving linen down towards client's
      feet. Ask the client to grasp and hold the top of the bath blanket while pulling linen
      to the foot of the bed. The bath blanket provides comfort, warmth, and privacy. Note: If
      the bed linen is to be reused place it over the bedside chair. If it is to be changed, place
      it in the linen hamper.
    Remove client's gown while keeping the client covered with the bath blanket. Place
     gown in linen hamper.
6. Make a bath mitt with the wash cloth (Figure 1). A bath mitt retains water and heat
   better than a cloth loosely held and prevents ends of washcloth from dragging across the
   skin.
    Triangular method: (1) Lay your hand on the wash cloth; (2) fold the top corner over
     your hand; (3, 4) fold the side corners over your hand; (5) tuck the second corner
     under the cloth on the palm side to secure the mitt.
    Rectangular method: (1) Lay your hand on the washcloth and fold one side over your
     hand; (2) fold the second side over your hand; (3) fold the top of the cloth down; and (4)
     tuck it under the folded side against your palm to secure the mitt.



                                                 Rectangular method




Lecturer/ Magda Bayoumi                         5
7. Wash the face. Begin the bath at the cleanest area and work downward toward the feet.
    Place towel under client's head.
       Wash the client's eyes with water only and dry them well. Use a separate corner of the
       washcloth for each eye. Using separate corners prevents transmitting microorganisms
       from one eye to the other. Wipe from the inner to the outer canthus. This prevents
       secretions from entering the nasolacrimal ducts.
      Ask whether the client wants soap used on the face. Soap has a drying effect, and the
       face, which is exposed to the air more than other body parts, tends to be drier.
      Wash, rinse, and dry the client's face, ears, and neck.
     • Remove the towel from under the client's head.
 8. Wash the arms and hands. (Omit the arms for a partial bath.)
      Place a towel lengthwise under the arm away from you. It protects the bed from
       becoming wet.
      Wash, rinse, and dry the arm by elevating the client's arm and supporting the client's
       wrist and elbow. Use long, firm strokes from wrist to shoulder, including the axillary
       area. Firm strokes from distal to proximal areas promote circulation by increasing
       venous blood return.
      Apply deodorant or powder if desired.
      Optional: Place a towel on the bed and put a washbasin on it. Place the client's hands in
       the basin. Many clients enjoy immersing their hands in the basin and washing
       themselves. Soaking loosens dirt under the nails. Assist the client as needed to wash,
       rinse, and dry their hands, paying particular attention to the spaces between their fin-
       gers.
      Repeat for hand and arm nearest you. Exercise caution if an intravenous infusion is
       present, and check its flow after moving the arm.
     9- Wash the chest and abdomen. (Omit the chest and abdomen for a partial bath.
          However, the areas under a woman's breasts may require bathing if this area is
          irritated.)
       Place bath towel lengthwise over chest. Fold bath blanket down to the client's
        pubic area. Keeps the client warm while preventing unnecessary exposure of the
        chest
     Lift the bath towel off the chest, and bathe the chest and abdomen with your
        mitted hand using long, firm strokes. Give special attention to the skin under the
        breasts and any other skin folds, particularly if the client is overweight. Rinse and
        dry well
     Replace the bath blanket when the areas have been dried
    10- Wash the legs and feet. (Omit legs and feet for a partial bath.)
    Expose the leg farthest from you by folding the bath blanket toward the other leg,
    being careful to keep the perineum covered. Covering the perineum promotes privacy
    and maintains the client's dignity
    Lift leg and place the bath towel lengthwise under the leg. Wash, rinse, and dry the
     leg using long, smooth, firm strokes from the ankle to the knee to the thigh.
     Washing from the distal to proximal areas promotes circulation by stimulating venous
     blood flow.
    Reverse the coverings and repeat for the other leg.
   Wash the feet by placing them in the basin of water at figure 2
    Dry each foot. Pay particular attention to the spaces between the toes. If you
      prefer, wash one foot after that leg before washing the other leg.
    Obtain fresh, warm bathwater now or when necessary. Water may become dirty or
    cold. Because surface skin cells are removed with washing, the bathwater from
    dark-skinned clients may be dark, however, this does not mean the client is dirty.
    Raise side rails when refilling basin. This ensures the safety of the client




Lecturer/ Magda Bayoumi                        6
         FIGURE 2 Soaking a foot in a basin.

           11.Wash the back and then the perineum.
               Assist the client into a prone or side-lying position facing away from you. Place the
                bath towel lengthwise alongside the back and buttocks while keeping the client
                covered with the bath blanket as much as possible. This provides warmth and undue
                exposure.
             Wash and dry the client's back, moving from the shoulders to the buttocks, and upper
             thighs, paying attention to the gluteal folds
               Perform a back massage now or after completion of bath. (See Technique 10-3
                Performing a Back Massage).
                Assist the client to the supine position and determine whether the client can wash
                 the perineal area independently. If the client cannot do so, drape the client as
                 shown in Technique 10-2 and wash the area.
           12.Assist the client with grooming aids such as powder, lotion, or deodorant.
Use powder sparingly. Release as little as possible into the atmosphere. This will avoid irritation
of the respiratory tract by powder inhalation. Excessive powder can cause caking, which leads to skin
irritation.
Help the client put on a clean gown or pajamas.
Assist the client to care for hair, mouth, and nails. Some people prefer or need mouth care prior
to their bath
For a Tub Bath or Shower
13.Prepare the client and the tub.
Fill the tub about one-third to one-half full of water at 43 to 46°C (110 to 115°F). Sufficient
water is needed to cover the perineal area.
Cover all intravenous catheters or wound dressings with plastic coverings, and instruct the
client to prevent wetting these areas if possible.
Put a rubber bath mat or towel on the floor of the tub if safety strips are not on the tub floor.
These prevent slippage of the client during the bath or shower.
14.Assist the client into the shower or tub.
Assist the client taking a standing shower with the initial adjustment of the water temperature
and water flow pressure, as needed. Some clients need a chair to sit in the shower because of
weakness. Hot water can cause elderly people to feel faint.
If the client requires considerable assistance with a tub bath, a hydraulic bathtub chair may be
required (see variations).


         Lecturer/ Magda Bayoumi                      7
Explain how the client can signal for help, leave the client for two to five minutes, and place an
"occupied" sign on the door.
15.Assist the client with washing and getting out of the tub.
Wash the client's back, lower legs, and feet, if necessary.
Assist the client out of the tub. If the client is unsteady, place a bath towel over the client's
shoulders and drain the tub of water before the client attempts to get out of it. Draining the
water first lessens the likelihood of a fall. The towel prevents chilling.
16.Dry the client, and assist with follow-up care.
Follow step 12.
Assist the client back to his or her room.
Clean the tub or shower in accordance with agency practice, discard the used linen in the
laundry hamper, and place the "unoccupied" sign on the door
Document
Type of bath given (Le., complete, partial, or self-help). This is usually recorded on a flow
sheet.
Skin assessment, such as excoriation, erythema, exudates, rashes, drainage, or skin
breakdown.
Nursing interventions related to skin integrity.
Ability of the client to assist or cooperate with
bathing.
Client response to bathing.
Educational needs regarding hygiene.
Information or teaching shared with the client or their family

Variation: Towel Bath
Fold a large terry cloth towel in a plastic bag and saturate it with the solution provided.
Wring out the towel, and then unroll it over the client, while at the same time moving the top
bed linen off the client.
Fold excess towel under the client's chin for subsequent use.
Use a gentle massaging motion to clean the body, starting at the feet and working toward the
head.
Fold the towel upward after the massage and replace it with a clean sheet.
Use the part of the towel folded under the chin to clean the client's face, neck, and ears.
Remove the towel. Roll the client to one side and apply the clean side of the towel to the back
of the neck, back, and buttocks.
Remove the towel.
Place clean linen on the bed, dress the client, and position the client appropriately.

     Variation: Bathing Using a Hydraulic Bathtub Chair
     A hydraulic lift, often used in a long-term care or rehabilitation setting, can facilitate the
        transfer of a client who is unable to ambulate to a tub. The lift also helps eliminate
        strain on the nurse's back.
       Bring the client to the tub room in a wheelchair or shower chair.
       Fill the tub and check the water temperature with a bath thermometer to avoid thermal
          injury to the client.
       Lower the hydraulic chair lift to its lowest point, outside the tub.
       Transfer the client to the chair lift and secure the seat belt.
       Raise the chair lift above the tub.
       Support the client's legs as the chair is moved over the tub to avoid injury to the legs.
       Position the client's legs down into the water and slowly lower the chair lift into the
          tub.



         Lecturer/ Magda Bayoumi                     8
           Assist bathing the client, if appropriate.
           Reverse the procedure when taking the client out of the tub.
           Dry the client and transport him or her to his or her room.

           Evaluation:
                      Note the client's tolerance of the procedure (e.g, respiratory rate and effort, pulse
                       rate, signs of resistance.
                      Conduct appropriate follow up, such as: condition and integraty of skin (dryness,
                       tugor, redness, tugor, redness, lesion, etc.)
                      Client strength
                      Percentage of bath done without resistance.
Preneal- genetal care:
Preineal-genetal care is also referred to as perineal care or peri-care. Perineal care is the part of bed
bath. Nurses also may find it embarrassing for many clients, particulary with clients with opposite sex.
Most of the clients who require bed bath from nurse are able to clean their own perineal area with
minimal assistance.

Nursing Process:
ASSESSMENT
Irritation, excoriation, inflammation, swelling
Excessive discharge
Odor; pain or discomfort
Urinary or fecal incontinence
Recent rectal or perineal surgery
Indwelling catheter.
Determine-genital hygiene practices
Self-care abilities
PLANNING:
Equipment:
Perineal-Genital Care Provided in Conjunction with the Bed Bath
                 Bath towel
                 Bath blanket
                 Disposable gloves
                 Bath basin with water at 43 to 46°C (110 to 115°F)
                 Soap
                 Wash cloth
           Special Perineal-Genital Care
                    Bath towel
                    Bath blanket
                    Disposable gloves
                    Cotton balls or swabs
                     Solution bottle, pitcher, or container filled with warm water or a
                      prescribed solution
                    Bedpan to receive rinse water
                    Moisture-resistant bag or receptacle for used cotton swabs
                    Perineal pad


           Lecturer/ Magda Bayoumi                           9
Preparation:
Determine whether the client is experiencing any discomfort in the perineal-genital area.
Obtain and prepare the necessary equipment and supplies
Performance:
        1. Explain to the client what you are going to do, why it is necessary, and how he or she
           can cooperate, being particularly sensitive to any embarrassment felt by the client.
        2. Wash hands and observe other appropriate infection control procedures (e.g.,
           disposable gloves).
        3. Provide for client privacy.
        4. Prepare the client
            Fold the top bed linen to the foot of the bed and fold the gown up to expose the
             genital area.
            Place a bath towel under the client's hips. The bath towel prevents the bed from
             becoming soiled.
        S. Position and drape the client and clean the upper inner thighs.
        For Females
            Position the female in a back-lying position with the knees flexed and spread well
             apart (abducted).
            Cover her body and legs with the bath blanket.
             Drape the legs by tucking the bottom corners of the bath blanket under the inner
             sides of the legs (Figure 3). Minimum exposure lessens embarrassment and helps to
             provide warmth. Bring the middle portion of the base of the blanket up over the
             pubic area.
            Put on gloves; wash and dry the upper inner thighs.




        FIGURE 3. Draping the client for perineal-genital care.
        For Males
           Position the male client in a supine position with knees slightly flexed and hips
            slightly externally rotated.
            Put on gloves; wash and dry the upper inner thighs.
        6. Inspect the perineal area.
            Note particular areas of inflammation, excoriation, or swelling, especially between
             the labia in females and the scrotal folds in males.
            Also note excessive discharge or secretions from the orifices and the presence of
             odors.
        7. Wash and dry the perineal-genital area.
         For Females
            Clean the labia majora. Then spread the labia to wash the folds between the labia
             majora and the labia minora (Figure 10-5 +). Secretions that tend to collect around


        Lecturer/ Magda Bayoumi                             10
      the labia minora facilitate bacterial growth.
    Use separate quarters of the washcloth for each stroke, and wipe from the pubis to
     the rectum. For menstruating women and clients with indwelling catheters, use
     disposable wipes, cotton balls, or gauze. Take a clean ball for each stroke. Using
     separate quarters of the washcloth or new cotton balls or gauzes prevents the
     transmission of microorganisms from one area to the other. Wipe from the area of least
     contamination (the pubis) to that of greatest (the rectum).
     Rinse the area well. You may place the client on a bedpan and use a periwash or
      solution bottle to pour warm water over the area. Dry the perineum thoroughly,
      paying particular attention to the folds between the labia. Moisture supports the
      growth of many microorganisms.
For Males
    Wash and dry the penis, using firm strokes.
     Handling the penis firmly may prevent an erection.
    If the client is uncircumcised, retract the prepuce (foreskin) to expose the glans
      penis (the tip of the penis) for cleaning. Replace the foreskin after cleaning the
      glans penis (Figure 10-6 +). Retracting the foreskin is necessary to remove the
      smegma that collects under the foreskin and facilitates bacterial growth. Replacing the
      foreskin prevents constriction of the penis, which may cause edema.
    Wash and dry the scrotum. The posterior folds of the scrotum may need to be
      cleaned in step 9 with the buttocks. The scrotum tends to be more soiled than the
      penis because of its proximity to the rectum; thus, it is usually cleaned after the penis.
8. Inspect perineal orifices for intactness.
    Inspect particularly around the urethra in clients with indwelling catheters. A
     catheter may cause excoriation around the urethra.
9. Clean between the buttocks.
    Assist the client to turn onto the side facing away from you.
    Pay particular attention to the anal area and posterior folds of the scrotum in males.
     Clean the anus with toilet tissue before washing it, if necessary.
    Dry the area well.
    For postdelivery or menstruating females, apply a perineal pad as needed from
     front to back. This prevents contamination of the vagina and urethra from the anal
     area.

10-Document any unusual findings such as redness, excoriation, skin breakdown, dis-
        charge or drainage, and any localized areas of tenderness.

                   Female genitals                                            Male genitals




Evaluation :
Relate current assessment to previous assessments
Conduct appropriate follow-up such as prescribed ointment for excoriation.
Report any deviation from normal to the physician




Lecturer/ Magda Bayoumi                        11
Hair Care
The appearance of the hair often reflects a personJs feelings of self-concept and sociocultural well-being.
Becoming familiar with hair care needs and practices that may be different than our own is an important
aspect of providing competent nursing care to all clients.


Common hair problem:
Alopecia (hair loss)-can be caused by chemotherapeutic agents and radiation of the head.
Dandruff-a diffuse scaling of the scalp. Often accompanied by itching. Can usually be
treated effectively with a commercial shampoo.
Pediculosis (Iice)-there are three common kinds:
-Head /ice (Pediculus caPitis): Found on the scalp and tends to stay hidden in the hairs.
-Body /ice (Pediculus corporis): Tends to cling to clothing so that when a client undresses. the
lice may not be in evidence on the body. These lice suck blood from the person and lay their
eggs on the clothing.
- Crab /ice (Pediculus pubis): Stays hidden in pubic hair.
Hirsutism-the growth of excessive body hair. The cause of excessive body hair is not
always known.

Shampooing the hair:
Hair should be washed as often to keep it clean. There are several ways to shampoo clients'
hair, depending on their health, strength, and age.




Shampooing the hair of a client confined to bed. Note the shampoo basin and the receptacle below.




Lecturer/ Magda Bayoumi                                   12
NURSING PROCESS: HAIR CARE:
ASSESSMENT
 Determine:
 History of the following conditions or therapies: recent chemotherapy,
  hypothyroidism, radiation of the head, unexplained hair loss, and growth of excessive
  body hair.
 Usual hair care practices and routinely used hair care products (e.g., hair spray,
  shampoo, conditioners, hair oil preparation, hair dye, curling or straightening
  preparations).
Whether wetting the hair will make it difficult to comb. Kinky hair is easier to comb
when wet; however, it is very difficult to comb when it dries
Assess:
 Condition of the hair and scalp. Is the hair straight, curly, or kinky? Is the hair
  matted or tangled? Is the scalp dry?
 Evenness of hair growth over the scalp, in particular, any patchy loss of hair; hair
  texture, oiliness, thickness, or thinness; presence of lesions, infections, or
  infestations on the scalp; presence of hirsutism
 Self-care abilities (e.g., any problems managing hair
  care)
 PLANNING
Equipment
 Clean brush and comb
 A wide-toothed comb is usually used for many black-skinned people because finer
  combs pull the hair into knots and may also break the hair.
 Towel
 Hair oil preparation, if appropriate
Performance
1. Explain to the client what you are going to do, why it is necessary, and how he or she
   can cooperate.
2. Wash hands and observe other appropriate infection control procedures.
3. Provide for client privacy.
4. Position and prepare the client appropriately.
     Assist the client who can sit to move to a chair.
    Hair is more easily brushed and combed when the client is in a sitting position. If health
    permits, assist a client confined to a bed to a sitting position by raising the head of
    the bed. Otherwise, assist the client to alternate side-lying positions, and do one side
    of the head at a time.
     If the client remains in bed, place a clean towel over the pillow and the client's
        shoulders. Place it over the sitting client's shoulders. The towel collects any removed
        hair, dirt, and scaly material.
     Remove any pins or ribbons in the hair.
  5.Remove any mats or tangles gradually.
  Mats can usually be pulled apart with fingers or worked out with repeated
brushings.
  If the hair is very tangled, rub alcohol or an oil, such as mineral oil, on the strands to
help loosen the tangles.
  Comb out tangles in a small section of hair toward the scalp. Stablilize the hair
with one hand and comb towards the ends of the hair with the other hand. This avoids


Lecturer/ Magda Bayoumi                       13
scalp trauma. Note: Excessive matting or tangled hair may be infested with lice.
  6.Brush and comb the hair.
  For short hair, brush and comb one side at a time. Divide long hair into two sections
by parting it down the middle from the front to the back. If the hair is very thick, divide
each section into front and back subsections or into severallayers.
  7.Arrange the hair as neatly and attractively as possible, according to the individual's
desires.
• Braiding long hair helps prevent tangles.
8. Document assessments and special nursing interventions. Daily combing and brushing
of the hair are not normally recorded.
Evaluation:
*Conduct ongoing assessments for problems such as dandruff, alopecia, pediculosism scalp
lesions, or excessive dryness or matting
*Evaluate effectiveness of medication if appropriate.




Lecturer/ Magda Bayoumi                      14

								
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