Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing and cleaning between the teeth. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease. The most common types of dental disease are tooth decay (cavities, dental caries) and gum diseases, including gingivitis, and periodontitis.

1. CLARKE INTERNATIONAL UNIVERSITY
ALLIED HEALTH SCIENCES
CLINICAL MEDICINE AND COMMUNITY
HEALTH
NAME : NDAYISABA CORNEILLE
REG NO : 2017-DCM –FT- 003
YEAR : ONE SEMESTER TWO
COURSE UNIT : PRINCIPLE OF NURSING II
LECTURER : DR.WAAKO
QUESTION
Taking Care Of Patient’s Hygiene

2. Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems
(e.g. bad breath) by regular brushing and cleaning between the teeth.
It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease.
The most common types of dental disease are tooth decay (cavities, dental caries) and gum diseases,
including gingivitis, and periodontitis.
Cleaning between the teeth is called interdental cleaning and is as important as tooth brushing.This is
because a toothbrush cannot reach between the teeth and therefore only cleans 50% of the surfaces.
There are many tools to clean between the teeth, including floss, flossettes, and interdental brushes. It is
up to each individual to choose which tool he or she prefers to use. Mouth care can be defined as the
scientific care of the teeth and mouth.
Mouth care keeps the mouth and teeth clean in order to : prevents mouth odors,prevents infections,
increases comfort, makes food taste better, prevents cavities, To remove food debris as well as dental
plaque without damaging the gum, To prevent halitosis or relieve it and freshen the mouth
orol hygiene includes:
 brushing the teeth, gums, and tongue
 flossing the teeth (removes plaque and tartar)
 rinsing the mouth with mouthwash
WHY IS IT ORAL CARE NEGLECT?
 Lack of personal perception of oral health problems by residents and staff
 Family members and staff placing dental care as a low priority
 Specialized care not available within the area
OTHER REASON
 Staffing shortages – care gets overlooked
 Lack of oral care education

3.  Staff’s approach to residents – care is refused
 Poor dietary habits
what we observe
 dry, cracked, swollen, or blistered lips
 unpleasant mouth odors
 loose, broken or decayed teeth
 swelling , redness, sores, bleeding, or white patches in the mouth or on the tongue
 bleeding, swelling, or redness of the gums
 loose, chipped, or broken dentures
 patient complaints
some patients will be able to perform oral hygiene independently. others may need you to assist with
oral hygiene.
.some may need you to provide the care for them.it should be provided in the morning, after meals, and
at bedtime.
provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis, basin,
cup and water.
assist the patient as needed.
Special Oral Hygiene

4. Usually given to unconscious or semiconscious patients.
Tell the patient what you are doing.
Turn the patient's head toward you
Use a very small amount of liquid
Clean all areas of the mouth:
.Teeth,Gum,Tongue,Roof of mouth
Apply lubricant to tongue and lips.
oral hygiene is given every two hours for the: .comatose patient .patient with a nasogastric tube
.patient receiving oxygen
Providing oral care for comatose patient:
The mouth of an unconscious person may hang open causing the mouth and mucous membranes to dry
out.or the oral secretions may accumulate in the mouth due to the person’s inability to cough or clear
the throat.
These conditions may lead to discomfort and the growth of pathogens.
Assemble articles for flossing and brushing in order to promotes efficiency.
 Provide privacy in order to make patient relaxe
 Wash the hands and apply the gloves for reducing the transmission of microorganisms
 Explain the procedures to the client in order to demonstrate respect to the patient.
 position the comatose patient on his side to prevent aspiration.
 place a towel under the patient’s head to catch secretions.
 Use a floss holder and floss between all teeth in order to prevent transfer of Microorganisms
from patient bite.

5.  Moisten toothbrush and brush the teeth and gums using friction in a vertical or circular
motion.on inner and outer surfaces of teeth ,hold brush at 45 o
angle against teeth and brush
from sulcus to crowns of teeth .on biting surfaces,move brush back and forth in short strokes
.all surface of teeth should be brushed from every angle in order to permit cleaning of back and
side of teeth and decrease microorganism growth in the mouth.tooth past may foam and cause
aspiration.
 After flossing and brushing,rinse mouth with an asepto syringe and performoral sunctin for
promoting cleansing and removal of secretion
 Dry the patient ‘s mouth for prevent skin irritation
 .apply lip moisturizer,if appropriate for maintaining skin integrity of lip.
 Leave patient in the lateral position ,remove the towel from under the patient mouth and face
for preventing pooling of secretion and aspiration
 Remove gloves ,wash hands and document care in order to reduce transmission of
microorganism and documents nursing care.
 always assume the unconscious person can hear you. always explain what you are doing.
ORAL CARE TIPS
 Since most of the plaque is found at the gum line, use a soft toothbrush and angle the bristles
at a 45 degree angle to the gum line.
 This should be done twice a day; after breakfast and most importantly before bed. The mouth
should also be rinsed after meals.
 Oral care is not just for grooming, it is for INFECTION CONTROL .
 Toothbrushes can be adapted with a bicycle handle or a soft rubber ball for patients/residents
with limited hand closure
 Good for stroke and arthritis patients

6.  Since partials are made of both metal and acrylic, there are special tablets available for soaking
 There are also special brushes tapered to clean around the clasps
Implementation: 1.self care patient –flossing and blushing
.Assemble articles for flossing and brushing in order to promotes efficiency
.Provide privacy in order to make patient relax
.Place the patient in a high-flower’s position in order to decrease the risk of aspiration.
.Wash the hands and apply the gloves for reducing the transmission of microorganisms
.Arrange articles within client’s reach for facilitating self-care.
.Assist patient with flossing and brushing as necessary .position mirror ,emesis basin ,towel
across the chest .doing this for decreasing microorganism growth in the mouth,use of mirror
permit cleaning back and sides of teeth.
.Assist patient with rinsing mouth for removing the toothpaste and oral secretions.
.Reposition client,raise side rails,and place call button within reach in order to promote
comfort ,safety,and communication.
.Rinse ,dry, and return articles to proper place for promoting a clean environment.
.Remove gloves ,wash hands and document care in order to reduce transmission of
microorganism and documents nursing care.
2. Self-care patient :Denture care
. .Assemble articles for flossing and brushing in order to promotes efficiency
.Provide privacy in order to make patient relaxe
.Place the patient in a high-flower’s position in order to decrease the risk of aspiration.
.Wash the hands and apply the gloves for reducing the transmission of microorganisms

7. .Assist patient with denture removal: 1.top denture-with tissue,grasp the denture with thumb
and forefinger and pull downward,-place in denture cup.2. bottom denture:place thumbs on the
gums and release the denture. Grasp denture with thumb and pull upword.-place in denture cup.
breaks seal created with dentures without causing pressure and injury to oral
membranes.prevents breaking of dentures.
.Apply toothpaste to brush and brush dentures either with cool water in the basin or under
running water in the sink.pad sink with towel to protect dentures in case they are dropped for
facilitate removal of microorganisms.
.Rinse thoroughly in order to remove the toothpaste
.Assist patient with rinsing mouth and replacing dentures for freshens mouth and facilitates
intake of solid food.
Reposition patient with side rails up and call button within reach in order to promote comfort,
safety, and communication .
.Rinse,dry ,and return articles to proper place in order to maintain a clean environment.
.Remove gloves ,wash hands and document care in order to reduce transmission of
microorganism and documents nursing care.
3.Full care patient: Brushing and flossing
.Assemble articles for flossing and brushing in order to promotes efficiency
.Provide privacy in order to make patient relaxe
.Wash the hands and apply the gloves for reducing the transmission of microorganisms and
exposure to the body fluids
.position client as condition allows:highflowler’s; semi-flowler’s; or lateral position,head turned
toward side in order to decrease risk of aspiration.
.place towel across client’s chest or under face and mouth if head is turned to one side for
catching secretions

8. .moisten toothbrush,apply small amount of toothpaste and brush teeth and gum.moistens mouth
and facilitates plaque removal.
.grasp the dental floss in both hands or use a floss holder and floss between all teeth,holding
floss against tooth while moving floss up and down side of teeth, for removes plaque and
prevents gum disease
.assist the client in rinsing mouth in order to remove toothpaste and oral secretions.
.Reapply toothpaste and brush the teeth and gums using friction in a vertical or circular
motion.on inner and outer surfaces of teeth ,hold brush at 45 o
angle against teeth and brush
from sulcus to crowns of teeth .on biting surfaces,move brush back and forth in short strokes
.all surface of teeth should be brushed from every angle in order to permit cleaning of back and
side of teeth and decrease microorganism growth in the mouth.
.assist the patient in rinsing and drying mouth in order to remove tooth paste and oral
secretions.
.apply lip moisturizer,if appropriate for maintaining skin integrity of lip.
.reposition patient,raise side rails and place call button within reach for promoting
comfort,safety and communication.
.rinse ,dry,and return articles to proper place for providing an orderly environment.
Remove gloves ,wash hands and document care in order to reduce transmission of
microorganism and documents nursing care.
• Eye, Ear, and Nose Care
1.Care of the eyes
Equipement :
If cleansing both eyes, each eye should be treated as a separate procedure. Use a separate
dressing pack for each eye to prevent cross contamination. Always treat the uninfected or
uninflammed eye FIRST

9. • Sterile dressing pack
• Gallipot
• Normal saline
• Patients Health Record
procedures
.Confirm patients identity by asking for full name and date of birth or confirm identity with
family/carer in order to Ensure positive identification of the patient
. Explain procedure and obtain valid consent in order To allow the patient to make an informed
decision and gain co-operation.
. Collect and check all equipment for preventing delays and enable full concentration
on the procedure.
. Patient to be encouraged to sit / lie with head well supported in a position they find
comfortable for facilitating ease and accuracy of procedure
. Ensure light source is adequate in order To facilitate ease and accuracy of procedure.
. Decontaminate hands prior to procedure for reducing the risk of transfer of transient
organisms on the healthcare workers hands.
. Open sterile dressing pack onto a clean field and place all sterile single use equipment required
within sterile field in order to maintain asepsis and prevent contamination of sterile equipment.
. Apply single use disposable apron in order To protect clothing or uniform from contamination
and potential transfer of microorganisms
. Apply single use disposable sterile gloves in a manner which prevents the outer surface of the
sterile gloves being touched by a non-sterile item in order To maintain asepsis, reduce the risk
of microbial contamination and prevent the spread of infection
. Use aseptic principle to ensure that only sterile single use items are used to keep exposure of
the
susceptible site to a minimum fo preventing contamination of a susceptible site by organisms
that could cause infection.

10. Always bathe the lids with the eyes closed first in order to reduce the risk of damaging the
cornea
Lower Lid
Using a sterile gauze swab moistened slightly with normal saline, ask the patient to look up and
gently
swab the lower lid from the nasal corner outwards once only. For Reducing the risk of swabbing
discharge into the lachrymal ducts or into the other eye
. Ensure the edge of the swab is not above the lower lid margin to avoid touching the cornea for
Reducing the risk of damage to the cornea
. Use a new swab for each wipe until all discharge has been removed for Reducing the risk of
cross infection
Upper Lid
Using a sterile gauze swab moistened slightly with normal saline, gently swab the upper lid by
gently
lifting the eye lid margin and asking the patient to look down from the nasal corner outwards
once
only. Avoid touching the corner in order to Facilitates access to the upper eyelid ,Reduces the
risk of swabbing discharge into the lachrymal ducts or into the other eye,Reduces the risk of
damage to the cornea and to Reduces the risk of cross infection
. On completion of procedure remove and dispose of Personal Protective Equipment (PPE) to
comply
with waste management policy in order to prevent cross infection and environmental
contamination
. Decontaminate hands following removal of PPE for removing any accumulation of transient
and
resident skin flora that may have built up under the gloves and possible contamination
following removal of PPE.

11. . If signs of infection or inflammation are noted, inform General Practitioner here Medical
treatment may be required
.Ensure patient / client is comfortable following procedure here there is Maintaining privacy
and dignity
. Document all actions and observations in nursing records in order to monitor trends and
fluctuations. Ensure compliance with Trust record keeping policies
2. Care of the ears: The ears are cleansed by the nurse during the bed
bath. A clean corner of a moistened washcloth rotated gently into the ear canal works best for
cleaning.A cotton-tipped applicator is useful for cleansing the pinna.The nurse should teach
patients never to use bobby pins, toothpicks, or cotton-tipped applicators to clean the internal
auditory canal.
3.Care of the nose:The patient can usually remove secretions from the nose by gently blowing
into a soft tissue. Teach the patient that harsh blowing causes pressure capable of injuring the
tympanic membrane, nasal mucosa, and even sensitive eye structures. If the patient is not able
to clean the nose, the nurse will assist, using a saline-moistened washcloth or cottontipped
applicator; for excessive secretions, suctioning may be required.
BATH CARE
A bath given to client who is in the bed (unable to bath itself)
Purpose:To prevent bacteria spreading on skin,To clean the client’s body,To stimulate the
circulation,To improve general muscular tone and joint, To make client comfort and help to
induce sleep, To observe skin condition and objective symptoms
when giving a bath you can examine the patient’s entire body.observe and report skin that is:
pale, dark, or reddened in color. rough or chapped in texture.dry or flaking, lacking in moisture.
injured (blisters, bruises, or lacerations). sore (pressure sores or infections)
Four Main Types Of Baths
 complete bed bath

12.  partial bed bath
 tub bath
 Shower
Complete Bed : complete bed bath is given to patients who are not able to bathe themselves.
involves washing the person’s entire body in bed. persons who are: unconscious; paralyzed; in a
cast or traction; weak from illness or surgery.
Procedures
 Place everything you need on the overbed table before beginning the bath.
 Rise the bed to a comfortable height and raise the rail on the far side of the bed.
 wash only one part of the body at a time. wash, rinse, and dry each part and then cover it with
the bath blanket.
 change the water in the basin whenever it becomes soapy, dirty, or cool.
 keep the soap in the soap dish between latherings.
 wash from the cleanest to the dirtest areas.
Partial Bath
Involves washing the areas of the body that cause discomfort and odor or need daily cleaning.
the areas that are washed in a partial bath are the face, hands, axillae, back, and perineal area or
a partial bath may refer to bathing the areas that the patient can not reach when he is bathing
himself in bed.
Tub bath :because of safety concerns tub baths are not frequently given in most nursing homes.
safety measures: never leave a patient alone in the tub. a bath should last no longer than 20
minutes. place a towel on the bottom of the tub to prevent slipping. adjust the water temperature
to 105°. drain the tub before the person gets out. clean the tub before and ater use.

13. SHOWER a resident will be placed on a shower chair to receive a shower
Never leave the patient alone on the shower chair or in the shower room. adjust the water
temperature before you place the person in the shower. clean the shower before and after use.
gloves may be worn while bathing a patient if desired.
PERINEAL CARE
Perineal care is bathing the genitalia and surrounding area. Proper assessment and care of the perineal
area will need professional clinical judgment.
Purpose:
1. To keep cleanliness and prevent from infection in perineal area
2. To make him/her comfortable
involves the cleaning of the genital and anal areas of the body
 the perineal area is warm, dark, and moist and so provides an ideal environment for
microorganisms to grow.
 the areas are cleaned at least once daily to prevent infection and odors and to provide comfort.
 peri-care should be provided after each incontinent episode.
 use standard precautions.
 may have to use the term private area
FEMALE PERI-CARE
 always cleanse from the urinary meatus toward the anus. ( clean to dirty )
 may have a prepackaged kit or use wet washcloths.
 use a different part of the washcloth for each stroke
 to clean the anal area , cleanse from the vagina toward the anus (clean to dirty)
MALE PERI-CARE

14.  start at the urinary meatus and use circular motions as you wipe downward to the base
 retract the foreskin if the patient is uncircumcised
 return the foreskin to its natural position when you are finished
HAIR CARE
A patient’s hair should be combed daily. In addition, other care is necessary to enhance morale,
stimulate circulation of the scalp, and prevent tangled, matted hair.
Daily Care.
Encourage the patient to rub his scalp with fingertips to stimulate circulation. Comb hair in a becoming
style. To assist a patient to comb matted and tangled hair, first comb the ends and progress toward the
scalp. Hold the lock of hair being combed between the scalp and the comb to avoid pulling. Brush the
hair as necessary
 people feel better about themselves when their hair is combed and looks attractive.
 patients should be asked how they would like their hair styled.
 do not change a patient’s hairstyle without permission.
 never cut a patient’s hair.
 make sure the style is age-appropriate.
c. Hair Cutting.
Barber service is provided in most service hospitals. The barber makes regular rounds on the nursing
unit or comes by appointment. The patient receiving the service pays the fee directly to the barber.
Occasionally, hairdresser service can be arranged for patients on the unit. Ambulatory patients go to the
barber shop or beauty parlor, if the medical officer approves.

15. d. Shampoo.
The patient confined to bed will require a cleansing shampoo at least every two weeks. With the
approval of the medical officer, plan the shampoo for a time when the patient feels rested and has no
conflicting treatments or appointments. If the patient can be moved to a stretcher, do so and take him to
a convenient sink. If this is not possible, do the shampoo in bed.
(2) Following is the procedure for administering a shampoo to a patient in bed.
(a) Place a newspaper on the chair and the bucket on the newspaper. Place the pitcher of water,
shampoo, comb, brush, and one of the two bath towels on the bedside cabinet.
(b) Move the patient to the near side of the bed. Lower the bed to a level position.
(c) Pull the pillow down under the patient’s shoulders to assisting extending the neck. Fold one bath
towel around the neck.
(d) Place the narrow side of the rubber sheet under his head and over the edge of the pillow. Roll the
sides of the sheet to improvise a trough, and place the free end in the bucket.
(e) Give the patient a washcloth for his eyes and face.
(f) Check provisions for water drainage before pouring any water.
(g) Wet his hair and apply shampoo. Lather and rinse it.
(h) Reapply shampoo and rinse the hair again repeatedly until his hair is “squeaky clean.” (A woman
will require more rinse water than a man, but otherwise the procedure is unchanged.)
(i) Slip a dry towel under the patient’s bed. Then roll and remove the rubber sheet. Pull the pillow up
into its normal place.
(j) Dry the hair by gently rubbing it with a clean towel.
(k) Remove the equipment and wipe up any water spilled on the floor.

16. (l) Assist the patient to comb and brush his hair with a clean comb and brush.
NAIR CARE
 soaking the hands helps to soften the nails before trimming.
 soak fingernails for 5 to 10 minutes
 always use a nail clipper- never scissors
 file rough nails with an emery board
 do not trim toenails!! only an rn or dr. can trim toenails.
CARE OF THE HANDS AND FEET
Special attention is often required to prevent infection, odor, and injury of the patient’s hands and feet.
Problems often arise from abuse or poor care of hands and feet, such as biting the nails and wearing ill-
fitted shoes. Assessment of the feet involves a thorough examination of all skin surfaces. Areas
between toes should be carefully checked.
Patients with diabetes mellitus or peripheral vascular disease should be observed for adequate
circulation of the feet. Because of poor vision and decreased mobility, the elderly are at risk for foot
disorders. Care of hands and feet can be administered during the morning bath or at another convenient
time.
Important Points.
(1) Notice general physical conditions that may place the patient at risk for infections.
(2) Prevent interruptions during the procedure.

17. (3) Soak in warm water to soften nails and loosen foreign particles.
(4) Prevent spread of microorganisms.
Procedure.
(1) Obtain physician’s order if necessary.(2) Explain procedure.(3) Prepare equipment:
Washbasin.,Emesis basin.,Washcloth.,Hand towel., Nail clippers, emery board, and orangewood stick,
Lotion., Disposable bath mat. Disposable gloves (optional).
(4) Wash hands, and arrange supplies within easy reach.(5) Position patient in chair, place disposable
mat under patient’s feet if possible, and provide patient with privacy.
(6) Fill the basin with water at 100º to 110ºF (38º to 44ºC). Place the basin on a disposable mat and
help patient place feet into basin. Soak feet for 15 to 20 minutes, rewarming water as necessary (7)
Place overbed table in low position in front of the patient. Fill emesis basin with water at 100º to 110ºF
(38º to 44ºC). Place the basin on the table and place patient’s fingers into basin. Soak fingernails 10 to
20 minutes; rewarm water as necessary
(8) Clean under fingernails with orange stick. Trim nails straight across and even with clippers. Shape
fingernails with emery board. Push cuticles back gently with washcloth or with orangewood stick.
(9) Don glove and wash areas of the feet that are calloused with washcloth.(10) Trim and clean toenails
as in step 8 for fingernails.(11) Apply lotion or cream to hands and feet. Return patient to bed and
position for comfort. (12) Remove gloves and store them in proper container. Clean all equipment and
store. Place soiled linen in laundry bag. Wash your hands.
Reference:
. Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.
. Dougherty, L. and Lister, S.E. (2008) The Royal Marsden Manual of Clinical Nursing
Procedures – Seventh Edition. Blackwell Publishing, Oxford.
. AliceAugustine, Jebamani Sugustine,Accamma Chacko: Clinical Nursing Procedure Manual,
B.I. Publications, 2004