Assessing a Patient's Hygiene & Personal Care

Instructor: Jennifer Mitchell

Jennifer is a clinical professor for nursing students in critical care and has several years of experience in teaching nursing.

Hygiene and personal care is an important part of a nurse's assessment of a patient. This module covers all the aspects of hygiene and personal care that should be assessed for patient care.

Hygiene and Personal Care

Assessing patient hygiene and personal care is important to ascertain how well patients care for themselves or a caregiver cares for them. Hygiene is necessary for health, comfort, well-being, and safety. You can assess hygiene by examining a patient's clothing, skin, mouth, hair, and nails.

Clothing is More Than Fashion

How do you dress when it is cold outside - shorts and a t-shirt or pants and a sweater? Think about this when you assess your patient. Clothing is the first impression you get of your patients and will give you an idea of how they care for themselves.

How is your patient dressed when he or she comes to see you? Is the patient dressed appropriately for the weather? Is clothing in good condition or is it ripped, frayed, or dirty? Do the patient's clothes fit, or are they too big or too small?

If the clothes are not in good condition or appropriate for the weather, ask the patient why. Patients may not be able to afford appropriate clothing or have the means to wash their clothing, in which case a referral should be made to assist them in getting clothing.

Skin Condition is Revealing

The condition of the skin can reveal quite a bit about a patient's status. Have you ever skipped a shower or bath and felt your skin? It can feel oily, dirty, and even develop acne when not cared for properly. If a patient's skin appears dirty or oily, that can either be due to the need for bathing or could be due to hormone imbalances or skin pigmentation.

The skin should be intact, free of wounds, lacerations, ulcerations or breakdown. Assess for dry skin, acne, excessive hair growth or hirsutism, rashes, eczema, bruising, and abrasions. If you notice anything out of the ordinary, ask yourself why does the patient's skin appear this way? Does the patient not have access to a bath or shower? Is there some type of condition, such as depression, that prevents the patient from being able to care for himself or herself? Is the patient cared for by another person who hasn't been able to give the patient a bath?

Mouth Condition Is Crucial

Do you know what your mouth feels like when you don't brush your teeth? Imagine not being able to brush your teeth or care for your mouth because you depend on a caregiver to do those things for you. What happens when oral care is not performed?

Teeth can develop plaque buildup and cavities, possibly leading to abscessed or infected teeth and gums. The gums can become inflamed, a process known as gingivitis. Malnutrition, lack of oral care, and injury can cause tooth loss. The lips become dry and cracked, which is very uncomfortable.

The mouth, teeth, and gums should be assessed for these conditions as they can lead to other health problems, such as heart valve issues. When assessing the condition of the mouth, gums, and teeth, ask how often teeth are being brushed and flossed. If oral care is not being performed, find out why.

Hair Is Not Just for Looks

When you don't wash your hair for a day or two, how does it feel? Oily, greasy, tangled, perhaps even a scratchy scalp? A patient's hair should be in good condition, not brittle or dry or falling out excessively. These can be signs of malnutrition, caused by poor diet. Hair can also become thinner and more brittle as we age, so this is a common finding in the elderly.

Abnormal findings can also indicate a hormone imbalance. When assessing the hair, do you notice dandruff, lice, split ends, tangles or mats, or irritation of the scalp? And don't just look at the hair on the head, also look at eyebrows, facial hair if the patient has it, and pubic hair if appropriate.

If you notice anything out of the ordinary, ask the patient or caregiver about it. How often do they wash their hair, and what products do they use? How is their diet? Do they have it cut regularly? If these actions are not being taken, find out why.

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