• Pediculosis (lice) is the infestation with wingless insects. See Figure 17-1. Infestation means being in or on a host. Lice attach their eggs (nits) to hair shafts. Nits are oval and yellow to white in color. After hatching, they bite the scalp or skin to feed on blood. Adult lice are tan to grayish white in color and about the size of a sesame seed. Lice bites cause severe itching in the affected area. Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linen, sexual contact, and by sharing combs and brushes. Lice are treated with medicated shampoos, lotions, and creams specific for lice. Thorough bathing is needed. So is washing clothing and linens in hot water.

• Pediculosis capitis (“head lice”) is the infestation of the scalp (capitis) with lice.

• Pediculosis pubis (“crabs”) is the infestation of the pubic (pubis) hair with lice.

• Pediculosis corporis is the infestation of the body (corporis) with lice.

• Scabies is a skin disorder caused by the female mite—a very small spider-like organism (Fig. 17-2). The female mite burrows into the skin and lays eggs. When the eggs hatch, the females produce more eggs. The person becomes infested with mites. The person has a rash and intense itching. Common sites are between the fingers, around the wrists, in the underarm areas, on the thighs, and in the genital area. Other sites include the breasts, waist, and buttocks. Highly contagious, scabies is transmitted to others by close contact. Special creams are used to kill the mites. The person’s room is cleaned. Clothing and linens are washed in hot water.

See Focus on Communication: Skin and Scalp Conditions.

Focus on Communication

Skin and Scalp Conditions

Some skin or scalp conditions may alarm you. Be professional. Do not say things that may embarrass the person.

Report an abnormal skin or scalp condition. Describe what you saw as best as you can. For example:

• “I saw some small red dots on Mr. Martin’s right underarm during his bath. Would you please take a look at them?”

• “I saw some small white specks in Mrs. Patel’s hair. Would you please look at them before I wash her hair?”

Brushing and Combing Hair

Brushing and combing hair are part of early morning care, morning care, and afternoon care. Some people also do so at bedtime. Provide hair care when it is needed and before visitors arrive.

Encourage patients and residents to do their own hair care. Assist as needed. The person chooses how to brush, comb, and style hair.

Long hair easily mats and tangles. Daily brushing and combing prevent the problem. So does braiding. You need the person’s consent to braid hair. Never cut the person’s hair.

Special measures are needed for curly, coarse, and dry hair. The person may have certain hair care practices and products. They are part of the care plan. Also, let the person guide you when giving hair care.

See Caring About Culture: Brushing and Combing Hair.

See Delegation Guidelines: Brushing and Combing Hair.

See Promoting Safety and Comfort: Brushing and Combing Hair.

See procedure: Brushing and Combing Hair.

Caring About Culture

Brushing and Combing Hair

Styling hair in small braids is a common practice in some cultures. The braids are left intact for shampooing. To undo these braids, the nurse obtains the person’s consent.

Delegation Guidelines

Brushing and Combing Hair

To brush and comb hair, you need this information from the nurse and the care plan.

• How much help the person needs

• What to do for matted or tangled hair

• What to do for curly, coarse, or dry hair

• What hair care products to use

• The person’s preferences and routine hair care measures

• What observations to report and record:

• Scalp sores

• Flaking

• Itching

• Patches of hair loss

• Hair falling out in patches

• Very dry or very oily hair

• Matted or tangled hair

• The presence of nits or lice

• Itching

• Complaints of a tickling feeling or something moving in the hair

• Irritability

• Sores on the head or body caused by scratching

• Rash

• When to report observations

• What patient or resident concerns to report at once

Promoting Safety and Comfort

Brushing and Combing Hair

Safety

Sharp brush bristles can injure the scalp. So can a comb with sharp or broken teeth. Report any concerns about the person’s brush or comb.

Comfort

Place a towel across the person’s back and shoulders to protect garments from falling hair. If the person is in bed, give hair care before changing linens and the pillowcase. If done after a linen change, place a towel across the pillow to collect falling hair.

Brushing and Combing Hair

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines: Brushing and Combing Hair. See Promoting Safety and Comfort: Brushing and Combing Hair.

2. Practice hand hygiene.

3. Identify the person. Check the ID (identification) bracelet against the assignment sheet. Also call the person by name.

4. Ask the person how to style hair.

5. Collect the following.

• Comb and brush

• Bath towel

• Other hair care items as requested

6. Arrange items on the bedside stand.

7. Provide for privacy.

Procedure

8. Lower the bed rail if up.

9. Position the person.

a. In a chair—Help the person to the chair. The person puts on a robe and non-skid footwear when up.

b. In bed—Raise the bed for body mechanics. Bed rails are up if used. Lower the bed rail near you. Assist the person to a semi-Fowler’s position if allowed.

10. Place a towel across the person’s back and shoulders or across the pillow.

11. Ask the person to remove eyeglasses. Put them in the eyeglass case. Put the case inside the bedside stand.

12. Brush and comb hair that is not matted or tangled.

a. Use the comb to part the hair.

1. Part hair down the middle into 2 sides (Fig. 17-3, A).

FIGURE 17-3 Part hair.
A, Part hair down the middle. Divide it into 2 sides. B, Then part 1 side into 2 smaller sections.

2. Divide 1 side into 2 smaller sections (Fig. 17-3, B).

b. Brush 1 of the small sections of hair. Start at the scalp and brush toward the hair ends (Fig. 17-4). Do the same for the other small section of hair.

FIGURE 17-4 Brush hair by starting at the scalp. Brush down to the hair ends.

c. Repeat step 12, a(2) and 12, b for the other side.

13. Brush or comb matted or tangled hair.

a. Take a small section of hair near the ends.

b. Comb or brush through to the hair ends.

c. Add small sections of hair as you work up to the scalp.

d. Comb or brush through each longer section to the hair ends.

14. Style the hair as the person prefers.

15. Remove the towel.

16. Let the person put on the eyeglasses.

Post-Procedure

17. Provide for comfort. (See the inside of the front cover.)

18. Place the call light within reach.

19. Lower the bed to a safe and comfortable level appropriate for the person. Follow the care plan.

20. Raise or lower bed rails. Follow the care plan.

21. Clean and return hair care items to their proper place.

22. Unscreen the person.

23. Complete a safety check of the room. (See the inside of the front cover.)

24. Follow agency policy for dirty linen.

25. Practice hand hygiene.

Shampooing

Many people shampoo 1, 2, or 3 times a week. Others shampoo every day. In nursing centers, shampooing is usually done on the person’s bath or shower day. If done by a hairdresser or barber, do not shampoo the person’s hair. Provide a shower cap for the bath or shower.

The shampoo method depends on the person’s condition, safety factors, and personal choice. The nurse tells you what method to use.

• Shampoo during the shower or tub bath. The person shampoos in the shower. You use a hand-held nozzle for those using shower chairs or taking tub baths. You direct a spray of water at the hair.

• Shampoo at the sink. The person sits or lies facing away from the sink. A folded towel is placed over the sink edge to protect the neck. The person’s head is tilted back over the edge of the sink (Fig. 17-5). You use a water pitcher or hand-held nozzle to wet and rinse the hair.

FIGURE 17-5 Shampooing at the sink. This person is on a stretcher in front of the sink.

• Shampoo in bed. The person’s head and shoulders are moved to the edge of the bed if possible. A shampoo tray placed under the head drains water into a basin placed on a chair by the bed (Fig. 17-6). You use a water pitcher to wet and rinse the hair.

FIGURE 17-6 A shampoo tray is used for a person in bed. The tray is directed to the side of the bed so water drains into a collecting basin.

Dry and style hair as quickly as possible after the shampoo. Women may want hair curled or rolled up before drying. Check with the nurse before doing so.

See Focus on Older Persons: Shampooing.

See Delegation Guidelines: Shampooing.

See Promoting Safety and Comfort: Shampooing.

See procedure: Shampooing the Person’s Hair, p. 256.

Focus on Older Persons

Shampooing

Oil gland secretion decreases with aging. Therefore older persons have dry hair. They may shampoo less often than younger adults do.

Delegation Guidelines

Shampooing

To shampoo a person, you need this information from the nurse and the care plan.

• When to shampoo the person’s hair

• What method to use

• What shampoo and conditioner to use

• The person’s position restrictions or limits

• What water temperature to use—usually 105°F (Fahrenheit) (40.5°C [centigrade])

• If hair is curled or rolled up before drying

• What observations to report and record:

• Scalp sores

• Flaking

• Itching

• The presence of nits or lice

• Patches of hair loss

• Hair falling out in patches

• Very dry or very oily hair

• Matted or tangled hair

• How the person tolerated the procedure

• When to report observations

• What patient or resident concerns to report at once

Promoting Safety and Comfort

Shampooing

Safety

Keep shampoo away from and out of the eyes. Have the person hold a washcloth over the eyes. To rinse, cup your hand at the person’s forehead. This keeps soapy water from running down the person’s forehead and into the eyes.

Remove hearing aids before shampooing. Water will damage hearing aids.

Return medicated products to the nurse. Never leave them at the bedside unless the nurse tells you to do so.

Wear gloves if the person has scalp sores. Follow Standard Precautions and the Bloodborne Pathogen Standard.

For a shampoo on a stretcher at a sink, follow the rules for stretcher use (Chapter 9). Lock the stretcher wheels and use the safety straps and side rails. The far side rail is raised during the procedure.

Some people shampoo themselves during a tub bath or shower. Place an extra towel, shampoo, and hair conditioner within the person’s reach. Assist as needed.

Comfort

When shampooing during the tub bath or shower, the person tips his or her head back to keep shampoo and water out of the eyes. Support the back of the person’s head with 1 hand. Shampoo with your other hand. Some persons cannot tip their heads back. They lean forward and hold a folded washcloth over the eyes. Support the forehead with 1 hand as you shampoo with the other. Make sure that the person can breathe easily.

Many people have limited range of motion in their necks. They are not shampooed at the sink or on a stretcher.

Shampooing the Person’s Hair

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines: Shampooing, p. 255. See Promoting Safety and Comfort: Shampooing, p. 255.

2. Practice hand hygiene.

3. Collect the following.

• 2 bath towels

• Washcloth

• Shampoo

• Hair conditioner (if requested)

• Bath thermometer

• Pitcher or hand-held nozzle (if needed)

• Shampoo tray (if needed)

• Basin or pan (if needed)

• Waterproof pad (if needed)

• Gloves (if needed)

• Comb and brush

• Hair dryer

4. Arrange items nearby.

5. Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name.

6. Provide for privacy.

7. Raise the bed for body mechanics for a shampoo in bed. Bed rails are up if used.

8. Practice hand hygiene.

Procedure

9. Lower the bed rail near you if up.

10. Cover the person’s chest with a bath towel.

11. Brush and comb the hair to remove snarls and tangles.

12. Position the person for the method used. To shampoo the person in bed:

a. Lower the head of the bed and remove the pillow.

b. Place the waterproof pad and shampoo tray under the head and shoulders.

c. Support the head and neck with a folded towel if necessary.

13. Raise the bed rail if used.

14. Obtain water. Water temperature is usually 105°F (40.5°C). Test water temperature according to agency policy. Also ask the person to check the water. Adjust the water temperature as needed. Raise the bed rail before leaving the bedside.

15. Lower the bed rail near you if up.

16. Put on gloves (if needed).

17. Ask the person to hold a washcloth over the eyes. It should not cover the nose and mouth. (Note: A damp washcloth is easier to hold. It will not slip. However, your agency may require a dry washcloth.)

18. Use the pitcher or nozzle to wet the hair.

19. Apply a small amount of shampoo.

20. Work up a lather with both hands. Start at the hairline. Work toward the back of the head.

21. Massage the scalp with your fingertips. Do not scratch the scalp with your fingernails.

22. Rinse the hair until the water runs clear.

23. Repeat steps 19 through 22.

24. Apply conditioner. Follow the container’s directions.

25. Squeeze water from the person’s hair.

26. Cover the hair with a bath towel.

27. Remove the shampoo tray, basin, and waterproof pad.

28. Dry the person’s face with a towel. Use the towel on the person’s chest.

29. Help the person raise the head if appropriate. For the person in bed, raise the head of the bed.

30. Rub the hair and scalp with the towel. Rub gently. Use the second towel if the first one is wet.

31. Comb the hair to remove snarls and tangles.

32. Dry and style hair as quickly as possible.

33. Remove and discard the gloves (if used). Practice hand hygiene.

Post-Procedure

34. Provide for comfort. (See the inside of the front cover.)

35. Place the call light within reach.

36. Lower the bed to a safe and comfortable level appropriate for the person. Follow the care plan.

37. Raise or lower bed rails. Follow the care plan.

38. Unscreen the person.

39. Complete a safety check of the room. (See the inside of the front cover.)

40. Clean, rinse, dry, and return equipment to its proper place. Remember to clean the comb and brush. Discard disposable items.

41. Follow agency policy for dirty linen.

42. Practice hand hygiene.

43. Report and record your observations.

Shaving

Many men shave for comfort and well-being. Many women shave their legs and underarms. Some women shave facial hair. Or they may use other hair removal methods—waxing, hair removal products, plucking, threading. See Box 17-1 for shaving rules.

Box 17-1 Rules for Shaving

• Use electric shavers for persons taking anticoagulant drugs. Never use safety razors.

• Protect bed linens. Place a towel under the part being shaved. Or place a towel across the person’s chest and shoulders to protect clothing.

• Soften the beard before shaving. Apply a warm, moist washcloth or towel to the face for a few minutes.

• Encourage the person to do as much as safely possible.

• Hold the skin taut as needed.

• Shave in the correct direction.

• Shaving the face with a safety razor—shave in the direction of hair growth.

• Shaving the underarms with a safety razor—shave in the direction of hair growth.

• Shaving the legs with a safety razor—shave up from the ankles. This is against hair growth.

• Using an electric shaver—shave against the direction of hair growth. If using a rotary-type shaver, move the shaver in small circles over the face. (note: Your state and agency may require shaving in the direction of hair growth. Follow the manufacturer’s instructions and the rules in your state and agency.)

• Do not cut, nick, or irritate the skin.

• Rinse the skin thoroughly.

• Apply direct pressure to nicks or cuts (Chapter 31).

• Report nicks, cuts, or irritation to the nurse at once.

Safety razors or electric shavers are used (Fig. 17-7). Patients and residents may have their own electric shavers. If the agency’s shaver is used, clean it before and after use. To brush out whiskers, follow the manufacturer’s instructions. Also follow agency policy for cleaning electric shavers.