• Define the key terms and key abbreviations listed in this chapter. • Explain why personal hygiene is important. • Identify the observations to report and record when assisting with hygiene. • Describe the care given before and after breakfast, after lunch, and in the evening. • Explain the purposes of oral hygiene. • Describe safety measures when giving mouth care to unconscious persons. • Explain how to care for dentures. • Describe the rules for bathing. • Identify safety measures for tub baths and showers. • Explain the purposes of perineal care. • Perform the procedures described in this chapter. • Explain how to promote PRIDE in the person, the family, and yourself. See Focus on Communication: Assisting With Hygiene, p. 228. See Focus on Older Persons: Assisting With Hygiene, p. 228. See Promoting Safety and Comfort: Assisting With Hygiene, p. 228. • Keeps the mouth and teeth clean. • Prevents mouth odors and infections. • Reduces the risk for cavities (dental caries) and periodontal disease (gum disease, pyorrhea). The nurse assesses the person’s need for mouth care. Illness, disease, and some drugs often cause: • A whitish coating in the mouth and on the tongue. • Redness and swelling in the mouth and on the tongue. • Dry mouth. Dry mouth also is common from oxygen, smoking, decreased fluid intake, and anxiety. See Delegation Guidelines: Oral Hygiene. See Promoting Safety and Comfort: Oral Hygiene. See procedure: Brushing and Flossing the Person’s Teeth. 1. Follow Delegation Guidelines: Oral Hygiene. See Promoting Safety and Comfort: Oral Hygiene. 4. Place the paper towels on the over-bed table. Arrange items on top of them. 5. Identify the person. Check the ID (identification) bracelet against the assignment sheet. Also call the person by name. 7. Raise the bed for body mechanics. Bed rails are up if used. 8. Lower the bed rail near you if up. 9. Assist the person to a sitting position or to a side-lying position near you. (Note: Some state competency tests require that the person is at a 75- to 90-degree angle.) 10. Place the towel across the person’s chest. 11. Adjust the over-bed table so you can reach it with ease. 12. Practice hand hygiene. Put on the gloves. 13. Hold the toothbrush over the kidney basis. Pour some water over the brush. 14. Apply toothpaste to the toothbrush. 15. Brush the teeth gently (Fig. 16-1). 17. Let the person rinse the mouth with water. Hold the kidney basin under the person’s chin (Fig. 16-2). Repeat this step as needed. 18. Floss the person’s teeth (optional). a. Break off an 18-inch piece of dental floss from the dispenser. b. Hold the floss between the middle fingers of each hand (Fig. 16-3, A). c. Stretch the floss with your thumbs. d. Start at the upper back tooth on the right side. Work around to the left side. e. Move the floss gently up and down between the teeth (Fig. 16-3, B). Move the floss up and down against the side of the tooth. Work from the top of the crown to the gum line. f. Move to a new section of floss after every second tooth. g. Floss the lower teeth. Use up and down motions as for the upper teeth. Start on the right side. Work around to the left side. 19. Let the person use mouthwash or other solution. Hold the kidney basin under the chin. 20. Wipe the person’s mouth. Remove the towel. 22. Provide for comfort. (See the inside of the front cover.) 23. Place the call light within reach. 24. Lower the bed to a safe and comfortable level appropriate for the person. Follow the care plan. 25. Raise or lower bed rails. Follow the care plan. 26. Rinse the toothbrush. Clean, rinse, and dry equipment. Return the toothbrush and equipment to their proper place. Wear gloves. 27. Wipe off the over-bed table with the paper towels. Discard the paper towels. 29. Complete a safety check of the room. (See the inside of the front cover.) 30. Follow agency policy for dirty linen. 31. Remove and discard the gloves. Practice hand hygiene. • Position the person on 1 side with the head turned well to the side (Fig. 16-4). In this position, excess fluid runs out of the mouth. • Use only a small amount of fluid to clean the mouth. • Do not insert dentures. Dentures are not worn when the person is unconscious. Keep the person’s mouth open with a padded tongue blade (Fig. 16-5). Do not use your fingers. The person can bite down on them. The bite breaks the skin and creates a portal of entry for microbes. Infection is a risk. Mouth care is given at least every 2 hours. Follow the nurse’s directions and the care plan. See Focus on Communication: Mouth Care for the Unconscious Person, p. 232. See Promoting Safety and Comfort: Mouth Care for the Unconscious Person, p. 232. See procedure: Providing Mouth Care for the Unconscious Person, p. 232. 1. Follow Delegation Guidelines: Oral Hygiene, p. 229. See Promoting Safety and Comfort: 4. Place the paper towels on the over-bed table. Arrange items on top of them. 5. Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name. 7. Raise the bed for body mechanics. Bed rails are up if used. 8. Lower the bed rail near you. 9. Position the person in a side-lying position near you. Turn his or her head well to the side. 11. Place the towel under the person’s face. 12. Place the kidney basin under the chin. 13. Separate the upper and lower teeth. Use the padded tongue blade. Be gentle. Never use force. If you have problems, ask the nurse for help. 14. Clean the mouth using sponge swabs moistened with the cleaning agent (see Fig. 16-4). a. Clean the chewing and inner surfaces of the teeth. b. Clean the gums and outer surfaces of the teeth. c. Swab the roof of the mouth, inside of the cheek, and the lips. e. Moisten a clean swab. Swab the mouth to rinse. 15. Remove the kidney basin and supplies. 16. Wipe the person’s mouth. Remove the towel. 17. Apply lubricant to the lips. 19. Provide for comfort. (See the inside of the front cover.) 20. Place the call light within reach. 21. Lower the bed to a level safe and comfortable for the person. Follow the care plan. 22. Raise or lower bed rails. Follow the care plan. 23. Clean, rinse, dry, and return equipment to its proper place. Discard disposable items. (Wear gloves.) 24. Wipe off the over-bed table with paper towels. Discard the paper towels. 26. Complete a safety check of the room. (See the inside of the front cover.) 27. Tell the person that you are leaving the room. Tell him or her when you will return. 28. Follow agency policy for dirty linen. 29. Remove and discard the gloves. Practice hand hygiene. A denture is an artificial tooth or a set of artificial teeth (Fig. 16-6). Often called “false teeth,” dentures replace missing teeth. Mouth care is given and dentures cleaned as often as natural teeth. Dentures are slippery when wet. They easily break or chip if dropped onto a hard surface (floors, sinks, counters). Hold them firmly when removing or inserting them. During cleaning, firmly hold them over a basin of water lined with a towel. This prevents them from falling onto a hard surface. See Promoting Safety and Comfort: Denture Care. See procedure: Providing Denture Care. 1. Follow Delegation Guidelines: Oral Hygiene, p. 229. See Promoting Safety and Comfort: • Denture brush or toothbrush (for cleaning dentures) • Denture cup labeled with the person’s name and room and bed number • Soft-bristled toothbrush or sponge swabs (for oral hygiene) • Mouthwash (or other noted solution) 4. Place the paper towels on the over-bed table. Arrange items on top of them. 5. Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name. 8. Lower the bed rail near you if up. 9. Practice hand hygiene. Put on the gloves. 10. Place a towel over the person’s chest. 11. Ask the person to remove the dentures. Carefully place them in the kidney basin. 12. Remove the dentures if the person cannot do so. Use gauze squares for a good grip on the slippery dentures. a. Grasp the upper denture with your thumb and index finger (Fig. 16-7). Move it up and down slightly to break the seal. Gently remove the denture. Place it in the kidney basin. b. Grasp and remove the lower denture with your thumb and index finger. Turn it slightly, and lift it out of the person’s mouth. Place it in the kidney basin. 13. Follow the care plan for raising bed rails. 14. Take the kidney basin, denture cup, denture brush, and denture cleaning agent to the sink. 15. Line the bottom of the sink with a towel. Fill the sink half-way with water. 16. Rinse each denture under cool or warm running water. Follow agency policy for water temperature. 17. Return dentures to the kidney basin or denture cup. 18. Apply the denture cleaning agent to the brush. 19. Brush the dentures as in Figure 16-8. Brush the inner, outer, and chewing surfaces. 20. Rinse the dentures under running water. Use warm or cool water as directed by the cleaning agent manufacturer. 21. Rinse the denture cup and lid. Place dentures in the denture cup. Cover the dentures with cool or warm water. Follow agency policy for water temperature. 23. Take the denture cup and kidney basin to the over-bed table. 25. Position the person for oral hygiene. 26. Clean the person’s gums and tongue. Use toothpaste and the toothbrush (or sponge swabs). 27. Have the person use mouthwash (or noted solution). Hold the kidney basin under the chin. 28. Ask the person to insert the dentures. Insert them if the person cannot. a. Hold the upper denture firmly with your thumb and index finger. Raise the upper lip with the other hand. Insert the denture. Gently press on the denture with your index finger to make sure it is in place. b. Hold the lower denture with your thumb and index finger. Pull the lower lip down slightly. Insert the denture. Gently press down on it to make sure it is in place. 29. Place the denture cup in the top drawer of the bedside stand if the dentures are not worn. The dentures must be in water or in a denture soaking solution. 30. Wipe the person’s mouth. Remove the towel. 33. Provide for comfort. (See the inside of the front cover.) 34. Place the call light within reach. 35. Lower the bed to a safe and comfortable level appropriate for the person. Follow the care plan. 36. Raise or lower bed rails. Follow the care plan. 37. Remove the towel from the sink. Drain the sink. 38. Rinse the brushes. Clean, rinse, and dry equipment. Return the brushes and equipment to their proper place. Discard disposable items. Wear gloves for this step. 39. Wipe off the over-bed table with paper towels. Discard the paper towels. 41. Complete a safety check of the room. (See the inside of the front cover.) 42. Follow agency policy for dirty linen. 43. Remove and discard the gloves. Practice hand hygiene. The rules for bed baths, showers, and tub baths are listed in Box 16-2. Box 16-2 Rules for Bathing • Follow the care plan for bathing method and skin care products. • Allow personal choice when possible. • Follow Standard Precautions and the Bloodborne Pathogen Standard (Chapter 12). • Collect needed items before starting the procedure. • Remove hearing aids before bathing. Water will damage hearing aids. • Provide for privacy. Screen the person. Close doors and window coverings—drapes, shades, blinds, shutters, and so on. • Assist with elimination. Bathing stimulates the need to urinate. Comfort and relaxation increase if urination needs are met. • Cover the person for warmth and privacy. • Reduce drafts. Close doors and windows. • Protect the person from falling. • Use good body mechanics at all times. • Follow the rules to safely move and transfer the person (Chapter 14). • Know what water temperature to use. See Delegation Guidelines: Bathing, p. 236. • Keep bar soap in the soap dish between latherings. This prevents soapy water. It also helps prevent slipping and falls in showers and tubs. • Wash from the cleanest areas to the dirtiest areas. • Encourage the person to help as much as is safely possible. • Rinse the skin thoroughly. Remove all soap. • Pat the skin dry to avoid irritating or breaking the skin. Do not rub the skin. • Dry well under the breasts, between skin folds, in the perineal area, and between the toes. • Bathe skin when urine or feces are present. This prevents skin breakdown and odors.
Assisting With Hygiene
Oral Hygiene
Brushing and Flossing Teeth
Brushing and Flossing the Person’s Teeth 
A, The brush is held at a 45-degree angle to the gums. Teeth are brushed with short strokes. B, The brush is at a 45-degree angle against the inside of the front teeth. Teeth are brushed from the gum to the crown of the tooth with short strokes. C, The brush is held horizontally against the inner surfaces of the teeth. The teeth are brushed back and forth. D, The brush is positioned on the chewing surfaces of the teeth. The teeth are brushed back and forth.
A, Floss is wrapped around the middle fingers. B, Floss is moved in up-and-down motions between the teeth. Floss is moved up and down from the crown to the gum line.
Mouth Care for the Unconscious Person
A, Place 2 wooden tongue blades together. Wrap gauze around the top half. B, Tape the gauze in place.
Providing Mouth Care for the Unconscious Person 
Denture Care
Providing Denture Care 
A, Brush the outer surfaces of the denture with back-and-forth motions. (Note that the denture is held over the sink. The sink is lined with a towel and filled half-way with water.) B, Position the brush vertically to clean the inner surfaces of the denture. Use upward strokes. C, Brush the chewing surfaces with back-and-forth motions.
Bathing
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Assisting With Hygiene
