The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [306]
Ideally, perineal hygiene should be attended to after the general bath or, at the very least, the water and wipes should be changed and cleaned once utilized due to the large colonies of bacteria that tend to live in or around this area (Gooch 1989, Gould 1994). It is generally acknowledged that soap and lotions administered incorrectly to the perineum/perianal area can cause irritation and infection (Ersser et al. 2005, Holloway and Jones 2005). Many nurses will use soap or a similar chemical derivative in order to promote thorough cleaning, but frequently lack of knowledge can lead to further problems, especially if all the soap is not removed; this can lead to discomfort for the patient if this area is not treated sensitively (Lindell and Olsson 1989).
Methods for hair care
The way a person feels is often related to their appearance, and hair condition and style is usually pertinent to this. Hair care can be complex and so it should be planned and delivered to the patient’s personal preferences.
Washing the hair of a bed-bound patient can be challenging, but there are several ways to manage this. To wash a patient’s hair, move the patient to the top of the bed and position their head so that it is supported over the end. The patient’s condition must always be assessed before performing this task as it would not be appropriate for patients with head and neck or spinal injuries. Shampooing frequency depends on the patient’s well-being and their hair condition. Referral to a hairdresser may be appropriate.
Grooming the hair provides an ideal opportunity to observe for dandruff, psoriasis, flaky skin and head lice. Head lice are extremely infectious so it is imperative to treat the hair with a medicated shampoo as soon as possible. Hospital policy/protocol should be followed regarding the disposal of infected linen. Towel drying of hair should occur and hairdryers can be used with the consent of the patient (NMC 2008a). However, use of a hairdryer may not be appropriate if patient has had recent alopecia (loss of hair) due to chemotherapy. Hairdryers should be checked for safety in accordance with local policy. In the oncology setting, chemotherapy is an established treatment and some cytotoxic drugs can cause alopecia. The patient’s physical, psychological and social needs can be affected by the loss of hair. Special care and skilled advice are required regarding the adjustment to hair loss. Referral to the hospital surgical appliance officer is appropriate to discuss the choice and fitting of a wig. A shampoo with a neutral pH is recommended for patients who are at risk of alopecia.
Care of the beard and moustache is also important. Excess food can often become lodged here so regular grooming is essential for hygiene and comfort purposes. Beard trimmers can be used as appropriate.
Methods for care of the nails and feet
The feet and nails require special care in order to avoid pain and infection. Poor toe nail condition can affect mobility and compromise independence which can increase length of hospital stay (NHS 2004). Finger and toe nails should be kept short and neat; nail clippers are recommended for the trimming of nails and emery boards for filing to prevent jagged edges (Malkin and Berridge 2009). Patients with visual impairment or dexterity problems and those with learning disabilities may require assistance with the trimming and filing of nails. Consideration should be given to the patient’s medical history; for example, do they have peripheral neuropathy, diabetes, peripheral vascular disease, necrosis or infection? If so, additional care should be given and advice sought from a chiropodist and the patient’s doctor (Malkin and Berridge 2009).
Specialist foot care advice from a chiropodist can be useful. Chronic diseases such as diabetes and the long-term use of steroids can result in problems such as pressure ulcers, breakdown of the skin integrity and delays in the healing process. Special attention should be paid to cleaning