Bed

making

Lemma Desalegn
(Bsc, MSc in Adult Health Nursing)
 outlines

01 02 Back care
Bed bath
03 04
Nails care
Mouth care eye, ear and
nose care
 Hygiene
• Hygiene promotes comfort, safety, and health.
• The skin is the body’s first line of defense against
disease.
• Intact skin prevents microbes from entering the
body and causing an infection. Likewise, mucous
membranes of the mouth, genital area, and anus
must be clean and intact.
• Besides cleansing, good hygiene prevents body
and breath odors. It is relaxing and increases
circulation.
• Bathing of clients is an essential component of
nursing care.
• The type of bath provided will depend on the
purpose of the bath and the client’s self-care
ability.
• The two general categories of baths are
cleaning and therapeutic.
 Cleaning Baths
• Cleaning baths are provided as routine client
care.
• The purpose of a cleaning bath is personal
hygiene.
• The five types of cleaning baths are shower,
tub, self-help or assisted bed bath, complete
bed bath, and partial bath.
 Therapeutic Bath

• Therapeutic baths require a physician’s order stating

the type of bath, temperature of water, body surface to
be treated, and the type of medicated solutions to use.
• A therapeutic bath is usually performed in a tub and
lasts about 20 to 30 minutes.
• hot or warm water, cool or tepid water, soak, sitz,
• Hot- or warm-water tub baths are used to reduce
muscle spasms, soreness, and tension.
• Cool or tepid baths are used to relieve tension or lower
body temperature.
 Principles of bath
• The water should feel comfortably warm for
the client
• People vary in their sensitivity to heat
generally it should be 43-460C (110-1150F)
• The water for a bed bath should be changed at
least once
 Before bathing a patient, determine
• The type of bath the client needs
• What assistance the client needs
• Other care the client is receiving – to prevent
undue fatigue
• The bed linen required
• Close doors and windows:
• Provide privacy
• The client will be more comfortable after
voiding and voiding before cleansing the
perineum is advisable
• Place the bed in the high position:
• Clean the eye from the inner canthus to the
outer using separate corners of the wash cloth
– prevents transmitting micro organisms,
prevents secretions from entering the
nasolacrmal duct
• Firm strokes from distal to proximal parts of
the extremities increases venous blood return
• Note: when bathing a client with infection,
the caregiver should wear gloves in the
presence of body fluids or open lesion.
 Giving bed bath
Definition
• Bed bath is a bath given to a patient in bed who is unable
to care for himself. Also called sponge bath, blanket bath.
Purpose:
• To prevent bacteria spreading on skin
• To promote relaxation, comfort and cleanliness and to
induce sleep
• To stimulate the circulation and improve general muscular
tone& joint
• To observe skin condition and objective symptoms
• To prevent body odors and pressure sores.
 Equipments required
• Trolley (1), screen (1)
• Bath towel (2) and Mackintosh (1): Ⓐ to covering over
mackintosh (1) Ⓑ for covering over client’s body and drying
(1)
• Basin (2): for without soap (1) for with soap (1) and Jug (1)
• Bucket (2): for clean hot water (1) for waste (1)
• Wash (Sponge) cloth (2): for wash with soap (1) for rinse
(1)
• Additional bed linens for making bed(one or two large
sheets as needed ,pillow case and clean pajamas or gown)
• Bath blanket if available or use top sheet as bath blanket
• Disposable gloves
• Soap with soap dish (1)
• Galipot with Gauze or cotton piece
• Lotion thermometer (if available) (1)
• bed pan or urinal if needed
• tray containing items for back care, nail care ,
mouth care and hair care like brush and comb
• Hygienic supplies, such as, lotion, powder or
deodorants (if required)
• Hamper for soiled cloths outside the room
 Procedure
• Explain the purpose and procedure to the client. Confirm
any orders. Check client identification and condition. If he
or she is alert or oriented, question the client about
personal hygiene preferences and ability to assist with the
bath.

• Wash your hands and clean the trolley from top to

bottom and from far to near. Gather all required
equipments. Bring all equipments to bed-side. Push
trolley inform you to keep the equipment from falling and
contamination. Close the curtain or the door. Put the
screen to provide privacy.
• Before starting bath offer bed pan or urinal
and removal bed pan or urinal. Empty it.
• Wash your hands and put on gloves.
Remove top bedding fold and place over
back of chair. If there is no chair, it should
be placed on foot of bed.
• Assist the client to move toward the side of the
bed where you will be working. Usually you
will do most work with your dominant hand.
• Remove gown, remove pillow unless this is
uncomfortable for patient pillow for turning
patient if necessary otherwise remove soiled
pillow case place soiled gown in it and place it
on chair or foot of bed between mattress and
foot of bed.
• Cover the client’s body
with a bath blanket if
available or use top
sheet.
• If an IV is present on the
client’s upper extremity,
thread the IV tubing
and bag through the
sleeve of the soiled
cloth. Re-hang the IV
solution. Check the IV
flow rate.
• Fill two basins about two-thirds full with warm
water (43-46℃or 110-1150F).
• Expose only the parts of the patient's body
being washed avoid unnecessary exposing.
• Wash, rinse and dry each body parts
thoroughly using washing towels and paying
particular attention to skin folds.
• Suggested order for washing body parts; eye,
Face, ear, neck, arms and hands farther away
and then nearest to the nurse, Chest,
abdomen, leg and foot farther away and then
nearest to the nurse, back, buttocks and
genital area. Change the water after it gets
dirty
• Face, neck, ears
• Put mackintosh and big
towel under the client’s
body from the head to
shoulders. Place face towel
under the chin which is
also covered the top sheet.
• Make a mitt with the
sponge towel and moisten
with plain water.
• Wash the client’s eyes.
Cleanse from inner to
outer corner. Use a
different section of the
mitt to wash each eye.
• Wash the client’s face,
neck, and ears. Use
soap on these areas
only if the client prefers.
Rinse and dry carefully.
• Upper extremities
• Move the mackintosh
and big towel under the
client’s far arm.
• Uncover the far arm.
• Fold the sponge cloth
and moisten.
• Wash the far arm with
soap and rinse. Use long
strokes: wrist to
elbow→ elbow to
shoulder→ axilla→ hand
• Place the basin on the
towel. Put the person’s
hand into the water.
Wash it well. Clean under
the fingernails with an
orangewood stick or nail
file.
• Dry by face towel
• Move the mackintosh
and big towel to the near
arm and uncover it
• Wash, rinse, and dry the
near arm.
• Chest and abdomen
• Move the mackintosh
and bath towel to the
upper trunk
• Put another bath towel
to over the chest
• Fold the sponge towel
and moisten
• Wash breasts with soap
and rinse. Dry by the big
towel covering.
• Move the bath towel covering the chest to
abdomen.
• Fold the sponge cloth and moisten.
• Wash abdomen with soap, rinse and dry
• Cover the trunk with top sheet and remove
the bath towel from the abdomen
Exchange the warm water.
• Lower extremities
• Move the mackintosh and bath towel to
under the far leg. Cover the near leg with bath
towel
• Fold the sponge cloth and moisten.
• Wash with soap, rinse and dry. Direction to
wash: from foot joint to knee→ from knee to
hip joint.
• Place the basin on the towel
near the foot. Lift the leg
slightly. Slide the basin
under the foot. Place the
foot in the basin. Use an
orangewood stick or nail file
to clean under toenails if
necessary.
• Repeat the same procedure
as 15.a- c) on the near side.
• Cover the lower extremities
with top sheet Remove,
mackintosh and big towel.
• Cover the lower
extremities with top
sheet Remove,
mackintosh and big
towel.
• Turn the client on left lateral position with
back towards you.
• Back and buttocks
• Wash back. Assist client into prone or side-
lying position facing away from you.
• Move the mackintosh and big towel under
the trunk. Cover the back with big towel
• Fold the towel and moisten. Uncover the
back.
• Wash the back and
buttocks using long,
firm strokes. Rinse and
pat dry with big towel.
• Give back rub and apply
lotion if needed ✽ See
our nursing manual
“Back Care”
• Remove the
mackintosh and big
towel
• Return the client to the supine position.
• Perineal care: Assist client to supine position.
Perform perineal care.
• Apply lotion and powder as desired. Assist the
client to wear clean cloth. Put on clean gown
protect the pillow or bed with face towel and
comp patient's hair. Cut and clean finger nails
and toe nails give mouth wash with plain
water
• After bed bath
• Make the bed tidy and keep the client in
comfortable position.
• Check the IV flow and maintain it with the
speed prescribed if the client is given IV.
• Give care of used equipment, remove glove
and wash hands,
• Document on the chart with your signature
and report any findings to senior staff.
 Giving tub bath
• Clients frequently prefer and enjoy tub baths. A
tub bath permits washing and rinsing in the tub.
Tub baths can also be therapeutic.
Equipment
• Soap
• Washcloth
• Bath towel
• Gown
• Slipper
• Stool
 Procedure
• Assist patient to undress
• Assist patient into the tub
and avoid falling
• Allow patient to bath himself
or assist as necessary
• Assist patient out of tub and
dry his body and put on
gown
• Return patient to room and
put to bed
• Clean bath tub and leave
room in order
• Discard soiled linen
 Safety measures
• Have correct temperature of water
• Avoid chilling
• Always keep bathroom unlocked
 Partial bath
• cleaning only body areas that would cause
discomfort or odor if not washed thoroughly.
These areas are the face, axillae, hands, and
perineal area.
 Self-help bath
• A self-help, or assisted,
bed bath is used to
provide hygienic care for
clients who are confined
to bed.
• In the self-help (assisted)
bed bath, the nurse
prepares bath equipment
but provides minimal
assistance. This assistance
is usually limited to
washing difficult-to-reach
body areas such as the
feet and back
 Shower
• Most ambulatory clients
are capable of taking a
shower. Clients with
limited physical ability
can be accommodated
by placing a waterproof
chair in the shower.
• The nurse provides
minimal assistance with
a shower.
 Giving back care
Definition
• Back care means cleaning and massaging back, paying
special attention to pressure points.
• Especially back massage provides comfort and relaxes
the client; thereby it facilitates the physical stimulation
to the skin and the emotional relaxation.

• Back massage is the application of pressure and

motion by the hands. It involves kneading, rubbing,
and using friction
 Purpose

• To improve circulation to the back

• To refresh the mode and feeling
• To relieve from fatigue, pain and stress
• To induce sleep
• To relax patient
• To prevent pressure sores or decubitus
 Equipments required
• Basin with warm water (2)
• Bucket for waste water (1)
• Sponge cloth (2): 1 for with soap 1 for rinse
• Big Towel (2): 1 for covering a mackintosh 1
for covering the body
• Oil/ Lotion/ Powder (1): according to skin
condition and favor
• Gauze pieces (2)
• Soap with soap dish (1)
• Face towel (1)
• Mackintosh (1)
• Tray (1)
• Trolley (1)
• Screen (1)
 Basic massage techniques
Effleurage
• The whole hand, gliding
and long rhythmic
strokes are used.
• Firm, even-pressured
strokes are directed
toward the heart to
assist blood return.
• Lighter pressure is used
when moving away
from the heart.
 Petrissage
• Pressing, squeezing,
kneading, and rolling
movements by both
hands (use entire hand)
are used. Deep
circulation is enhanced.
• C-shaped motions
stimulate the muscle
body. Promotes muscle
relaxation.
 Friction

• Thumb pads, heel of

hand, or fingertips are
used.
• Focused, deep, circular
motions are used.
Penetrates deeper
muscle layers.
• Is done after effleurage
and petrissage.
 Tapotement

• Brisk, vigorous, rhythmic,

percussive movements
are used.
• Invigorates and
stimulates tired muscles.
 Vibration

• Very fine, rapid, shaking

movements are
administered by the
entire hand.
• Stimulates or relaxes
muscles.
• Notes:-Massage techniques can be used with
all age groups and are especially beneficial to
those who are immobilized
 Giving mouth care
• Mouth care is defined as the scientific care of
the teeth and mouth.
• Purpose
– To keep the mucosa clean, soft, moist and intact
– To keep the lips clean, soft, moist and intact
– To prevent oral infections
– To remove food debris as well as dental plaque
without damaging the gum
– To alleviate pain, discomfort and enhance oral
intake with appetite
– To prevent halitosis or relieve it and freshen the
mouth
 Common problems occurring in the oral
cavity are
• Bad breath (halitosis)
• Dental caries (cavities)
• Plaque
• Inflammation of the gums (gingivitis)
• Inflammation of the oral mucosa (stomatitis)
 Equipment
• Brushing and Flossing
• Glass of fresh water (Cup of water)
• Mouth wash solution(1.3 hydrogen peroxide
solution 1/2 tsp, salt or sodium bicarbonate
to a glass or water(250cc)
• Applicators -cotton tipped
• Tongue depressor wrapped with gauze
bandage
• Emesis basin or kidney dish
• Towel and paper bag or folded paper for
waste
• Lubricate liquid paraffin or mineral oil cold
cream, glycerine & lemon juice, Vaseline)
• Tooth brush and tooth paste if patient has his
own Ethiopian tooth stick may be used
• Denture Care, Denture brush, Denture cleaner,
Denture cup if needed
• Non-sterile gloves , Mirror , Lip moisturizer
 Mouth Wash Solutions
• Normal solution: a solution of common salt
with H2O in proportion of 4 gm/500 cc of
water
• Hydrogen peroxide – 5-20 cc (in water)
• KMNO4 – in crystal form 4cc or KMNO4
solution in a glass of water (1:700) or one
small crystal in a glass of water
• Lemon juice: 2TSF lemon juice in a cup of
water - an improvised method for mouth wash
 Procedure
• Prepare the pt
• Explain the procedure
• Assist the patient to a sitting
position in bed (if the health
condition permits).
• If not assist the patient to side
lying with the head on
pillows.
• Place the towel under the
pt's chin.
• If pt confined in bed, place
the basin under the pt's chin
 Brush the teeth

• Moisten the tooth with water and spread

small amount of tooth paste on it
• Brush the teeth following the appropriate
technique.
 Brushing technique
• Hold the brush against the
teeth with the bristles at up
degree angle.
• Use a small vibrating
circular motion with the
bristle at the junction of the
teeth and gums use the
some action on the front
and the back of the teeth.
• Use back and forth motion
over the biting surface of
the teeth.
• Brush the tongue last
 Flossing
• It removes resides particles
between the teeth
• Technique
– Wrap one end of the floss around
the 3rd finger of each hand
– To floss the upper teeth. Use the
thumb and index finger to stretch
the floss. Move the floss up and
down between the teeth from the
tops of the crowns to the gum
– To floss the lower teeth, use your
index fingers to stretch the floss
• Note: If the patient has denture,
remove them before starting and
wash them with brush
• Give pt water to rinse the mouth and let him/her
to spit the water into the basin.
• Re-comfort the pt
• Remove the basin
• Remove the towel
• Assist the patient in wiping the mouth
• Reposition the patient and adjust the bed to leave
patient comfortably
• Give proper care to the equipments
• Document assessment of teeth, tongue, gums and
oral mucosa.
• Report any abnormal findings
Mouth care for unconscious patient
Equipment
• Cleaning agent (check the care plan)
• Sponge swabs
• Padded tongue blade
• Water cup with cool water
• Hand towel
• Kidney basin
• Lip lubricant
• Paper towels
• Gloves
 Procedure
• Explain the purpose and procedure to the
client or to the family . Check client’s
identification and condition. Perform hand
hygiene and Place the towels on the over bed
table. Arrange items on top of them.
• Provide for privacy. Lower the bed rail near
you if up.
• Practice hand hygiene. Put on the gloves.
• Position the person in a
side-lying position near
you. Turn his or her
head well to the side.
• Place the towel under
the person’s face.
• Place the kidney basin
under the chin.
• Separate the upper and
lower teeth. Use the
padded tongue blade.
Be gentle. Never use
force.
• Clean the mouth using
sponge swabs moistened
with the cleaning agent
(see Fig. ).
• Clean the chewing and inner surfaces of the
teeth.
• Clean the gums and outer surfaces of the
teeth.
• Swab the roof of the mouth, inside of the
cheeks, and the lips.
• Swab the tongue.
• Moisten a clean swab with water. Swab the
mouth to rinse.
• Place used swabs in the kidney basin.
• Remove the kidney basin and supplies.
• Wipe the person’s mouth. Remove the towel.
• Apply lubricant to the lips.
• Remove and discard the gloves. Practice hand
hygiene.
• Report and record your observations.
 Giving perineal care
Definition
• Perineal care involves bathing or cleaning the
genital and anal or surrounding areas. These
areas provide a warm, moist, and dark place
for microbes to grow. Cleaning prevents
infection and odors, and it promotes comfort.
Perineal care is very important for persons
who

• Have urinary catheters

• Have had rectal or genital surgery.
• Are menstruating
• Are incontinent of urine or feces.
• Are uncircumcised.
Purpose:
1. To keep cleanliness and prevent from
infection in perineal area
2. To make him/her comfortable
 Equipments required
– Gloves( non- sterile) (1 pair)
– Sponge cloth (1)
– Basin with warm water (1)
– Waterproof pad or gauze
– Towels (1)
– Mackintosh (1)
– Soap with soap dish (1)
– Toilet paper
– Bed pan (1): as required
 Procedure
– Provide adequate explanation about the
procedure to the client.
– Hand washing .Gather all required equipments.
Bring to the bed side
– Close the door to the room and place the screen
to provide privacy
– Perform hand hygiene and put on gloves
– Raise the bed to a comfortable height if possible.
• Preparation the
position:-
• Uncover the client's
perineal area.
• Drape the person as in
Figure
• Fill the wash basin. Water temperature is
usually 105°F to 109°F (40.5°C to 42.7°C).
Follow the care plan for water temperature.
Measure water temperature according to
agency policy. Ask the person to check the
water temperature. Adjust the water
temperature if it is too hot or too cold.
• Help the person flex her knees and spread her
legs. Or help her spread her legs as much as
possible with the knees straight.
• Place a waterproof pad under her buttocks.
Remove any wet or soiled incontinence
products. Fold the corner of the bath blanket
between her legs onto her abdomen.
• Wet the washcloths. Squeeze out excess water
from a washcloth. Make a mitted washcloth.
Apply soap.
• Cleanse the thighs and groin:
• Make a mitt with the sponge cloth.
• Cleanse the client's upper thighs and groin
area with soap and water.
• Rinse and dry.
• Wash the genital area next.
Female client:
• Use a separate portion of
the sponge towel for each
stroke
• Change sponge towel as
necessary.
• Separate the labia and
cleanse downward from the
pubic to anal area.
• Wash between the labia
including the urethral
meatus and vaginal area.
• Rinse well and pat dry.
Male Client:
• Gently grasp the client’s
penis.
• Cleanse in a circular motion
moving from the tip of the
penis backwards toward the
pubic area
• In an uncircumcised male,
carefully retract the foreskin
prior to washing the penis.
• Return the foreskin to its
former position.
• Wash, rinse, and dry the
scrotum carefully.
• Assist the client to turn
on the side. Separate
the client's buttocks and
use toilet paper, if
necessary, to remove
fecal materials.
• Cleanse the anal area, rinse thoroughly, and
dry with a towel. Change sponge towel as
necessary.
• Apply skin care products to the area according
to need or doctor's order.
• Return the client to a comfortable position.
• Remove gloves and perform hand hygiene.
• Document the procedure, describing the
client's skin condition. Sign the chart
 Sitz bath
• It is used to sock the client's pelvic area.
• Sitz baths cleanse and reduce inflammation in
the perineal and anal areas. Only the client’s
pelvic area is immersed in warm fluid; the client
sits in a special tub or chair or in a basin placed
on the toilet seat so that the legs and feet
remain out of the water.
• Used for clients who have had rectal surgeries,
an episiotomy during childbirth, painful
hemorrhoids, or vaginal inflammation
 Purpose:
• To relieve pain in post operative rectal
condition
• Smoothen irritated skin (perineum)
• Facilitates wound healing (after episiotomy)
• To release the bladder in case of urinary
retention
 Procedure
• A client sits in a special tub or a bowel. The area
from the mid things to the iliac crests or umbilicus
- increases circulation to the perineum (when the
legs are also immersed blood circulation to the
perineum or pelvic area decrease)
• If it is going to be given in the tub – fill ½ the tube
with water and add the ordered medication
• In a bowel – fill 2/3 of it with water – add the
ordered medication and dilute
• Water temperature should be from 40° to
43°C (105° to 110°F).
• Prevent overexposure and chilling by draping a
bath blanket over the client’s shoulders and
thighs, and prevent drafts.
• The medication to Rx the perineum in KMNO4
sol. 250 mg KMNO4 in 500 ml of water
• The duration of the bath is generally 15-20
minutes (20-25) depending on the client’s
health
• Assess the client during the bath for extensive
vasodilatation, faintness, dizziness, weakness,
increased pulse rate, and pallor. Help the
client to dry.
Giving Hair shampoo (Hair Washing)
• Definition
• Hair washing defines that is one of general
care provided to a client who cannot clean the
hair by himself/ herself.
• Purpose
• To maintain personal hygiene of the client
• To increase circulation to the scalp and hair
and promote growing of hair
• To make him/her feel refreshed
 Equipments required:
• Mackintosh(2): to prevent wet (1) to make Kelly
pad (1)
• Big towel(2): to cover mackintosh (1) to round
the neck (1)
• Paper bag (2): for clean (1) for dirty (1)
• Cotton ball with oil or non-refined cotton
• Bucket (2): for hot water (1) for wasted water (1)
• small towel (1)
• Shampoo or soap (1)
• Hair oil (1): if necessary
• Brush, comb: (1)
• Plastic jug (1)
• Cloth pin or clips (2)
• Steel Tray (1)
• Kidney tray (1)
• Cushion or pillow (1)
• Clean cloth if necessary
• Old newspaper
• Trolley (1)
 Procedure
• Perform hand hygiene
• Gather all equipments
• Check the condition of client. Explain the purpose
and the procedure to the client.
• Bring and set up all equipments to the bed-side
• Help the client move his/her head towards edge if
the bed and remove the pillow from the head
• Put another pillow or a cushion under the
bending knee. Make him/her comfortable position
• Setting mackintosh and towel to the client:
• Place a mackintosh covered a big towel under
the upwards from the client head to
shoulders of client
• Have a big towel around his/her neck
• Put the folding mackintosh under the client’s
neck.
• Washing:
• Brush the hair.
• Insert the cotton balls into the
ears
• Wet the hair by warm water and
wash it roughly
• Apply soap or shampoo and
massage the scalp well while
washing the hair using fingernails
• Rinse the hair and reapply
shampoo for a second washing, if
indicated
• Rinse the hair thoroughly
• Apply conditioner if requested or
if the scalp appears dry
• Wrapping the hair
• Remove cotton balls from the ears into paper
bag & mackintosh with the towel from client’s
neck.
• Wrap the hairs in the big towel which are used
to cover the client's neck part.
• Drying the hair
• Wipe the face and neck if needed
• Dry the hair as quick as possible
• Massage the scalp with oil as required
• Comb the hair and arrange the hair according to the
client’s preference
• Make the client tidy and provide comfortable position
• Clean the equipments and replace them to proper
place. Discard dirty. Perform hand hygiene
• Document the condition of the scalp, hair and any
abnormalities on the chart with your signature.
• Report any abnormalities to senior staff.
 Nail care (fingers and toes)
• Definition
• Nail cutting that one of nursing care and
general care for personal hygiene is to cut
nails on hands and foots.
• Purpose
1. To keep nails clean
2. To make neatness
3. To prevent the client’s skin from scratching
4. To avoid infection caused by dirty nail
 Equipments required
1. Nail Cutter (1)
2. Gallipot with water (1): for cotton
3. Kidney tray (1)
4. Sponge cloth (1)
5. Middle towel (1)
6. Mackintosh (1)
7. Plastic bowl in small size (1)
8. Soap with soap dish (1)
Procedure: Caring for Fingernails
1. Perform hand hygiene
2. Gather all the required equipments.
3. Check the client’s identification.
4. Explain to the client about the purpose and the
procedure.
5. Put all the required equipments to the bed-side
and set up it.
6. Assist the client to a comfortable upright
position.
7. In sitting position:
A. Soaking
i. Put a mackintosh with covering towel on the bed.
ii. Put the basin with warm water over the mackintosh.
iii. Soak the client’s fingers in a basin of warm water and
mild soap. Scrub and wash them up.
iv. Dry the client’s hands thoroughly by using the middle
towel covering the mackintosh.
B. Cutting
I. Trim the client’s nails with nail clippers.
II. Wipe all fingernails from thumb to 5th nail side by side by
wet cotton ball. One cotton ball is used for one nail finger.
III. Shape the fingernails with a file, rounding the corners and
wipe both hands by a sponge towel.
8. Replace equipments and discard dirty.
9. Perform hand hygiene.
• Caring for Toenails
• Follow the same procedure as for the fingernails with
some exceptions:
• Cutting
• Cut toenails straight across and do not round off the
corners
• Do not shape corners
• Never cut the toenails of the clients with diabetes or
hemophilia. These clients are particularly susceptible
to injury.
 Foot care
• Proper foot and nail care are essential for ambulation and
standing. Foot and nail care are often ignored until
problems exist.
• Purposes
• To prevent infection and soft tissue trauma from ingrown
or jagged nails & to eliminate odor.
• Hygienic care of feet and nails consists of regular trimming
of nails; cleaning under nails; cleaning, rinsing, and drying
feet and nails; and wearing properly fitted shoes.
• Soaking of nails assists with their cleaning if nails are dirty
or thickened.
 Procedures
1. Soak feet in warm water and a detergent or
in warm oil.
2. Use an orangewood stick to clean the nails
and release the cuticle growth from the nail.
3. File or cut the nails straight across to prevent
ingrown nails.
4. Trim the cuticles as necessary. Pat all areas
dry with a clean towel. Apply an emollient.
 Eye care
• Eye care is part of maintaining a client’s
personal hygiene and is usually performed as
part of bathing/showering.
• Generally the normal physiological processes of
blinking and tear production maintain the
cleanliness of the eyes, along with daily
washing.
• Eyes are constantly cleansed by the production
of tears and movement of eyelids over the
eyes.
• When a client has difficulty in meeting their
eye care needs then the nurse may need to
assist, particularly if discharges or crusts
appear around the eyes.
• This can usually be removed by gentle eye
swabbing, Eyelids should be washed daily
with a warm
• washcloth from the inner to outer canthus.
Eyelashes and eyebrows should be washed as
necessary
 Equipment
1. Trolley (1)
2. Tray for equipment (1)
3. Kidney tray (1)
4. Towel (1) and washcloth(1)
5. Sterile 0.9 per cent sodium chloride
6. Gloves and others necessary equipment
 Procedure
1. Explain procedure to client and wash hands
2. Gather all equipment, Ensure privacy for the
client and Ensure good light source
3. Assist the client into a comfortable position
Prepare equipment,
4. Wash hands and Apply glove
5. Cover the client’s chest using the towel
6. Instruct client to close their eyes
7. Moisten swab in the solution and gently swab
from the inner canthus outwards, using one
wipe. Repeat in the same direction until the
eye is free from crusts/discharge
• If the client has an infection, wash hands
before moving from one eye to the other and
always swab the non-infected eye first
 If the eye is to be touched to remove a
foreign body, a cotton bud should be used
8. Gently dry the client’s eyelids. Remove and
dispose of equipment safely
9. Leave the client comfortable. Remove glove
and wash hands
10. Evaluate care delivery, document and report
any change in client’s condition
 Eye Care for the Comatose Client
• Cleanse eyelids, eyelashes, and eyebrows with
warm washcloth at least every 4 hours.
• Clean from inner to outer canthus. If eyes remain
open and blink reflex is absent, liquid tear
solutions should be applied to prevent corneal
drying and ulcerations.
• Eyes can be closed and covered with an eye patch
or protective shield. The eye patch or protective
shield should be removed at least every 4 hours
to assess eyes and provide eye care
 Ear care
• Hearing can be affected by foreign material or wax
in the external ear canal.
• Cleaning of the ears involves cleaning of the
external ear canal and auricles.
• Objects should not be inserted into the ear canal.
• Excess wax or foreign material should be removed
by gently washing the external ear and auricles with
a warm washcloth while pulling the ear downward
in the adult client.
• Irrigation of the ear may be necessary to remove
dried wax.
 Nose care
• The nose provides the sense of smell, prevents entrance of
foreign material into the respiratory tract, humidifies inhaled
air, and facilitates breathing.
• Excessive or dried secretions may impair nasal function.
• Excessive nasal secretions are removed by inserting a cotton-
tipped applicator moistened with water or saline into the
nostrils.
• The applicator should not be inserted beyond the cotton tip.
• Infants may have excessive nasal secretions removed by a
suction bulb. Clients with a naso-gastric tube should receive
careful skin care to the nose area to prevent skin breakdown.