CARE OF HAND AND FEET

1. CARE OF HAND AND FEET

3. Purpose
• To keep clean
• To prevent skin injury (% scratching)
• To prevent infection
• To promote comfort
• To improve grooming
• To promote self-esteem
• To detect or examine the abnormalities
• To prevent worm infestations

4. CARE OF THE NAILS
Inspect the feet daily including the top and soles of the feet and the area
between the toes.
Wash and soak the feet using lukewarm water (37 degree celcius)
If the feet perspire ,apply a foot powder.
If dryness is noted along the feet ,apply soft oil and rub gently into the skin
File the toe nails straight across the square.
Avoid wearing elastic stockings
Wear clean socks daily.

5. • Do not walk bare foot
• Wear properly fitted shoes.
• Exercise regularly to improve circulation to the lower extrimities
• Immediately wash minor cuts and dry them thoroughly , mild
antiseptics may be applied to the skin .

6. COMMON FOOT AND NAIL PROBLEMS
• CALLUS
It is a thickened portion of the epidermis caused by local friction or
pressure
• CORNS
It is caused by friction and pressure from shoes . It is seen mainly on
toes ,over bony prominence.

7. CORNS AND CALLUS

8. • ATHELET’S FOOT(Tinea pedis)
It is a fungal infection of foot mainly induced by wearing of constricting
foot wears.
• INGROWN NAILS
Toe nails or finger nails grow inward into soft tissue around nail
resulting from improper nail trimming
• PARONYCHIA
It is the inflammation of tissue surrounding nails following an injury . It
is common among diabetic patients

9. ATHELET’S FOOT

10. INGROWN NAILS

11. PARONYCHIA

12. • FOOT ODOR
It is the result of excessive perspiration promoting microorganism
growth.

13. PURPOSES
• To keep the feet clean and dry
• To trim nails and keep them short to prevent injury
• To teach the patient in proper way to inspect the feet and hands for
any dryness and signs of infection.

14. ARTICLES REQUIRED
A tray containing ,
• A pair of scissors or a nail clipper
• Wet swabs in a small bowl
• A jug with water for washing hands
• A kidney tray with Dettol 1 in 40 solution
• A paperbag
• A towel
• Wash basin
• Was cloth
• Mat, Mackintosh and Drawsheet

15. PROCEDURE
STEPS RATIONALE
Check the client’s identification and doctor’s order
Explain to the client about the purpose and procedure
Gather all the required equipments to the bedside
Provides privacy and assist the client to a comfortable
upright position
In sitting position,
 Soaking
Put a mackintosh with covering towel on the bed
Put the basin with warm water over mackintosh
Soak the client’s hands in a basin of warm water and apply
mild soap.
Scrub and wash them up.
Dry hands by using towel
To assess needs
It fosters cooperation
To prevent spread of infection and to
promote effective care
To make nails soft , there by you can cut
nails easily and safely

16.  CUTTING
• Trim the client’s nails with nail clippers
• Wipe all fingernails from thumb to 5th nail side by side by
wet cotton ball . One cotton ball is used for one nail finger.
• Shape the fingernails with a filer , rounding the corners
and wipe both hands by a sponge towel
CARE OF FINGERNAILS
• Apply lotion or cream to hands
• Position patient on chair, place disposable mat under
patient’s feet if possible and provide patient with privacy.
• Fill the basin with warm water (100- 110 deg fahreheit)
To prevent dryness
To provide comfort
To make nails soft , thereby you can cut nails
easily and safely

17. Place the basin on a disposable mat and help the patient to
place feet into basin . Soak feet for 15-20 minutes.
CARE OF FEET
• Cut toe nails straight across and do not round off the
corners , do not shape corners
• Apply lotion or cream to feet
• Make the client comfortable and replace equipment and
discard dirty water and swab
• Perform hand hygiene and record the procedure
• If the nails tend to grow inward at the corners , place a
wisp of cotton under the nail to prevent toe pressure . A
notch cut in the centre will pull in edges and corners .
Sometimes, very thick ,hard toe nails require surgical
removal
• To prevent dryness
• To prepare equipment for the next procedure

18. SPECIAL INSTRUCTIONS FOR CARE OF FEET
• Notice and feel your feet daily for blisters, open sores , cuts and color
changes or ingrown toe nails.

19. • Cut toe nails straight across

20. • Wash your feet daily with soap and lukewarm water .Take care to
wash between toes

21. • Wear clean soaks which must fit well and have no holes or tears

22. • Examine your shoes everyday for pebbles ,nails or any irritating object

23. • Keep your feet dry especially between toes . Use powder, if needed.

24. • Keep your skin soft , put lotion on top and bottom of your feet ,do not
apply between the toes.

25. CARE OF EYES EARS AND NOSE

27. CARE OF EYES
• PURPOSES
To clean the eye of discharge and crusts
Prior to eye drop instillation
To soothe eye irritation
To prevent abrasion in the unconscious patients
To prevent from corneal damage

28. • ARTICLES REQUIRED
A tray containing ,
Sterile gauze swabs or cotton balls
Sterile 0.9% Nacl
Paperbag
Sterile gloves
Disposable gloves
Appropriate eye ointment if prescribed.

29. PROCEDURE
• Explain the procedure to the patient and make sure that the bed area is
clear of any obstructions
• Provide a comfortable position to the patient
• Ensure patient’s privacy
• Make an assessment of the patient’s eyes
• Wash hands and put on gloves
• Place disposable towel around the patient’s neck
• Ask the patient to close their eyelids to avoid damage to the cornea
• With a gauze swab dampened in the saline 0.9% gently clean the eye from
the inner canthus to outer canthus .Do not apply direct pressure over the
eyes

30. • Repeat the procedure for both eyes
• Exudate from the eyes should be removed carefully and as often as
necessary to keep the eyes clean.
• An unconscious patient need frequent special eye care,the physician
may order lubricating eye drops ,in some cases the eyes may be
medicated and covered to prevent further irritation
• Eyeglasses can be used
• Dry the patient’s eyelids gently to remove excess fluid
• Replace the equipments

31. • Ensure the patient is comfortable
• Wash hands thoroughly
• Document the procedure .

32. CARE OF EARS

36. PROCEDURE
• The ears are cleaned during bed bath
• A clean corner of the moistened washcloth rotated gently into the ear
is used for cleaning
• Also a cotton tipped applicator is helpful for cleaning the pinna
• The care of hearing aid is also involves routine cleaning, battery care
and proper insertion techniques . The specialist must assess the
knowledge and routine for cleaning and caring the hearing aid
• The hearing aid should be turned off when its not in use.The outside
of hearing aid should be cleaned with clean cloth.
• Proper care of hearing aid is essential.

37. CARE OF NOSE

40. PURPOSES
To clean the mucus from the nose
To clean allergens and irritants
To decrease swelling in the nose and increases airflow

41. PROCEDURE
 Secretions in the nose can be removed by having the patient to blow into a soft
tissue . The specialist must teach the patient that harsh blowing can cause pressure
capable of injuring the eardrum ,nasal mucosa and even sensitive structures.
If the patient is not able to clean his nose ,the specialist will assist using a saline
moistened washcloth or cotton tipped applicator . Do not insert the applicator
beyond the cotton tip.
Suctioning may be necessary if the secretions are excessive

42. When patient’s receive oxygen per nasal cannula or have a nasogastric
tube , you should cleanse the nares every 8 hours. Use a cotton tipped
applicator moistened with saline . Secretions are likely to collect and
dry around the tube ; therefore you will need to cleanse the tube with
soap and water.

43. PERINEAL CARE

44. DEFINITION
Perineal care is a clean procedure, cleansing of the patient’s external
genitalia , perineum, anus and the surrounding area which routinely
done during bed bath, after urination and bowel movement.

48. Patient who require special attention to perineal area.
1. Patient who are unable to do self-care.
2. Patient with genito-urinary tract infection.
3. Patient with incontinence of urine and stool.
4. Patient with indwelling catheters.

49. • 5. Postpartum patients.
6. Patients after surgery on the genitor-urinary system.
7. Patients with injury, ulcer or surgery on perineal area.

50. • Preliminary Assessment
1. Assess the condition of perineal skin-any itching, irritation, ulcers,
oedema, drainage etc.
2. Assess the need and frequency of perineal care.
3. Assess whether perineal care should be done under an aseptic
technique or a clean technique.

51. • . Check the physician’s order for any specific instructions.
5. Assess the patient ability for self care.
6. Assess the patient’s mental state to follow instructions.
7. Check the articles available in patients unit.

52. • Preparation of Articles:
A Tray containing
Mackintosh
Purpose: To protect the bed.
Wet cotton ball or rag pieces in a bowl.
Purpose: To clean perineum.

53. A jug with warm water or antiseptic solution.
Purpose: Gauze or rag pieces in a container.
Long artery forceps in kidney tray.
Purpose: To hold swabs for cleaning.
.

54. Paper bag.
Purpose: To receive wastes.
Clean linen, pads, dressing etc as needed.
Purpose: To keep patient clean.
Bed pan.
Purpose: if the patient is in need to passing urine or stool

55. Preparation of Patient:
1. Explain procedure to the patient.
2. Provide privacy by screens and drapes. Drape the patient as for
vaginal examinations.
3. Remove all articles that may interfere with the procedure e.g. air
cushion.
4. Give extra pillows to raise the head.

56. 5. Roll the draw sheet to opposite side to prevent soiling when bedpan is
placed under buttocks, over draw sheet.
6. Offer bed pan. Keep the clean bed-pan on the bed on your working side.
7. Untie the pads, if any and observe the discharges its color, odor, amount
etc.
8. Leave the patient for sometime so that she may pass urine or stool if
necessary.
9. Get the toilet tray and arrange the articles conveniently on bed side table

57. • Steps:
1. Wash hands
Reason: To prevent cross infection.
2. Pour water over perineum.
Reason: To wash off the discharge from the perineal area.
3. Clean the perineum using the wet swabs.
Reason: To prevent the entrance of bacteria from the colon into
urinary tract.
4. Hold the swabs with forceps and clean from above.

58. • . Use one swab for one swabbing.
6. Clean perineum from the midline outward in following order
a. The vulva
b. The labia
c. Inside of labia on both sides.
d. Outside of labia on both sides.

59. 7. Clean the perineal region and anus thoroughly.
8. Remove the bed pan by supporting the hip as before. Turn the
patient to one side and dry the buttocks with dry rag piece.

60. • After Care:
1. Apply the medicine and pad if necessary.
2. Remove the mackintosh if extra one is used.
3. Change linen if necessary straighten the bed clothes. Arrange the bed linen.
4. Make patient comfortable.

61. 5. Take the bed pan to sanitary annex. Remove cotton swabs, and empty the
contents into toilet.
6. Clean all articles.
7. Boil forceps.
8. Replace articles