Chapter 16: Hygiene, Mobility, and Skin Integrity

The hygiene section emphasizes individualized personal care based on each client's physical and cognitive capabilities, with specific protocols for different body areas. Bathing practices must account for increased oxygen demand, and antimicrobial solutions like chlorhexidine gluconate are preferred over standard soap to reduce bacterial colonization. Perineal care requires careful attention to prevent infection and skin breakdown, particularly in vulnerable populations. Foot care demands special consideration, as clients with diabetes or vascular disease require professional podiatry consultation rather than nurse-administered nail trimming and soaking due to infection risks. Oral hygiene prevents dental decay and aspiration complications, while shaving requires electric razors for clients with bleeding risks. The mobility section explains how immobility triggers cascading physiological consequences across multiple systems: metabolic changes including decreased caloric expenditure and protein catabolism, cardiovascular complications such as orthostatic hypotension and thromboembolism, respiratory depression with secretion pooling and pneumonia risk, and musculoskeletal deterioration including contractures and osteoporosis. Safe use of assistive devices—crutches, canes, and walkers—requires proper measurement, positioning, and sequencing to prevent nerve damage and falls. Crutch axillae placement must maintain adequate clearance, and clients must understand weight-bearing patterns and stair negotiation techniques. Skin integrity depends on multiple factors including nutritional status, particularly protein and albumin levels, adequate tissue perfusion, and age-related changes. Wound healing progresses through three distinct phases: inflammation lasting three to five days, fibroblastic phase extending to four weeks with granulation tissue formation, and maturation phase potentially lasting up to one year. Exudate classification—serous, serosanguineous, sanguineous, and purulent—guides treatment decisions. Pressure injury prevention and management form a critical component, with stages ranging from nonblanchable erythema to full-thickness tissue loss exposing bone and muscle. Nurses must understand that massage of reddened areas causes harm, and regular repositioning every two hours remains fundamental. Dressing selection depends on wound depth, exudate volume, and healing phase, with options including hydrocolloids, calcium alginates, hydrogels, and foam products optimizing the healing environment.