BED BATH DESCRIPTION A complete bed bath cleans the skin, stimulates circulation, provides mild exercise, and

promotes comfort. Bathing also allows assessment of skin condition, joint mobility, and muscle strength. Depending on the patient's overall condition and duration of hospitalization, he may have a complete or partial bath daily. A partial bath including hands, face, axillae, back, genitalia, and anal region can replace the complete bath for the patient with dry, fragile skin or extreme weakness and can supplement the complete bath for the diaphoretic or incontinent patient. PURPOSES

ASSESSMENT PLANNING Prepare the necessary equipment/ materials for the procedure: o Bath basin o Bath blanket o Skin cleanser o Towel o Washcloth o Skin lotion o Orangewood stick o Gloves o Deodorant o Hospital-grade disinfectant o Optional: chlorhexidine-impregnated cloth, bath oil, perineal pad, abdominal (ABD) pad, and linen-saver pad

IMPLEMENTATION KAR HEALTH EDUCATION COMMUNICATION ETHICO-MORAL RESPONSIBILITY LEGAL RESPONSIBILITY PROCEDURE 1. Explain procedure to client and ask client about bathing preferences. 2. Prepare room for comfort and draw privacy curtains or close the door. RATIONALE Promotes clients cooperation. Ensures clients privacy.

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3. Offer client bedpan or urinal. Provide towel and washcloth. 4. Perform hand hygiene. Apply disposable gloves as needed.

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5. Position the bed at a comfortable working height.

This promotes client comfort during the procedure. Hand washing is the single, most effective way for preventing the transmission of microorganisms and infectious diseases. Use of gloves serves as barrier for secretions. This promotes proper body mechanics and thus reducing strain on the nurses back. Aids the nurses access to the client and maintains comfort throughout the procedure.

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Perform Complete or Partial Bath 6. Lower side rail closest to you, and assist client in assuming a comfortable position that maintains body alignment. Assist/move client toward side of bed closest to you. 7. Loosen top covers beginning at foot of bed. Place bath blanket over top sheet. Fold and remove top sheet from under blanket. 8. If top sheet is to be reused, fold it for later replacement. If not, place it in laundry bag. 9. Remove clients gown or pajamas. 10. Pull side rail up. Fill washbasin two-thirds full with warm water. Have client test temperature by placing fingers in water.

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Removal of top linens prevent them from becoming soiled or moist during the bath. Putting on bath blanket provides warmth and privacy. Proper disposal prevents the transmission of microorganisms Provides full exposure of body parts during bathing. Raising side rails maintains clients privacy as the nurse leaves bedside. Warm water used during the bath promotes comfort, relaxes muscles, and prevents unnecessary chilling. Having the patient test water temperature prevents accidental burns.

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11. Remove pillow if allowed and raise head of bed 30 to 45 degrees. Place bath towel under clients head by asking the client to lift his head while the nurse supports the neck. Place second bath towel over clients chest. 12. Fold washcloth around fingers of your hand to form mitt. Immerse mitt in water and wring thoroughly. 13. Wash clients eyes with plain warm water. Use different section of mitt for each eye. Move mitt from inner to outer canthus. Soak any crusts on eyelid for 2 to 3 minutes with damp cloth before attempting removal. Dry eye thoroughly but gently. 14. Ask if client prefers to have soap used on face. Wash, rinse, and dry well clients forehead, cheeks, nose, neck, and ears. 15. Remove bath blanket from clients arm that is closest to you. Place bath towel lengthwise under arm. 16. Bathe clients arm with soap and water using long, firm strokes from distal to proximal areas. Raise and support clients arm above head (if possible) while washing axilla.

Removal of pillow makes it easier to wash clients ear and neck. Placement of towels prevents soiling of bed linen and bath blanket.

Mitt retains water and heat better than loosely held washcloth. Soap irritates the eyes. Using separate sections of the mitt reduces transmission of infection. Bathing eye from inner to outer canthus prevents secretions from entering the nasolacrimal duct.

Soap tends to dry face, which is exposed to air more than any other body parts. Prevents soiling of bed.

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17. Rinse and dry arm and axilla thoroughly. Apply deodorant or talcum powder, if used.

Soap lowers surface tension and facilitates removal of debris and bacteria when friction is applied during washing. Long, firm strokes stimulates circulation. Movement of arm exposes axilla and exercise joints normal range-of-motion. Alkaline residue of soap discourages the growth of normal skin bacteria while excess moisture can cause skin maceration or

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18. Fold bath towel in half and lay it on bed beside client. Place basin on towel. Immerse clients hand in water. Allow hand to soak for 3 to 5 minutes before washing hand and fingernails. Remove hand from basin and dry well. 19. Raise side rail and move to other side of bed. Lower side rails and repeat steps 15 through 17 for other arm. 20. Check temperature of bath water. 21. Change the water as often as necessary. 22. Cover clients chest with bath towel, and fold bath blanket down to umbilicus. Lift edge of towel away from clients chest. Bathe clients chest using long, firm strokes with mitted hand. Wash skinfolds under female clients breasts. Keep clients chest covered between washing and rinsing. Dry well. 23. Place bath towel(s) lengthwise over clients chest and abdomen. Fold blanket down to just above clients pubic region. 24. Lift bath towel. Bathe clients abdomen with mitted hand. Stroke from side to side. Keep clients abdomen covered between washing and rinsing. Dry well. 25. Assist client put on clean

softening. Deodorant controls body odor. Soaking softens cuticles and calluses of hand, loosens debris beneath nails, and enhances feeling of cleanliness. Thorough drying removes moisture in between fingers.

Raising the side rails ensures client safety.

Warm water maintains client comfort To keep the water warm and clean. Draping prevents unnecessary exposure of body parts. Towel maintains warmth and privacy. Secretions and dirt collect easily in areas of tight skinfolds which are susceptible to excoriation if breasts are pendulous .

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Prevents chilling and unnecessary exposure of body parts.

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Prevents chilling and unnecessary exposure of body parts. Moisture and sediment that collect in skinfolds predispose the skin to maceration and irritation. Maintains clients warmth

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gown or pajama top. 26. Cover clients chest and abdomen with top of bath blanket. Expose clients nearer leg by folding blanket toward midline. Drape clients perineum and other leg. 27. Bend clients leg at knee by positioning your arm under clients leg. Elevate leg from mattress slightly while grasping clients heel, and slide bath towel lengthwise under leg. Ask client to hold foot still. Place bath basin on towel on bed, and secure its position next to the foot to be washed. 28. Raise he lower leg while supporting it with one hand and slide the basin under the lifted foot. Soak the foot while washing the leg. 29. Use long, firm strokes in washing from clients ankle to knee and from knee to thigh, unless contraindicated. Dry well. 30. Cleanse clients foot, making sure to bathe between toes. Clean and clip nails as needed. Dry well. Apply lotion to dry skin. Do not massage any reddened area on clients skin. 31. Raise side rail and move to other side of bed. Lower side rail and repeat steps 26 through 29 for clients other leg and foot. 32. Cover client with bath blanket, raise side rail for clients safety, and change

and comfort. Prevents unnecessary exposure of body parts.

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The towel prevents soiling of bed linen. Support of joint and extremity during lifting prevents strain on musculoskeletal structures. Sudden movement by client could spill bath water.

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Proper positioning of foot prevents pressure being applied from edge of basin against calf. Soaking softens calluses and rough skin. Promotes venous return.

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Secretions and moisture may be present in between toes. Application of lotion helps retain moisture and softens skin.

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Decreased bath water temperature can cause chilling. Clean waster

bath water. SAFE & QUALITY NURSING CARE 33. Lower side rail. Assist client in assuming a prone or sidelying position (as applicable). Place towel lengthwise along clients side. 34. Keep client draped by sliding bath blanket over his or her shoulders and thighs. Wash, rinse, and dry back from neck to buttocks using long, firm strokes. Pay special attention to folds of buttocks and anus. Give client a back rub. Change bath water.

reduces transmission of microorganisms Exposes back and buttocks for bathing.

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Maintains warmth, and prevents unnecessary exposure. Skinfolds near buttocks and anus may contain fecal secretions that harbour microorganisms.

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Changing bath water prevents transfer of microorganisms from anal area to genitalia. 35. Apply disposable gloves if Prevents contact with not done previously. microorganisms in body secretions. 36. Assist client in assuming a Maintains clients privacy. side-lying or supine position. Clients who are capable of Cover clients chest and performing partial bath upper extremities with towel usually prefer to wash their and lower extremities with own genitalia. bath blanket. Expose clients genitalia only. Wash, rinse, and dry perineum. 37. Dispose of gloves in Prevents transmission of receptacle. infection. 38. Apply additional body lotion or oil on client as desired. 39. Assist client in dressing. Comb clients hair. 40. Make clients bed. Moisturizing lotion prevents dry, chapped skin. Promotes clients body image.

Provides a clean environment and provides client comfort 41. Remove soiled linen and Prevents transmission of place it in laundry bag. infection. Clean Clean and replace bathing environment promotes equipment. Replace call light clients comfort. Keeping

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and clients personal possessions. Leave room as clean and comfortable as possible. 42. Perform hand hygiene.

call light and articles of care within reach promotes clients safety. Reduces the transmission of microorganisms.

EVALUATION Observe clients skin, paying particular attention to areas that were previously soiled, reddened, or that showed early signs of breakdown. Observe clients range of motion during the bath. Ask client to rate level of comfort. Record bath on flow sheet. Note level of assistance required. Record condition of clients skin and any significant findings. Report evidence of alterations in clients skin integrity.

NURSING CONSIDERATIONS Clients whose level of independence and mobility change frequently may require more or less assistance during bathing If available, be sure that clients with an IV or upper extremity injury have a gown with snap or tie sleeves. Thus there is easy access to upper extremities during hygiene If a client us at risk for falls, be sure to raise side rails up before obtaining fresh water or other supplies. Remember side rails cannot be used as a restraint. Clients with history of deep vein thrombosis (DVT) should not have their lower extremities washed with long firm strokes. Do not massage any reddened area on clients skin because massaging causes breaks in the skin surface capillaries and increased risk of skin breakdown. If client becomes excessively fatigued and unable to cooperate or participate in bathing, reschedule bathing to a time when client is more rested

MAKING A WASHCLOTH MITT To make a washcloth mitt, take a clean, dry washcloth and fold it in thirds lengthwise around your hand. Fold the top of the washcloth down and tuck it into the bottom of the mitt.

Cleaning the eyes from inner to outer cantus.

Washing of the arms from distal to proximal.

Performing foot care.