BATHING A CLIENT

Bathing
Removes accumulated oil, perspiration, dead skin cells and some
bacteria.
Stimulates circulation. It also produces a sense of well-being.
Is refreshing and relaxing and frequently improves morale, appearance
and self-respect.
Offers an excellent opportunity for the nurse to assess all clients. The
nurse can observe the condition of the clients skin and physical
conditions such as sacral edema or rashes. While assisting a client with
a bath, the nurse can also assess the clients psychosocial needs such
as orientation to time and ability to cope with the illness.
2 categories of baths:
A. Cleaning baths- are given for hygienic purposes and include these
types:
1. Complete bed bath/ Bedbath. The nurse washes the entire body
of a dependent client in bed. It is a type of bath given to a client
who cannot perform his/her own personal hygiene or who can but in
a very limited way. The client is required to remain in bed as part of
the therapeutic regimen.
2. Self- help bed bath. Clients confined to bed are able to bathe
themselves with help from the nurse for washing the back and
perhaps the feet.
3. Partial bath (abbreviated bath). Only the parts of the clients
body that might cause discomfort or odor, if neglected, are washed:
the face, hands, axillae, perineal area and back. Omitted are the
arms, chest, abdomen, legs and feet. The nurse provides this care
for dependent clients and assists self-sufficient clients confined to
bed by washing their backs. Some ambulatory clients prefer to take

a partial bath at the sink. The nurse can assists them by washing
their backs.
4. Bag bath. This bath is a commercially prepared product that
contains 10 to 12 presoaked disposable washcloths that contain norinse cleanser solution. The package is warmed in microwave. The
warming time is about 1 minute but the nurse needs to determine
how long it takes to attain a desirable temperature. Each area of the
body is cleaned with a different cloth and then air dried. Because
the body is not rubbed dry, the emollient in the solution remains on
the skin.
5. Tub bath. Tub baths are often preferred to bed baths because it is
easier to wash and rinse in a tub. Tubs are also used for therapeutic
baths. The amount of assistance the nurse offers depends on the
abilities of the client. There are specially designed tubs for
dependent clients. These tubs greatly reduce the work of the nurse
in lifting clients in and out of the tub and offer greater benefits than
a sponge bath in bed.
6. Shower. Many ambulatory clients are able to use shower facilitates
and require only minimal assistance from the nurse
B. Therapeutic baths- are given for physical effects such as to soothe
irritated skin or to treat an area (e.g., the perineum). Medications may
be placed in the water. A therapeutic bath is generally taken in a tub
one-third or one-half full. The client remains in the bath for a
designated time, often 20 to 30 minutes. If the clients back, chest and
arms are to be treated; these areas need to be immersed in the
solution. The bath temperature is generally included in the order; 37.7
C to 46 C (100 F to 115 F) may be ordered for adults and 40.5 C (105 F)
is usually ordered for infants.

PURPOSES

To remove transient microorganisms, body secretions and excretions,

and dead skin cells
To stimulate circulation to the skin
To promote a sense of well-being
To produce relaxation and comfort
To prevent and eliminate unpleasant body odors

ASSESSMENT

Physical or emotional factors (e.g., fatigue, sensitivity to cold, need for

control, anxiety or fear)
Condition of the skin (color, texture and turgor, presence of pigmented
spots, temperature, lesions, excoriations, abrasions, and bruises).
Areas of erythema (redness) on the sacrum, bony prominences, and
heels should be assessed for possible pres-sure sores
Presence of pain and need for adjunctive measures (e.g., an analgesic)
before the bath
Range of motion of the joints
Any other aspect of health that may affect the clients bathing process
(e.g., mobility, strength, cognition)
Need for use of clean gloves during the bath

EQUIPMENT
Basin or sink with warm water (between 43C and 46C [110F and
115F])
Soap and soap dish
Linens: bath blanket, two bath towels, washcloth, clean gown or
pajamas or clothes as needed, additional bed linen and towels, if
required
Clean gloves, if appropriate (e.g., presence of body fluids or open
lesions)
Personal hygiene articles (e.g., deodorant, lotions)
Shaving equipment
Table for bathing equipment
Laundry bag

1.

2.

3.

4.

5.

PROCEDURE
Introduce yourself, and verify the
clients identity. Explain to the
client what you are going to do,
why it is necessary, and how the
client can cooperate.
Perform hand hygiene, and
observe other appropriate
infection control procedures.
Provide for client privacy by
drawing curtains or closing the
door to the room.
Prepare the client and the
environment:
Invite a family member or
significant other to participate, if
desired.
Close the window and doors to
ensure the room is at a
comfortable temperature.
Offer the client a bedpan or urinal,
or ask whether the client wishes to
use the toilet or commode.

Encourage the client to perform as

much personal self-care as
possible.
During the bath, assess each area
of the skin carefully.
Prepare the bed, and position the
client appropriately.
Position the bed at a comfortable
working height. Lower the side rail
on the side close to you. Keep the
other side ail up. Assist the client
to move near you.
Place a bath blanket over the top
sheet. Remove the top sheet from
under the bath blanket by starting

RATIONALE
Enhances cooperation and
participation; reduces anxiety and
fear

Reduces transmission of
microorganisms.
Hygiene is a personal matter.

Air currents increase loss of heat

from the body by convection.
Warm water and activity can
stimulate the need to void. The
client will be more comfortable
after voiding, and voiding before
cleaning the perineum is
advisable.
This promotes independence,
exercise, and self-esteem.

This avoids undue reaching and

straining and promotes good body
mechanics. It also ensures client
safety.
The bath blanket provides comfort,
warmth, and privacy.

at clients shoulders and moving

the linen down towards clients
feet. Ask the client to grasp and
hold the top of the bath blanket
while pulling the linen to the foot
of the bed.

6.

7.

Note: If the bed linen is to be

reused, place it over the bedside
chair. If it is to be changed, place
it in the linen hamper.
Remove the clients gown while
keeping the client covered with
the bath blanket. Place the gown
in the linen hamper.
Make a bath mitt with the
washcloth.

Wash the face.

Place towel under the clients

head.
Wash the clients eyes with water
only, and dry them well. Use a
separate corner of the washcloth
for each eye. Wipe from the inner
to the outer canthus.
Ask whether the client wants soap
used on her face.

8.

Wash, rinse, and dry the clients

face, ears, and neck.
Remove the towel from under the
clients head.
Wash the arms and hands.
Place a towel lengthwise under
the arm farther away from you.
Wash rinse, and dry the arm by

A bath mitt retains water and heat

better than a cloth loosely held
and prevents ends of washcloth
from dragging across the skin.
Begin the bath at the cleanest area
and work downward toward the
feet.

Using separate corners prevents

transmitting microorganisms from
one eye to the other.
This prevents secretions from
entering the nasolacrimal ducts.
Soap has a drying effect, and the
face, which
is exposed to the air more than
other body parts, tends to be drier.

It protects the bed from becoming

wet.
Firm strokes from distal to proximal

elevating the clients arm and

supporting the clients wristed and
elbow.
Apply deodorant or powder, if
desired. Special caution is needed
for clients with respiratory
alterations.
Optional: Place a towel on the bed,
and put a washbasin on it. Place
the clients hands in the basin.
Assist the client as needed to
wash, rinse, and dry hands, paying
particular attention to the spaces
between fingers.
Repeat for the hand and arm
nearer you. Exercise caution if an
IV infusion is present, checking
flow after moving the arm. Avoid
submersing the IV site if the
dressing site is not
a clear, transparent dressing.
9. Wash the chest and abdomen.
Place a bath towel lengthwise over
the chest. Fold the bath blanket
down to the clients pubic area.
Lift the bath towel off chest, and
bath chest and abdomen with your
mitted hand, using long, firm
strokes. Rinse and dry well.
Replace the bath blanket when the
areas have been dried.
10 Wash the legs and feet.
.
Expose the leg farther from you by
folding the bath blanket towards
the other leg, being careful to
keep the perineum covered.
Lift the leg and place the bath
towel lengthwise under it. Wash,
rinse, and dry the leg, using log,
smooth, firm strokes from the

areas promote circulation by

increasing venous blood return.
Powder is not recommended for
these clients due to the potential
respiratory adverse effects.
Many clients enjoy immersing their
hands in the basin and washing
themselves. Soaking loosens dirt
under the nails.

A clear transparent dressing will

keep water from an IV site;
however, a gauze dressing
becomes contaminated when it
becomes wet with the water.

Keeps the client warm while

preventing unnecessary exposure
of the chest.

Covering the perineum promotes

privacy and maintains the clients
dignity.
Washing from the distal to
proximal areas promotes
circulation by stimulating venous
blood flow.

ankle t the knee to the thigh.

Reverse the coverings, and repeat
for the other leg.
Wash the feet by placing them in
the basin of water.

Dry each foot.

Obtain fresh, warm bath water

now or when necessary.
11 Wash the back and then the
.
perineum.
Assist the client into a prone or
side- lying position facing away
from you. Place the bath towel
lengthwise alongside the back and
buttocks while keeping the client
covered with the bath blanket as
much as possible.
Wash and dry the clients back,
moving from he shoulders to the
buttocks and upper thighs, paying
attention to the gluteal folds.

Perform a back massage now or

after completion of bath.
Assist the client to the supine
position and determine whether
the client can wash the perineal
areas independently. If the client
cannot do, drape the client and
wash the area.
12 Assist the client with grooming
.
aids, such as powder, lotion, or
deodorant.
Use powder sparingly. Release as

Placing the feet in a basin of water

is comfortable and relaxing and
allows for thorough cleaning of the
feet and the areas between the
toes and under the nails.
To prevent growth of
microorganisms that causes odor
and skin diseases.
Water may become dirty or cold.

This provides warmth and prevents

undue exposure.

Fecal material near the anus may

be a source of microorganisms.
Prolonged pressure on the sacral
area or other bony prominence
may compromise circulation and
lead to development of decubitus
ulcer.
A backrub improves circulation.
Providing perineal self-care may
decrease embarrassment for the
patient. Effective perineal care
reduces odor and decreases the
risk
for
infection
through
contamination.

This will avoid irritation of the

little as possible into the

atmosphere.

Help the client put on a clean

gown or pajamas.
Assist the client to care for hair,
mouth, and nails.
17 Document:
.
Type of bath given.
Skin assessment such as
excoriation, erythema,
exudates, rashes, drainage, or
skin breakdown..
Nursing interventions related to
skin integrity.
Ability of the client to assist or
cooperate with bathing.
Client response to bathing.
Educational needs regarding
hygiene.
Information or teaching shared
with the client or their family.

respiratory tract by powder

inhalation. Excessive powder can
cause caking, which leads to skin
irritation.
This provides for the patients
warmth and comfort.