CLEANSING BED BATH

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Definition: The nurse is primarily responsible in meeting the hygienic needs of the client. Bathing provides an opportunity for the nurse to provide care and meet the psychosocial needs of clients, assess clients and perform health education activities

 A complete bed bath is a bath provided to weak, dependents clients who are confined to bed

EQUIPMENTS:

1 Bath blanket or large towel 2 Bath towels 2 Wash cloths A clean gown or pajamas 2 pairs of gloves A clean linen

 Tray containing the following: Wash basin half filled with water (43C - 46C or as preferred by patient) Soap in a soap dish Patients comb/hair brush Talcum powder/lotion/oil Nailclippers 2 pitchers ( 1 with cold and the other one with hot water) Paper for lining Bath thermometer

Pail for used water Bedpan or urinal Laundry bag or cart Working gloves

ASSESSMENT

ACTIONS

Rationale

1. Check the chart for patients diagnosis, activity orders, positioning or movement or any orders specific to hygiene

2. Assess patient condition first by taking the vital signs, watch for current s/s related to medical diagnosis such as fatigue, pain level of consciousness.

To determine patients limitations or ability to participate, thus preventing accidental injury to client during bathing. To be able to prioritize the nursing needs. Remember that hygiene may be lower priority than rest for patient who is short of breath or experiencing pain.

3. Check to see whether needed special supplies or equipment are already in the room.

PLANNING

4. Determine whether or not you will need any assistance.

Organization facilitates the performance of the task

5. Determine what supplies and equipment are need.

Organization management

promotes

efficient

time

6. Wash your hands

IMPLEMENTATION

7. Identify and explain the procedure with the client and assess clients ability to assist in bathing as well as with personal hygiene preferences.

To be sure you are carrying out the procedure for the correct patient. Thus, promotes clients cooperation and participation.

8. Adjust room temperature and ventilation, and close room doors and windows. Close

Prevents rapid loss of body heat during bathing. Ensures privacy.

9. Offer client bedpan or urinal. Provide towel and washcloth for client.

Client will feel more comfortable after voiding. Prevents interruption of bath.

10. Wash hands. Option: wear gloves

Reduces transmission of microorganisms

11. Raise the bed to working height. Bring the client toward side closest to you.

Having the bed in high position and having less effort in reaching across bed prevents strain on the nurses back.

12. Lower the side rails close to you and assist Aids nurses access to clients. Maintain client client in assuming comfortable position maintaining comfort. body alignment 13. Loosen top covers at foot of bed. Place the bath Removal of top linens prevents them from blanket over top sheet while the clients hold the becoming soiled or moist during bath. Blanket provides warmth and privacy. bath blanket in place. Fold and remove top sheet from under blanket. 14. If top sheet is to be reused, fold it over a chair. If Proper disposal prevents transmission of not, place soiled linen in laundry bag. Taking care microorganisms not to allow linen to contact with your uniform

15. Assist client with oral care. This may be done after the bath if the client prefers it.

Oral hygiene helps maintain the teeth and gums in good condition. It also alleviates unpleasant odors and taste.

16. Remove the clients gown or pajamas while maintaining privacy. If extremity is injured or has reduced mobility, begin removal from unaffected side. NOTE: If with intravenous tube, remove gown from arm with IV first, and then lower IV container. Rehang IV container and check the flow rate.

Provides full exposure of body parts during bathing. Undressing unaffected side first allows easier manipulation of gown over body parts with reduced ROM.

17. Pull side rails up. Fill washbasin full, with warm water (43-46C). Have client place fingers in water to rest temperature tolerance. OPTION: Place plastic container of bath lotion in bath water.

Raising side rail maintain safety as you leave bedside. Warm water promotes comfort and prevents chilling. Testing temperature prevents accidental burning of clients skin. Keep lotion warm for application to skin

18. Lower side rail. Remove pillow if allowed and raise head of bed 30-45 degrees. Place bath towel under clients head.

Removal of pillow makes it easier to wash clients ears and neck. Placement of towel prevents soiling of bed linen.

19. Place bath towel over clients chest.

Prevents soiling of bath blanket and easy access to towel.

20. Fold washcloth around fingers of your hand to Mitt retains water and heat better than loosely form a mitt. Immerse mitt in water and wring held washcloth, keeps cold edges from thoroughly brushing against client, and prevents splashing. 21. With wet wash cloth (no soap), wipe the farther eye from inner to outer canthus using different section of mitt for each eye. NOTE: Soak encrustations on eyelid for 2-3 minutes with damp cloth before attempting removal. Dry eye thoroughly but gently. Soap irritates eyes. Use of separate sections of mitt reduces infection transmission. Bathing the eye from inner to outer canthus. Prevents secretions from entering nasolacrimal duct. Pressure can cause internal injury.

22. Wash, rinse and dry well forehead, cheeks, nose, neck and ears. Avoid soap on the face if the client prefers.

Soap tends to dry face more quickly and maybe avoided as a personal preference.

23. Expose the clients far arm and place the towel lengthwise under it. Using firm long strokes, soap, rinse and dry the arm and axilla. Strokes should be from distal to proximal areas. If clients prefers, apply deodorant or talcum powder.

The towel prevents soiling of bed. Washing the far side first eliminates contaminating a clean area once it is washed. Gentle friction stimulates circulation and helps remove dirt, oil and organism. Excess moisture causes skin maceration or softening. Deodorant controls body odor.

24. Place a folded towel on bed beside client. Place basin on towel. Immerse clients hand in water. Soap, rinse and dry the hand. OPTION: Allow hand to soak for 3-5 minutes before washing hand and finger nails.

Soaking softens the cuticle and calluses of hand and loosens debris beneath nails. Soaking also enhances feeling of cleanliness. It allows thorough washing of hand between the fingers and drying removes moisture from between fingers

25. Do step 23 & 24 to the nearer arm.

26. Spread the towel across the clients chest. Lower the bath blanket to the umbilical area. Soap, rinse and dry the chest. Keep the chest covered with a towel between the washing and rinsing. Pay special attention to the skin folds under the female clients breast.

Spreading the towel across the clients chest will avoid unnecessary exposure and chilling. Secretions and dirt collect easily in areas of tight skinfolds.

27. Lower the bath blanket to cover the perineal area. Place the towel over the clients chest 28. Soap, rinse and dry the clients abdomen giving special attention to bathing umbilicus and abdominal folds. Stroke from side to side. Keep abdomen covered between washing and rinsing.

Prevents chilling and exposure of body parts

Moisture and sediments that collect in skinfolds predispose clients to skin maceration and irritation

29. Return the bath blanket to the original place by covering the chest and abdomen. Expose far leg by folding blanket over midline. Be sure perineum is draped.

Prevents unnecessary exposure.

30. Bend clients leg at knee by positioning your arm under leg while grasping clients heel, elevate leg and slide the bath towel under leg.

Prevent soiling of linen. Support of joint and extremity during lifting prevents strain on musculoskeletal structure.

31. Place the bath basin on towel on bed and place patients foot in the basin. Make sure that foot is place on the bottom of basin. OPTION: Allow foot to soak while you wash leg

Proper positioning of foot prevents pressure from being applied from edge of basin against calf. Soaking softens calluses and rough skin. NOTE: If client is unable to hold leg in basin, do not immerse, simply wash it with washcloth

32. Unless contraindicated use long, firm strokes in Promotes venous return. Long, firm strokes washing, rinsing and drying from ankle to knee to would not be used for client with blood clots. thigh to groin. Pay particular attention to the back of Keeps epidermis lubricated. knee groin. Apply moisturizer as needed

33. Support the ankle and heel with your hand and leg with your arm, soap, rinse dry foot, making sure to bathe between toes. If skin dry, apply lotion. Clip nails as needed. Change water.

34. Do step 30-33 to the nearer leg.

35. Cover client with bath blanket. Discard washcloth and towel.

36. Assist client in assuming prone or sidelying position. Place towel lengthwise along clients side. 37. Wear gloves, if not done. 38. Wash, rinse and dry back from neck to coccyx using long, firm strokes. Pay special attention to folds of buttocks and anus. Observe for redness or other indications of skin breakdown in the sacral area. Prevents contact with microorganism in body secretions. The direction moves from clean to contaminated area. Skin folds near buttocks and anus may contain fecal secretions that harbor microorganism. Prolonged pressure on the bony prominences may compromise circulation and lead to the development of decubitus ulcer.

39. If not contraindicated, give backrub. Refill basin with clean water and washcloth.

Drop in water temperature during bathing can cause chilling. Clean water and wash cloths reduces transfer of microorganism. Exposes back and buttocks for bathing.

40. Assist client in assuming side-lying position or supine position. Cover chest and upper extremities with towel and lower extremities with a bath blanket. Expose only the genitalia. Wash, rinse and dry the perineum with special attention to the skinfolds. If client prefers to do it by himself, make a mitt on his hand.

Improves circulation to the tissues and aids in relaxation. The used towels and water are contaminated after washing the gluteal area.

Changing to clean supplies decreases the spread of microorganisms from the anal area to the genital.
Maintains clients privacy. Clients capable of performing partial bath usually prefer to wash their own genitalia. Skinfolds are sites for accumulation of secretions and moisture

41. Dispose the gloves and wash hands. Help the client to a clean gown before attending to his/her grooming needs. If with IVF, insert the arm with IVF first and check the drip rate. 42. Protect the pillow with towel and groom the clients hair. Note: Women may want to apply make-up. 43. Change bed linen 44. Remove soiled linen and place in dirty linen bag. Cleanse and replace bathing equipment. Replace call light and personal possessions. Leave room as clean and comfortable as possible. Dont forget to raise the side rails especially for patient at risk for fall. Proper positioning of foot helps reduce strain and discomfort to the client. Secretions and moisture maybe present between toes. Lotion helps to retain moisture and softens skin.

Prevents transmission of microorganism. A clean gown promotes the warmth and comfort of the client. This facilitates ease in dressing

Hair is lost during the process of combing. The towel collects loose hair. Combing hair and applying make-up maintains clients body image.

Provides clean environment and comfort to the patient. Prevents transmission of infection. Clean environment promotes comfort. Keeping call light, articles of care within reach and always raise the side rails promotes safety.

45. Wash hands.

Reduce transmission of microorganism.

46. Record any significant observations. Share this to the attending physician (AP) and the nurse on duty (NOD)

A careful record is important for planning and individualizing the clients care.

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