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CLEANSING BED BATH
Click to add title • 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 (43°C - 46°C or as preferred by patient)
• Soap in a soap dish
• Patient’s 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 patient’s 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 patient’s 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 promotes efficient time
management
6. Wash your hands
IMPLEMENTATION
7. Identify and explain the procedure with the
client and assess client’s 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 nurse’s back.
12. Lower the side rails close to you and assist
client in assuming comfortable position maintaining
body alignment
Aids nurse’s access to clients. Maintain client
comfort.
13. Loosen top covers at foot of bed. Place the bath
blanket over top sheet while the client’s hold the
bath blanket in place. Fold and remove top sheet
from under blanket.
Removal of top linens prevents them from
becoming soiled or moist during bath. Blanket
provides warmth and privacy.
14. If top sheet is to be reused, fold it over a chair. If
not, place soiled linen in laundry bag. Taking care
not to allow linen to contact with your uniform
Proper disposal prevents transmission of
microorganisms
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 client’s 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. Re-
hang 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 ⅔ full, with warm
water (43-46°C). 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 client’s 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 client’s head.
Removal of pillow makes it easier to wash
client’s ears and neck. Placement of towel
prevents soiling of bed linen.
19. Place bath towel over client’s chest. Prevents soiling of bath blanket and easy
access to towel.
20. Fold washcloth around fingers of your hand to
form a mitt. Immerse mitt in water and wring
thoroughly
Mitt retains water and heat better than loosely
held washcloth, keeps cold edges from
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 client’s 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 client’s 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 client’s 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 client’s breast.
Spreading the towel across the client’s 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 client’s chest
Prevents chilling and exposure of body parts
28. Soap, rinse and dry the client’s abdomen
giving special attention to bathing umbilicus
and abdominal folds. Stroke from side to side.
Keep abdomen covered between washing
and rinsing.
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 client’s 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 patient’s 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
washing, rinsing and drying from ankle to knee to
thigh to groin. Pay particular attention to the back of
knee groin. Apply moisturizer as needed
Promotes venous return. Long, firm strokes
would not be used for client with blood clots.
Keeps epidermis lubricated.
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 side-
lying position. Place towel lengthwise along
client’s 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 client’s 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.
Prevents transmission of microorganism. A
clean gown promotes the warmth and comfort
of the client.
This facilitates ease in dressing
42. Protect the pillow with towel and groom the
clients hair.
Note: Women may want to apply make-up.
Hair is lost during the process of combing. The
towel collects loose hair. Combing hair and
applying make-up maintains client’s body
image.
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. Don’t 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.
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 client’s care.
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