Bed Bath
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.
Equipment
Bath basin • bath blanket • soap • towel • washcloth • skin lotion • orangewood stick • gloves • deodorant • optional: bath oil, perineal pad, abdominal (ABD) pad, linen-saver pad.
Preparation of equipment
Adjust the temperature of the patient's room, and close any doors or windows to prevent drafts. Determine the patient's preference for soap or other hygiene aids because some patients are allergic to soap or prefer bath oil or lotions. Assemble the equipment on an overbed table or bedside stand.
Implementation
Tell the patient you'll be giving him a bath, and provide privacy. If the patient's condition permits, encourage him to assist with bathing to provide exercise and promote independence.
Raise the patient's bed to a comfortable working height to avoid back strain. Offer him a bedpan or urinal.
Fill the bath basin two-thirds full of warm water (about 115° F [46.1° C]), and bring it to the patient's bedside. If a bath thermometer isn't available, test the water temperature carefully with your elbow to avoid scalding or chilling the patient; the water should feel comfortably warm.
If the bed will be changed after the bath, remove the top linen. If not, fanfold it to the foot of the bed.
Put on gloves. Position the patient supine if possible.
Remove the patient's gown and other articles, such as elastic stockings, elastic bandages, and restraints (as ordered). Cover him with a bath blanket to provide warmth and privacy.
Place a towel under the patient's chin. To wash his face, begin with the eyes, working from the inner to the outer canthus without soap. Use a separate section of the washcloth for each eye to avoid spreading ocular infection.
If the patient tolerates soap, apply it to the cloth, and wash the rest of his face, ears, and neck, using firm, gentle strokes. Rinse thoroughly because residual soap can cause itching and dryness. Then dry the area thoroughly, taking special care in skin folds and creases. Observe the skin for irritation, scaling, or other abnormalities.
Turn down the bath blanket, and drape the patient's chest with a bath towel. While washing, rinsing, and drying the chest and axillae, observe the patient's respirations. Use firm strokes to avoid tickling the patient. If the patient tolerates deodorant, apply it.
Place a bath towel beneath the patient's arm farthest from you. Then bathe his arm, using long, smooth strokes and moving from wrist to shoulder, to stimulate venous circulation. If possible, soak the patient's hand in the basin to remove dirt and soften nails. Clean the patient's fingernails with the orangewood stick if necessary. Observe the color of his hand and nail beds to assess peripheral circulation. Follow the same procedure for the other arm and hand.
Turn down the bath blanket to expose the patient's abdomen and groin, keeping a bath towel across his chest to prevent chills. Bathe, rinse, and dry the abdomen and groin while checking for abdominal distention or tenderness. Then turn back the bath blanket to cover the patient's chest and abdomen.
Uncover the leg farthest from you, and place a bath towel under it. Flex this leg and bathe it, moving from ankle to hip to stimulate venous circulation. Don't massage the leg, however, to avoid dislodging any existing thrombus, possibly causing a pulmonary embolus. Rinse and dry the leg.
If possible, place a basin on the patient's bed, flex the leg at the knee, and place the foot in the basin. Soak the foot, and then wash and rinse it thoroughly. Remove the foot from the basin, dry it, and clean the toenails. Observe skin condition and color during cleaning to assess peripheral circulation. Repeat the procedure for the other leg and foot.
Cover the patient with the bath blanket to prevent chilling. Then lower the bed and raise the side rails to ensure patient safety while you change the bath water.
When you return, roll the patient on his side or stomach, place a towel beneath him, and cover him to prevent chilling. Bathe, rinse, and dry his back and buttocks.
Massage the patient's back with lotion, paying special attention to bony prominences. Check for redness, abrasions, and pressure ulcers.
Bathe the anal area from front to back to avoid contaminating the perineum. Rinse and dry the area well.
After lowering the bed and raising the side rails to ensure the patient's safety, change the bath water again. Then turn
P.75
the patient on his back and bathe the genital area thoroughly but gently, using a different section of the washcloth for each downward stroke. Bathe from front to back, avoiding the anal area. Rinse thoroughly and pat dry.
If applicable, perform indwelling urinary catheter care. Apply perineal pads or scrotal supports as needed.
Dress the patient in a clean gown, and reapply any elastic bandages, elastic stockings, or restraints removed before the bath.
Remake the bed or change the linens, and remove the bath blanket.
Place a bath towel beneath the patient's head to catch loose hair, and then brush and comb his hair.
Return the bed to its original position, and make the patient comfortable.
Carry soiled linens to the hamper with outstretched arms. To avoid spreading microorganisms, don't let soiled linens touch your clothing. Remove gloves.
Special considerations
Fold the washcloth around your hand to form a mitt while bathing the patient. This keeps the cloth warm longer and avoids dribbling water on the patient from the cloth's loose ends. Change the water as often as necessary to keep it warm and clean.
Carefully dry creased skin-fold areas—for example, under breasts, in the groin area, and between fingers, toes, and buttocks. Dust these areas lightly with powder after drying to reduce friction. Use powder sparingly to avoid caking and irritation and to avoid provoking coughing in patients with respiratory disorders.
If the patient has very dry skin, use bath oil instead of soap unless contraindicated. No rinsing is necessary. Warm the lotion before using it for back massage because cold lotion can startle the patient and induce muscle tension and vasoconstriction. (See “Back Care,†page 85.)
A bag bath involves the use of 8 or 10 premoistened, warmed, disposable cloths (in a plastic bag or prepackaged pouch container) that contain a no-rinse surfactant instead of soap. Prior to use, the prepackaged cloths are warmed in a microwave or special warming unit supplied by the manufacturer. A separate cloth is used to wash each part of the body. A bag bath saves time compared to the conventional bed bath because no rinsing is required.
To improve circulation, maintain joint mobility, and preserve muscle tone, move the body joints through their full range of motion during the bath.
If the patient is incontinent, loosely tuck an ABD pad between his buttocks and place a linen-saver pad under him to absorb fecal drainage. Together these pads will help prevent skin irritation and reduce the number of linen changes.
NURSING ALERT Don't wash a trauma or rape victim until she has been examined by the physician and, possibly, the police. Washing may remove important evidence (powder burns or body fluids) that may be needed later in court.
Documentation
Record the date and time of the bed bath on the flowchart. Note the patient's tolerance for the bath, his range of motion, and his self-care abilities, and report any unusual findings.
Equipment
Bath basin • bath blanket • soap • towel • washcloth • skin lotion • orangewood stick • gloves • deodorant • optional: bath oil, perineal pad, abdominal (ABD) pad, linen-saver pad.
Preparation of equipment
Adjust the temperature of the patient's room, and close any doors or windows to prevent drafts. Determine the patient's preference for soap or other hygiene aids because some patients are allergic to soap or prefer bath oil or lotions. Assemble the equipment on an overbed table or bedside stand.
Implementation
Tell the patient you'll be giving him a bath, and provide privacy. If the patient's condition permits, encourage him to assist with bathing to provide exercise and promote independence.
Raise the patient's bed to a comfortable working height to avoid back strain. Offer him a bedpan or urinal.
Fill the bath basin two-thirds full of warm water (about 115° F [46.1° C]), and bring it to the patient's bedside. If a bath thermometer isn't available, test the water temperature carefully with your elbow to avoid scalding or chilling the patient; the water should feel comfortably warm.
If the bed will be changed after the bath, remove the top linen. If not, fanfold it to the foot of the bed.
Put on gloves. Position the patient supine if possible.
Remove the patient's gown and other articles, such as elastic stockings, elastic bandages, and restraints (as ordered). Cover him with a bath blanket to provide warmth and privacy.
Place a towel under the patient's chin. To wash his face, begin with the eyes, working from the inner to the outer canthus without soap. Use a separate section of the washcloth for each eye to avoid spreading ocular infection.
If the patient tolerates soap, apply it to the cloth, and wash the rest of his face, ears, and neck, using firm, gentle strokes. Rinse thoroughly because residual soap can cause itching and dryness. Then dry the area thoroughly, taking special care in skin folds and creases. Observe the skin for irritation, scaling, or other abnormalities.
Turn down the bath blanket, and drape the patient's chest with a bath towel. While washing, rinsing, and drying the chest and axillae, observe the patient's respirations. Use firm strokes to avoid tickling the patient. If the patient tolerates deodorant, apply it.
Place a bath towel beneath the patient's arm farthest from you. Then bathe his arm, using long, smooth strokes and moving from wrist to shoulder, to stimulate venous circulation. If possible, soak the patient's hand in the basin to remove dirt and soften nails. Clean the patient's fingernails with the orangewood stick if necessary. Observe the color of his hand and nail beds to assess peripheral circulation. Follow the same procedure for the other arm and hand.
Turn down the bath blanket to expose the patient's abdomen and groin, keeping a bath towel across his chest to prevent chills. Bathe, rinse, and dry the abdomen and groin while checking for abdominal distention or tenderness. Then turn back the bath blanket to cover the patient's chest and abdomen.
Uncover the leg farthest from you, and place a bath towel under it. Flex this leg and bathe it, moving from ankle to hip to stimulate venous circulation. Don't massage the leg, however, to avoid dislodging any existing thrombus, possibly causing a pulmonary embolus. Rinse and dry the leg.
If possible, place a basin on the patient's bed, flex the leg at the knee, and place the foot in the basin. Soak the foot, and then wash and rinse it thoroughly. Remove the foot from the basin, dry it, and clean the toenails. Observe skin condition and color during cleaning to assess peripheral circulation. Repeat the procedure for the other leg and foot.
Cover the patient with the bath blanket to prevent chilling. Then lower the bed and raise the side rails to ensure patient safety while you change the bath water.
When you return, roll the patient on his side or stomach, place a towel beneath him, and cover him to prevent chilling. Bathe, rinse, and dry his back and buttocks.
Massage the patient's back with lotion, paying special attention to bony prominences. Check for redness, abrasions, and pressure ulcers.
Bathe the anal area from front to back to avoid contaminating the perineum. Rinse and dry the area well.
After lowering the bed and raising the side rails to ensure the patient's safety, change the bath water again. Then turn
P.75
the patient on his back and bathe the genital area thoroughly but gently, using a different section of the washcloth for each downward stroke. Bathe from front to back, avoiding the anal area. Rinse thoroughly and pat dry.
If applicable, perform indwelling urinary catheter care. Apply perineal pads or scrotal supports as needed.
Dress the patient in a clean gown, and reapply any elastic bandages, elastic stockings, or restraints removed before the bath.
Remake the bed or change the linens, and remove the bath blanket.
Place a bath towel beneath the patient's head to catch loose hair, and then brush and comb his hair.
Return the bed to its original position, and make the patient comfortable.
Carry soiled linens to the hamper with outstretched arms. To avoid spreading microorganisms, don't let soiled linens touch your clothing. Remove gloves.
Special considerations
Fold the washcloth around your hand to form a mitt while bathing the patient. This keeps the cloth warm longer and avoids dribbling water on the patient from the cloth's loose ends. Change the water as often as necessary to keep it warm and clean.
Carefully dry creased skin-fold areas—for example, under breasts, in the groin area, and between fingers, toes, and buttocks. Dust these areas lightly with powder after drying to reduce friction. Use powder sparingly to avoid caking and irritation and to avoid provoking coughing in patients with respiratory disorders.
If the patient has very dry skin, use bath oil instead of soap unless contraindicated. No rinsing is necessary. Warm the lotion before using it for back massage because cold lotion can startle the patient and induce muscle tension and vasoconstriction. (See “Back Care,†page 85.)
A bag bath involves the use of 8 or 10 premoistened, warmed, disposable cloths (in a plastic bag or prepackaged pouch container) that contain a no-rinse surfactant instead of soap. Prior to use, the prepackaged cloths are warmed in a microwave or special warming unit supplied by the manufacturer. A separate cloth is used to wash each part of the body. A bag bath saves time compared to the conventional bed bath because no rinsing is required.
To improve circulation, maintain joint mobility, and preserve muscle tone, move the body joints through their full range of motion during the bath.
If the patient is incontinent, loosely tuck an ABD pad between his buttocks and place a linen-saver pad under him to absorb fecal drainage. Together these pads will help prevent skin irritation and reduce the number of linen changes.
NURSING ALERT Don't wash a trauma or rape victim until she has been examined by the physician and, possibly, the police. Washing may remove important evidence (powder burns or body fluids) that may be needed later in court.
Documentation
Record the date and time of the bed bath on the flowchart. Note the patient's tolerance for the bath, his range of motion, and his self-care abilities, and report any unusual findings.
