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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