BED BATH
Bed bath means bathing a patient who is confined to bed and cannot have the physical and mental capability of self-bathing
Bath is the act of cleaning the body. Baths are given for therapeutic purposes
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Purposes
- To cleanse body of dirt, debris and perspiration
- To refresh
- To stimulate circulation
- To provide comfort and relaxation
- To enhance self-concept
- To provide tactile stimulation
- To facilitate head to be assessment
- To regulate body temperature
- To induce sleep
- To prevent pressure sore
- To remove toxic substances from body surface
- To maintain an effective nurse-patient relationship
- To give health instruction to patient
- To remove unpleasant odors due to perspiration
- To relieve fatigue
- To prevent contractures by giving exercises
- To minimize the skin irritation
Types of Patients Needing Bed Bath
- Unconscious or semiconscious patients
- Postoperative patients
- Patients with strict bed rest
- Paraplegic patients
- Orthopedic patients in plaster – cast and traction
- Seriously ill patients
Types of Cleansing Bath
Bed bath: it is the bathing of a patient who is confined to bed
Therapeutic bath: doctor specifies the temperature of the water, medications to be added and the body part to be treated
Partial bath: it is the act of cleaning particular areas in the body part. They are face, axilla, and genitalia, upper and lower-limbs
Self-administered bath: this is same as in bed bath except the patient is assisting in taking bath
Tub bath or bath room bath: this bath is allowed to the patient only if he has enough confidence for self-help and to withstand procedure
Scientific Principles
- Heat is conveyed to the body by convection
- The tolerance of heat is different in different persons
- The skin is sometimes irritated by the chemical composition of certain soaps
- Moving the joints through their full range of movement helps prevent loss of muscle tone and improves circulation
- Long smooth strokes on the arms and legs that are directed from the distal end to proximal increases the rate of venous flow
- Healthy unbroken skin is a defense against harmful agents and assures resistance to injuries to a certain extent
- Hygiene practices vary in society according to the socioeconomic standard and culture of the individual
- Practice of food technique save time, energy material and adds to the comfort of the patient
- Sensory receptors in the skin are sensitive to heat, pains, touch and pressure
Factors Affecting the Skin
- Impaired self-care
- Immobilization
- Exposure to pressure and moisture
- Vascular insufficiency
- Reduced sensation
- Nutritional alternation
- Constrictive external devices
General Instructions
- Explain the procedure to the patient
- Maintain privacy of the patient
- Put off the fans and close the windows and doors to avoid chill
- Do not give bath immediately after the lunch
- Cleaning is to be done from the cleanest area to the less clean area
- The temperature of the water should be 110 – 115 degree F
- A thorough inspection of the skin and back is necessary to find out early signs of pressure sore
- Use soap which contains less alkali
- Special attention must be given to the creases and folds and bony prominences between fingers and toes and pubic region
- Remove the soap completely to avoid the drying effect of the soap on the skin
- Do not touch the body with wet hands it is unpleasant to the patient
- Creams or oils used to prevent drying or excoriation of the skin
- The nurse should maintain good posture and balances of the body during bed bath
Preliminary Assessment
- Identify the patient and assess the need
- Check doctors order for any specific precautions
- Assess the general condition of the patient
- Assess the patient’s ability of self-help
- Assess the patient’s mental status to follow directions
- Check the patient’s preference for soap, powder, etc
- Check whether the patient has taken the meal in the previous one hour
- Find out the available articles in the unit
- Provide privacy avoid draught and maintain proper light
- Teach the patient and relatives about personal hygiene
Preparation of the Patient and Environment
- Explain the sequence of the procedure to the patient
- Close the windows and doors to prevent draughts put off the skin
- Arrange the necessary articles at the bedside
- Maintain the room temperature which will be must comfortable for patient
- Adjust the height of the bed to the comfortable work of the nurse
- Bring the patient to the edge of the bed and towards the nurse to prevent overreaching
- Provide privacy by means of curtains
- Offer bed pan or urinals if necessary
- Keep the patient flat if the condition permits remove extra pillows and back rest
- Remove the personal clothing and cover the patient with the bath blankets
Equipment
- Basins – 2 (big land small 1)
- Soap and soap dish
- Wash cloth – 2
- Bath touch – 2
- Face towel – 1
- Bath blanket of sheet – 1
- Surgical spirit and powder
- Nail cutter
- Comb and oil
- Kidney tray or paper bag
- Jugs – 2
- Bucket – 1
- Clean bed linen
- Clean dress to patient
- Bucket or a laundry bag
- Bath thermometer – 1
Procedure
- Explain the procedure
- Remove the patients dress, cover with bath sheet while removing top sheet and dress
- Mix hot and cold water in basin half full and check the temperature on the back of your hand
- Spread face towel around neck
- Wet sponge towel and form mitten around gingers after removing excess water
- Clean body in following
Face
- Wet and apply soap to forehead, face, over and behind ear and neck
- Clean eyes from inner to outer canthus
- Rinses sponge towel and allow patient to wipe face
- Dry with face towel, replace at head end of bed
Arms
- Place towel lengthwise under the farthest arm if there is IV do not disturb it
- Take soapy bath mitt and soap the arm and axilla
- Massage the pressure areas
- Place the hand in basin of water to wash
- Rinse and dry well, paying attention to skin under breast
- Recover with towel
Chest
- Avoid unnecessary exposure
- Cover chest with towel and turn bath sheet down to abdomen
- Wet chest and apply soap in rotatory movment, paying attention to skin creases
- Remove soap thoroughly by wiping from neck to check
- Dry with bath towel
Abdomen
- Fold top sheet up to suprapubic region cover the chest with bath towel
- Wet and clean abdomen with soap
- Clean umbilicus and dry with bath towel
- Cover the patient with top water and remove towels
Back
- Turn the patient on side or left lateral position. Close to edge of bed, with back towards nurse
- Expose back including buttocks, spread bath towel on bed, close the patients back
- Wet the area and apply soap with rotatory movements clean and remove soap and dry the area
- Give massage by applying firm pressure with palms and fingers from sacrum to shoulder in sequence, covering whole back
- Help the patient to return to supine position
Legs
- Uncover the farthest leg and place towel under leg
- Apply soap to the leg and give special attention to the groin
- Massage the pressure points
- Place foots in basin of water to wash
- Rinse and dry well, paying special attention in between the toes
- Repeat the procedures on the near leg
Pubic Region
- Clean pubic region with wet large rag piece (for helpless patient)
- Permit patient to clean if so desired
- Discard rag pieces into large K-basin
- Give perineal care for helpful patient
After Care
- Provide clean gown and pajama
- Replace articles after cleaning
- Discard dirty water in sluice room
- Clean the bed linen if needed
- Offer a hot drink (coffee or tea) if permitted
- Position the patient for comfortable and proper alignment
- Cut short the finger nails and toe nails
- Comb the hair and arrange the hair
- Hand wash
- Record the procedure in the nurse’s record with time, date, type and abnormalities noticed
