Definition: Removing accumulated oil, perspiration, dead skin cells & some bacteria
Purposes:
- To remove transient microorganisms, body secretions & dead skin cells
- To stimulate circulation to the skin
- To promote a sense of well being
- To produce a relaxation & comfort
- To prevent & eliminate unpleasant body odors
Assess:
- Condition of the skin
- Physical or emotional factors
- Presence of pain & need for adjunctive measures before the bath
- Range of motion of the joints
- Any other aspect of health that may affect the clients bathing process
- Need for use of clean gloves during the bath
Equipment:
- Basin or sink w/ warm water
- Soap & soap dish
- Linens: bath blanket, two bath towels, wash cloth, clean gowns or pajamas or clothes
- Gloves if appropriate
- Personal hygiene articles
- Shaving equipment
- Table for bathing equipment
- Laundry hamper
Preparation:
- Purpose & type of bath the client needs
- Self-care ability of the client
- Any movement or positioning precautions specific to the client
- Other care the client may be receiving such as physical therapy or x-rays, in order to coordinate all aspects of health care and prevent unnecessary fatigue.
- The client’s comfort level w/ being bathed by someone else
- Necessary bath equipment & linens.
Procedure:
1. Introduce self..
2. Perform hand hygiene & other appropriate infection control procedure.
3. Provide privacy. – Hygiene is a personal matter
4. Prepare the client & the environment. Invite a family member or significant other to participate if desired.
- Close windows & doors to ensure the room is in a comfortable temperature. – Air current increases loss of heat from the body by convection.
- Offer the client a bedpan or urinal or ask whether the client wishes to use the toilet or commode. – Warm water & activity can stimulate the need to void. The client will be more comfortable after voiding & voiding before cleaning the perineum is advisable.
- Encourage the client to perform as much personal care as possible. – This promotes independence & self-esteem
- During the bath, assess each area of the skin carefully.
5. Prepare the client & position the client appropriately.
- Position the bed at a comfortable working level. Lower the side rail on the side close to you. Keep the other side rail up. Assist the client to move near you. – This avoids undue reaching & Straining & promotes good body mechanics.
- Place a bath blanket over the top sheet. Remove the top sheet from under the bath blanket by starting at the client’s shoulders & moving linen down toward the client’s feet. – The bath blanket provides comfort, warmth & privacy. If linen is to be re used put it in the bed side chair, if it is to be changed put in the hamper not on the floor.
- Remove client’s gown while keeping the client covered with the bath blanket. Place gown in linen hamper.
6. Make a bath mitt w/ the wash cloth. – A bath mitt retains water & heat better than a close loosely held & prevents ends of wash cloth from dragging across the skin.
7. Wash the face. – Begin the bath at the cleanest area & work downward toward the feet.
- Place towel under the client’s head.
- Wash the client’s eyes w/ water only & dry them well. Use a separate corner of the wash cloth for each eye. – Using separate corners prevents transmitting microorganisms from one eye to the other. Wipe from the inner canthus to the outer canthus. – This prevents secretions from entering the nasolacrimal ducts.
- Ask the client if he/she want soap on the face. – Soap has a drying effect on the face which is exposed to the air more than other body parts tend to be drier.
- Wash, rinse & dry the client’s face, ears & neck.
- Remove the towel from under the client’s head.
8. Wash the arms & hands. (Omit the arms in partial bath). Place a towel lengthwise under the arms away from you. – It protects the bed from becoming wet.
- Wash, rinse & dry the arm by elevating the client’s arm & supporting the client’s wrist & elbow. Use long firm strokes from wrist to shoulders, including the axillary area. – Firm strokes from distal to proximal areas promote circulation by increasing venous blood return.
- Apply deodorant or powder if desired.
- Place a towel on the bed & put a washcloth on it. Place the client’s hands in the basin. – Many clients enjoy immersing their hands in the basin & washing themselves. Soaking loosens dirt under the nails. Assist the client as needed to wash, rinse & dry the hands, paying particular attention to the spaces between the fingers.
- Repeat for hand and arm nearest you. Exercise caution if IV is present & check its flow after moving the arm.
9. Wash the chest & abdomen. (Omit in partial bath).
- Place the bath towel lengthwise over the chest. For the bath blanket down to the client’s pubic area. – This keeps the client warm while preventing unnecessary exposure of the chest.
- Lift the bath towel off the chest & bath the chest & abdomen w/ your mitted hand using long firm strokes. Give especial attention to the skin under the breasts & any other skin folds particularly if the client is overweight. Rinse & dry well.
10. Wash the legs & feet.
- Expose the legs farthest from you by folding the bath blanket toward the other leg being careful to keep the perineum covered. – Covering the perineum promotes privacy & maintains the client’s dignity.
- Lift leg & place the bath towel lengthwise under the leg. Wash, rinse & dry the leg using long, smooth firm strokes from the ankle to the knee and to the thigh. – Washing from the distal to proximal areas promotes circulation by stimulating venous blood flow.
- Reverse the coverings & repeat for the other leg.
- Wash the feet by placing them in a basin of water.
- Dry each foot. Paying particular attention to the spaces between the toes.
- Obtain fresh warm bath water now or when necessary. – Water may become dirty & cold. Because surface skin cells are removed w/ washing, the bathwater from dark skinned client maybe dark, however this does not mean the client is dirty. Lowe the bed when refilling the basin. – This ensures the safety of the client.
11. Wash the back & then the perineum.
- Assist the client into a prone or side-lying position facing away from you. Place the bath towel lengthwise alongside the back & buttocks while keeping the client covered with the bath blanket as much as possible. – This provides warmth & prevents undue exposure.
- Wash & dry client’s back, moving from shoulders to the buttocks & upper thighs, paying attention to the gluteal folds.
- Perform back massage now or after completion of bath.
- Assist the client to the supine position & determine whether the client can wash the perineal area independently. If the client cannot do so drape the client.
12. Assist the client w/ grooming aids such as powder, lotion or deodorant.
- Use powder sparingly. Release as little as possible into the atmosphere. – This will avoid irritation of the respiratory tract by powder inhalation. Excessive powder can cause caking which leads to skin irritation.
- Help the client put on clean gown or pajama.
- Assist the client to care for hair, mouth & nails.
FOR A TUB BATH OR SHOWER
13. Prepare the client & the tub
- Fill the tub about 1/3 to ½ full of water at 43 degree Celcius to 46 degree Celsius. – Sufficient water is needed to cover the perineal area.
- Cover all intravenous catheters or wound dressings with plastic coverings & instruct the client to prevent wetting these areas.
- Put a rubber bath mat or towel on the floor of the tub if safety strips are not on the tub floor. – These prevents slippage of the client during the bath or shower.
14. Assist the client into the shower or tub.
- Assist the client taking a standing shower w/ the initial adjustment of the water temperature & water flow pressure as needed. Some clients need a chair to sit on in the shower because of weakness. Hot water can cause elderly people to feel faint.
- If the client requires considerable assistance w/ a tub bath, a hydraulic bath tub chair maybe required.
- Explain how the client can signal for help, leave the client for 2 to 5 minutes & place an occupied sign on the door. For safety reasons do not leave a clients who may be at risk.
15. Assist client w/ washing & getting out of the tub.
- Wash the client’s back, lower legs & feet if necessary.
- Assist the client out of the tub. If the client is unsteady, place a bath towel over the client’s shoulders & drain the tub w/ water before the client attempts to get out of it. – Draining the water first lessens the likelihood of a fall. The towel prevents chilling.
16. Dry the client and assist w/ follow-up care
- Follow step 12
- Assist the client back to his/her bed
- Clean the tub or shower in accordance w/ agency practice, discard the used linen in the laundry hamper & place the unoccupied sign on the door.
17. Document
- Type of bath given
- Skin assessment such as excoriation, erythema, exudates, rashes, drainage or skin breakdown.
No comments:
Post a Comment