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.
Bath basin ▪ bath blanket ▪ skin cleaner ▪ towel ▪ washcloth ▪ skin lotion ▪ orangewood stick ▪ gloves ▪ deodorant ▪ hospital-grade disinfectant ▪ Optional: chlorhexidine-impregnated cloth, bath oil, perineal pad, abdominal (ABD) pad, and linen-saver pad.
Preparation of Equipment
Adjust the temperature of the patient’s room, and close any doors or windows to prevent drafts and provide privacy. Determine the patient’s preference for skin cleaner or other hygiene aids because some patients are allergic to soap or prefer bath oil or lotions. Gather the equipment on an overbed table or bedside stand.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.1
Tell the patient you’ll be giving him a bath, and provide privacy. Offer him a bedpan or urinal. Position the patient supine if possible. If the patient’s condition permits, encourage him to assist with bathing to provide exercise and promote independence.
Fill the bath basin two-thirds full of warm water (about 115° F [46° C]), and bring it to the patient’s bedside. If a bath thermometer isn’t available, test the water temperature carefully to avoid scalding or chilling the patient; the water should feel comfortably warm.
Raise the patient’s bed to a comfortable working height to avoid back strain.
If the bed will be changed after the bath, remove the top linen. If not, fanfold it to the foot of the bed.
Cover the patient with a bath blanket to provide warmth and privacy.
Put on gloves.
Remove the patient’s gown and other articles, such as elastic stockings, elastic bandages, and restraints (as ordered).
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 skin cleaner, 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. Wash skin folds under the female patient’s breasts by lifting each breast. 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.
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