Also referred to as balneotherapy, the therapeutic bath combines water and additives to soothe and relax the patient, relieve fatigue and sore muscles and joints, clean the skin, relieve inflammation and pruritus, and soften and remove crusts, scales, debris, and old medications. Used primarily for their antipruritic and emollient actions, these baths coat irritated skin with a soothing, protective film. Because they constrict surface blood vessels, they also have an anti-inflammatory effect.
The addition of oatmeal powder, soluble cornstarch, or soybean complex to water creates a colloid bath, which has a soothing effect and is used to treat generalized itching. Oil baths are useful for lubricating dry skin and easing eczematous eruptions. Sodium bicarbonate added to water produces an alkaline bath that has a cooling effect and helps relieve pruritus. A medicated tar bath may be used to treat psoriasis. The film of tar left on the skin works in combination with ultraviolet light to inhibit the rapid cell turnover characteristic of psoriasis. (See Comparing therapeutic baths.)
A bedridden patient may benefit from a local soak with the therapeutic additive instead of a therapeutic tub bath.
Comparing Therapeutic Baths
|Antibacterial||Used to treat infected eczema, dirty ulcerations, furunculosis, and pemphigus|
|Colloidal||Used to relieve pruritus and to soothe and coat irritated skin; indicated for any irritated or oozing condition, such as atopic eczema|
|Emollient||Used to clean and hydrate the skin; indicated for any dry skin condition|
|Tar||Used to treat scaly dermatoses, sometimes in combination with ultraviolet light therapy; loosens scales and relieves pruritus|
Bathtub ▪ bath mat ▪ rubber mat ▪ bath (utility) thermometer ▪ therapeutic additive ▪ measuring device ▪ colander or sieve for oatmeal powder ▪ two washcloths ▪ two towels ▪ patient gown or loose-fitting cotton pajamas ▪ lubricating cream or ointment, if ordered ▪ gloves.
Preparation of Equipment
Verify the doctor’s order.1 Gather the supplies and draw the bath before bringing the patient to the bath area to prevent chilling him. Make sure the tub is clean and disinfected because a patient with skin breakdown is particularly vulnerable to infection. Place the bath mat next to the tub and the rubber mat on the bottom of the tub to prevent falls; the therapeutic additive may make the tub exceptionally slippery. Fill the tub with 6″ to 8″ (15 to 20 cm) of water at 95° to 100°F (35° to 37.8°C).
The treatment’s purpose and the type of additive used will determine the water temperature. Cool to lukewarm water is used for relieving pruritus and when adding tar or starch. Warm baths soothe, but water warmer than 100°F causes vasodilation, which could aggravate pruritus.
Measure the correct amount of therapeutic additive, according to the doctor’s order or package instructions. As the tub is filling, thoroughly mix the additive in the water. Add most substances directly to the water, but place oatmeal powder in a sieve or colander under the tub faucet to help it dissolve. Begin with 2 tbs of oatmeal powder; then add more powder or water as needed to regulate the thickness of the oatmeal bath.
When giving a tar bath, wear a plastic apron or protective gown because tar preparations stain clothing.
Make sure that the bathroom is well ventilated. Some patients may experience allergic reactions or hypersensitivity to the additive in the water or to the smell of the additive. If a reaction occurs, limit the patient’s time in the bath and notify the ordering doctor. If a skin reaction to the additive occurs, gently wash the additive from the skin and notify the ordering doctor.