Bathing an Adult Client: Purposes & Assessment

Bathing an Adult Client: Purposes

• Eliminates transient microorganisms, body secretions, excretions, and dead skin cells
• Stimulates skin circulation
• Promotes well-being, relaxation, and comfort
• Prevents and eliminates unpleasant body odors

Assessment

• Determine physical and emotional factors like fatigue, cold sensitivity, need for control, anxiety, or fear
• Examine the skin condition for color, texture, turgor, pigmented spots, temperature, lesions, excoriations, abrasions, and bruises
• Screen areas of erythema (redness) on the sacrum, bony prominences, and heels for potential pressure sores
• Determine presence of pain and if analgesic measures are needed before the bath
• Check the range of motion of joints
• Investigate health aspects affecting the bathing process like mobility, strength, and cognition
• Check the need for clean gloves

Implementation Considerations

• Determine the bath type needed
• Evaluate the extent of assistance the client can provide
• Note movement and positioning precautions related to the client's mobility
• Coordinate care with other treatments like physical therapy or x-rays to prevent fatigue
• Evaluate the client's comfort level with being bathed by someone
• Gather bathing supplies

Bathing Notes

• Use easy-to-remove gowns with Velcro or snap fasteners
• When changing a client's gown after a bath, pay special attention if a special gown is not available or the gown is soiled
• Reassess the IV site for secure connections and taping
• Use universal precautions, especially during perineal care
• Glove use is optional but assess the need and provide explanations

Performance Steps

• Introduce yourself, verify the client's ID, explain the procedure, and discuss bathing preferences
• Practice hand hygiene and infection prevention
• Provide client privacy by closing curtains or doors, using privacy signs if available
• Invite family or significant others to participate if desired
• Close windows and doors to maintain a comfortable temperature
• Offer a bedpan or urinal use use of the toilet or commode
• Encourage the client to perform self-care when possible
• Carefully assess each skin area during the bath

Bed Bath Prep

• Position the bed at a comfortable height and lower the side rail near you, keep the other rail up
• Assist the client to move closer to you
• Place a bath blanket over the top sheet, then remove the top sheet
• Have the client grasp the top of the bath blanket while pulling the sheet to the foot of the bed

Continued Steps

• Place reusable bed linen over the bedside chair
• Put soiled bed linen in a linen hamper
• Keep the client covered by the bath blanket
• Make a bath mitt with the washcloth
• Start the bath at the cleanest area and proceed downward
• Place a towel under the client's head

Washing the Face

• Use water only to wash the client’s eyes using a separate corner of the washcloth for each eye
• Wipe from the inner to the outer canthus
• Ask if the client wants soap used on the face
• Wash, rinse, and dry the client’s face, ears, and neck
• Remove the towel from under the client’s head

Arms and Hands

• Omit the arms for a partial bath
• Place a towel lengthwise under the arm away from you
• Elevate the client’s arm when washing wrist and elbow
• Use long, firm strokes from wrist to shoulder, focusing on the axillary area
• Apply deodorant or powder if wanted while taking caution with clients facing respiratory issues

Additional Actions

• Place a towel on the bed, place a washbasin on it, and put the client’s hands in the basin
• Assist the client to wash, rinse, and dry the hands, concentrating on the spaces between their fingers
• Repeat the process for the other arm and hand
• If an IV infusion is present, proceed with caution when repeating for second hand
• Avoid submersing the site in water if there is a gauze dressing.

Chest and Abdomen

• Omit for partial bath, unless the area under a woman’s breasts requires cleansing
• Place a bath towel lengthwise over chest and fold the bath blanket to the client’s pubic area
• Lift the bath towel off the chest and then use a gloved hand to bathe with firm strokes
• Rinse and dry the skin under the breasts
• Replace the bath blanket after drying

Legs and Feet

• Omit for partial bath
• Expose the leg farthest from you by folding the bath blanket, keep the perineum covered
• Place a bath towel lengthwise under the leg and wash from ankle to knee to thigh
• Repeat the steps for the other leg
• Place the feet in the basin of water
• Pay attention to spaces between the toes
• Wash one foot after that respective leg prior to washing the other leg

Completing the Bath

• Obtain fresh, warm bathwater as needed
• Lower the bed and raise the side rails when refilling the basin
• Assist the client to a prone or side-lying position while facing away from you
• Cover the client, and place a bath towel lengthwise alongside the back and buttocks
• Wash and dry the back using long firm strokes
• Discard gloves if used
• A back massage can be done either at that moment or after finishing the bath
• Move the client to the supine position so the perineal area can be washed

Grooming Notes

• Use powder and lotion sparingly, releasing as little as possible into the air
• Assist the client with putting on a clean gown or pajamas
• Support the client in grooming hair, mouth, and nails
• Provide mouth care prior to a bath per patient needs and preference

Documentation

• Note type of bath given on flow sheet
• Assess skin conditions, like excoriation, erythema, etc
• Record nursing interventions related to skin integrity
• Document the capacity of the client to assist
• Note the client's response to bathing, and note the need to monitor vitals
• Record any educational needs and what information you shared with the client or their family

Perineal/Genital Care: Purposes

• Eliminate perineal secretions and odors
• Promote client comfort

Assessment and Determination

• Check for irritation, excoriation, inflammation, or swelling
• Assess for excessive discharge, odor, pain, or discomfort
• Note urinary or fecal incontinence
• Record occurrences of rectal or perineal surgery
• Inspect for an indwelling catheter
• Ask hygiene practices and self-care abilities

Supplies Used

• Bath towel
• Bath blanket
• Washcloth
• Clean gloves
• Soap
• Bath basin with warm water at 43°C to 46°C (110°F to 115°F)

Implementation - Preparation

• Determine if the client is experiencing discomfort
• Gather supplies

Performance

• Explain the procedure, especially regarding embarrassment
• Practice hand hygiene
• Give privacy (curtains, closing door)
• Prepare the client by folding top bed linen to the foot of the bed to expose the genital area
• Place a bath towel under the client's hips

Implementation: Positioning and Cleansing

Female Clients

• Place in a back-lying position with knees flexed and spread
• Drape the body and legs with the positioning bath blanket
• Wash and dry upper inner thighs after applying gloves

Male Clients

• Place in supine position with knees slightly flexed and hips slightly rotated
• Wash and dry upper inner thighs after applying gloves

Observing the Perineal Area

• Inspect for inflammation, excoriation, or swelling, paying attention between the labia in females or scrotal folds in males
• Note excessive discharge or abnormal odors from orifices

Cleansing

For Female Clients

• Clean the labia majora while spreading to wash labia minora
• Use separate quarters for each stroke and wipe from pubis to rectum
• Use clean wipes for menstruating women or those with in-dwelling catheters
• Rinse and dry, paying close attention to folds

For Male Clients

• Wash and dry the penis with firm strokes
• Retract foreskin to reveal the glans penis and replace afterwards
• Wash and dry the scrotum
• Clean posterior folds of the scrotum when cleaning the buttocks

Completion

• Inspect perineal orifices for intactness, especially with indwelling catheters
• Clean in between the buttocks
• Clean the anus with toilet tissue if needed
• For menstruating females, place a perineal pad from front to back
• Discard gloves, perform hand hygiene, and record any unusual findings like redness

Changing and Unoccupied Bed: Purposes

• Enhance the client's comfort
• Provide a clean and neat environment
• Ensure a smooth surface to prevent skin irritation

Assessment of Client

• Confirm the client's ability to be out of bed
• Check the client's blood pressure, pulse, and respirations
• assess client's mobility status.
• Note the necessity of tubes and other equipment attached to the client

Equipment Needed

• Clean gloves
• Two flat sheets or one fitted and one flat sheet
• Cloth drawsheet (optional)
• One blanket
• One bedspread
• Incontinent pads (optional)
• Pillowcases for head pillows
• Plastic laundry bag

Procedure Preparation and Steps

• Gather only the linens needed
• Introduce yourself, verify the client's identity, explain the bed change
• Practice hand hygiene
• Provide client privacy
• Place fresh linen on a clean surface
• Ensure client can move to a chair
• Raise bed to appropriate height
• Wear gloves if linens are soiled

Stripping the Bed Procedure

• Check linens for client belongings and detach signal cords
• Systematically loosen bedding starting at the head of the bed
• Remove any soiled pillowcases and place pillows on the bedside chair
• Fold reusable linens into fourths
• Remove and discard the incontinent pad if soiled
• Roll all soiled linen inside the bottom sheet and place it in a linen hamper
• Move the mattress up to the head of the bed

Applying Bottom Linens

• Place the folded bottom sheet with its center on the bed, with the hem side down with enough material to tuck in
• Tuck at the top corner of the near side and work from the head to the foot
• Place the drawsheet
• Tuck the sheet at the head, pull firmly, and miter the corner

Applying Top Linens

• Place with the hem side up so its center-fold is at the center of the bed
• Make vertical or horizontal toe pleats
• Follow the same procedure for the blanket and spread to have their top edges 15 cm (6 in.) from the head
• Fold the top of the top sheet down over the spread to create a cuff
• Secure pillowcases
• Place bedside table and the bed to a safe height for the client
• Document nursing assessments

Surgical Bed Preparation

• Horizontally fan-fold lines
• Leave pillows on a chair
• Apply bottom linens
• Place top linens, and make a cuff but do not mitter the corners
• Fold up top linens, meeting in middles
• Pick up linens and fan-fold lengthwise to the other side
• Heighten the beds and lower side rails as needed
• Lock wheels of bed

Changing an Occupied Bed; Purposes:

• Conserving client energy
• Promoting comfort
• Creating a neat and clean environment
• Providing a smooth bed to prevent skin issues

Assessment of Client

• Look for skin integrity concerns
• Evaluate client's ability to reposition
• Check for any incontinence or drainage
• Note special orders or precautions for client positioning

Preparation

• Determine what linens are already in the room
• Introduce Self
• Verify the client's identity
• Explain the procedure and how the client can participate
• Sanitize hands
• Gloves if linens are soiled

Removing Top Bedding

• Remove equipment attached to the bed linen
• Loosen bed linens
• Leave the top sheet or replace with bath blanket
• The sheet should reach the foot of the bed

Drawsheet and the bottom sheet

• Raise the side rail
• Roll the client away from you
• Fanfold linen and tuck in
• Add new linen and fanfold
• Lower the side rail, roll the client to the other side, replace pillows, remove linen, and unfold

Top Bedding

• Fold or tuck under shoulders
• Secure safety measures
• Raise the side rails
• Clients should be able to reach bed controls
• Bed making is not typically recorded