Bed Shampooing for Patients

• Shampooing hair in bed is appropriate for patients who cannot bathe or shower independently
• Frequency depends on individual needs
• Shampooing hair in bed is defined as washing hair with shampoo or soap as often as required to maintain cleanliness.

The purposes of shampooing hair in bed are:

• Cleansing hair and scalp
• Improving self-esteem
• Treating scalp conditions with medication
• Removing substances like blood, body secretions, or electrode jelly

Assessment before shampooing includes:

• Examining hair; noting texture, distribution and cleanliness
• Checking for parasites
• Observing the scalp; looking for lacerations, lesions or dry patches or swollen areas
• Observing itching
• Checking for dandruff
• Knowing if patient is receiving treatments that cause hair loss
• Checking the medical history for conditions affecting hair
• Identifying deficits interfering with hygienic practices
• Asking about the client's usual hair care routine
• Inquiring about itching, burning or tenderness
• Noting history of scalp problems

Equipment

• Tray with shampoo, 2 bath towels, hot water pitcher, comb/brush, and 2 dry cotton balls
• Two pails: One with 2/3 clean water and one empty
• Shampoo trough, a waterproof pad, and paper linings

Procedure:

• First assess the need for shampoo and contraindications
• Next explain the procedure.
• Assemble equipment at bedside.
• Close the curtains or door before starting.
• Raise the bed and lower the side rail.
• Position the patient near you and reposition the pillow
• Lay a waterproof pad and towel under the patient's head.
• Replace the top sheet with a bath blanket
• Place the shampoo though under the patient’s head
• Place empty pail to collect drainage from the through
• Place a rolled towel under the nape, with ends on the chest.
• Comb/brush.
• Place a damp washcloth over the eyes and cotton balls in ears.
• Wet hair with warm water, apply shampoo.
• Work into a lather, massaging the scalp with fingertips.
• Rinse hair with clean water.
• Remove shampoo trough.
• Wrap the head with a towel.
• Remove washcloth and cotton balls.
• Remove the waterproof pad and reposition the pillow.
• Change the head towel with a dry one.
• Fluff the hair with towel and comb.
• Remove shampooing items and discard the water.
• Place side rail up and lower the bed.
• Clean all equipment.
• Wash your hands.
• Note and report any scalp indications.
• Document the procedure, your patient's reactions, and any findings regarding the scalp.

Oral Care

• Defined as the brushing and flossing of teeth, including inspection of the mouth for dental caries, gum problems, and soft plaque deposits.

Purposes of oral care

• Cleansing teeth of food and microorganisms
• Maintaining tissue integrity and moisture
• Freshening the mouth
• Improving pleasure while eating
• Preventing infection, discomfort, and dental caries
• Maintaining/improving self-concept

Equipment for oral care

• Toothbrush, toothpaste
• Emesis basin
• Glass of water
• Towel, mouthwash (optional)
• Dental floss (optional)
• Petroleum jelly (optional)
• Gloves

Oral care - Independent Patient

• First, identify and explain the procedure
• Bring supplies to bedside
• Provide privacy and wash hands
• Put on gloves and arrange equipment.
• Help the patient to a sitting position, or turn to the side.
• Place a towel across the chest and adjust the bed.
• Encourage the patient to brush independently.
• Otherwise, moisten the toothbrush and apply toothpaste.
• Brush at a 45-degree angle to the gum line.
• Brush all surfaces and the tongue.
• Rinse and spit until clear.
• Assist with flossing and offer mouthwash.
• Clean dentures if needed, grasping with gauze to prevent slippage.
• Place them in a denture cup, adding cleanser if preferred.
• Rinse dentures thoroughly and return.
• Apply petroleum jelly to the lips.
• Make sure patient is in a safe, comfortable position.
• Wash hands, dispose of used items, and document.

Oral Care - Dependent Patient

• The patient is unable to perform oral care independently.
• Gather a toothbrush, toothpaste, kidney basin, water, straw, towel, tongue depressor, mouthwash, lubricating jelly, gloves, hydrogen peroxide (half strength), suction, and an asepto syringe.
• First, identify and explain the procedure to the patient.
• Bring the equipment to the bedside.
• Provide privacy and wash hands
• Put on gloves.
• Adjust the bed and lower the rail.
• Position the patient on his side, head tilted toward you.
• Place a towel across the chest and a basin under the chin.
• Open the mouth and insert a padded tongue depressor.
• Clean teeth with a padded tongue blade moistened with mouthwash, or use gauze.
• Rinse with a small amount of water.
• Suction any drainage, and wipe/lubricate the mouth.
• Then, place in comfortable position, do aftercare, remove equipment, and document.

Foot and Nail Care

• Intended to cleanse, promote comfort, maintain integument, stimulate circulation, prevent injury/odors, and treat local infection

Equipment for foot and nail care

• Warm water pitcher and basin
• Soap and dish, 2 towels
• Nail cutter/scissors and file, lotion, gloves
• Powder and a waterproof pad
• Nail brush

Procedure:

• First, identify the client and assess foot condition
• Next, explain the procedure, then wash your hands
• Assemble supplies after providing privacy.
• Put on gloves and place a pillow under the client's knee
• Place a pad under the foot with a towel on top.
• Soak each foot for 3-5 minutes, then wash with soap, scrub the nails, and switch to the other foot.
• Change the water, dry well, and trim nails straight across, if approved.
• Apply lotion/powder, make comfortable and clean equipment.
• Remove gloves, wash and document.

Back Massage

• Intended to stimulate skin and underlying tissues with hand pressure
• Allows skin assessment and stimulation of blood flow
• Communicates concern, promotes relaxation and rest
• Effleurage uses gliding strokes toward the heart with light pressure away.
• Petrissage is the pressing, squeezing and rolling movement to stimulate circulation.
• Friction is focused, deep circular motions.
• Tapotement uses brisk, vigorous percussive movements.

Contraindications for back massage include;

• Tender or red areas
• Rib fractures
• Incisions in chest and back
• Recent back trauma

Equipment for back massage:

• Massage lubricant or lotion
• Powder
• Bath blanket and towel
• Stethoscope
• Sphygmomanometer

Procedure:

• Offer and explain the back rub to the client
• Remove jewelry and wash your hands
• Assemble supplies, close the door, and adjust the bed
• Assess heart/respiratory rate and blood pressure
• Help patient to lying position; expose the back and warm lotion
• Apply with light strokes from sacrum toward shoulders.
• Stroke upward to shoulders and downward to buttocks in continuous strokes for 3–5 minutes.
• Massage the area using circular motions, and keep hands in contact, then pat dry and apply powder.
• Finally, reposition the client, adjust the bed and linen, then wash hands and document

Cleansing Bed Bath

• This is a bath given to weak or bedridden patients in which the staff wash the entire body.

Purposes:

• To cleanse and refresh the body.
• To stimulate circulation and provide tactile stimulation.
• To exercise joints and muscles.
• To promote relaxation and improve one's self-concept.
• To facilitate a head to toe assessment.

General Instructions:

• Make sure to maintain privacy and adjust the room if necessary.
• A bed bath should be given an hour before or after meals.
• Special attention should be given to areas such as the ears, armpits, or areas with skin folds.

Equipment:

• Bath blanket or large towel, 4 Bath towels & 3 washcloths
• Gloves (2 pairs)
• Patient's clothing and linen (as needed)
• The following items set up on a tray:
  • Wash basin half filled with warm water
• Soap and soap dish
• Patient’s comb / hair brush
• Talcum powder / lotion / oil A pair of nail cutter Two pitchers, one with cold and the other one with hot water
  • Paper for lining
• Bath thermometer
• Pail for used water & bedpan or urinal & laundry bag

Procedure:

• Review the patient’s chart for any precautions regarding their movement and positioning, identify the patient and explain the procedure to them.

• Assess the patient’s ability to assist in bathing, wash your hands, and put on clean gloves.

• Close the curtains around the bed, turn off any fans or air conditioning and offer the bedpan to the patient to void / defecate.

• Raise the bed and lower the side rail. And assist the patient to the side of the bed - have them lie on their back.

• Then loosen the top covers and place the bath blanket over them.

• Help the patient with oral hygiene, and remove their gown while keeping the bath blanket in place.

  • Raise the side rail and fill the basin with warm water - have the patient check the water temperature.

• If allowed, remove the pillow, raise the bed, and put a towel under the patient’s head. Get the washcloth wet and make a bath mitt

• Ask the patient if they would prefer that you not use soap on their face, and wipe each eye from the inner to the outer canthus with a fresh side of the mitt each time.

• Rinse the washcloth and wash the face from the forehead > cheeks > nose > chin > neck > ears

• Expose the patient’s far arm and lay the towel lengthwise under it. wash with long strokes, making sure to thoroughly reach the armpit.

• After washing the arm, wash the patients hands in the basin to remove debris as also wash under the finger nails

• Lower the bath blanket to the umbilical area and wash the abdomen: Paying any special attention to any skin folds around the umbilicus or around any pannus tissue that may be present.

• Return the bath blanket to its original position and expose the far leg washing the complete circumference of the thigh, leg and foot. Wash the back: Have them state of prone or lateral in a position with their side exposed. Use warm wash cloths to wash the back buttocks. Make sure to use a downward stroke from the kneck to upper area.

• Pat and completely dry client Help you client apply the new gown and make them comfortable with new sheets. Make sure to clean clients nail and hair while at it.

• Dispose: Discard the items or replace item if necessary.

• Lower the bed, and put the cord within reach. Wash your hands, check in for any observations and report it immediately.