Complete Bed Bath and Positioning.pptx

Complete Bed Bath and Positioning LEVEL 1 - CON Faculty BED BATH BATHING of clients is an essential component of nursing care. Whether the nurse preforms the bath or delegates the activity to another health care provider, the nurse retains the responsibility for assuring that the hygienic needs of...

Complete Bed Bath and Positioning LEVEL 1 - CON Faculty BED BATH BATHING of clients is an essential component of nursing care. Whether the nurse preforms the bath or delegates the activity to another health care provider, the nurse retains the responsibility for assuring that the hygienic needs of the client are met. The type of bath provided will depend on the purpose of the bath and the client’s self-care ability. The two general categories of bath are cleansing and therapeutic.  PURPOSE OF BED BATH 1. To make the client clean and feel comfortable. 2. To increase sense of well being. 3. To promote muscular relaxation and relieve feeling of fatigue. 4. To remove transient microorganisms, body secretions and excretions, & dead skin cells. 5. To stimulate circulation to the skin. 6. To prevent and eliminate unpleasant body odors.  Types of Patients Needing Bed Bath 1. Unconscious or semiconscious patients 2. Postoperative patients 3. Patients with strict bed rest 4. Paraplegic patients 5. Orthopedic patients with plaster: cast and traction 6. Seriously ill patients CLEANING BATHS - Provided are routine client care - The purpose is personal hygiene - 5 types of Cleaning Baths: ⮚ Shower ⮚ Tub ⮚ Self-Help Bath ⮚ Complete Bed Bath ⮚ Partial Bed Bath  SHOWER and TUB - Most ambulatory clients are capable of taking a shower. - Clients with limited physical ability can be accommodated by placing a waterproof chair in the shower. - The nurse provides minimal assistance with a shower. - They also allow you to observe skin conditions and assess joint mobility and muscle strength. - If not precluded by the patient’s condition or safety considerations, privacy during bathing promotes the patient’s sense of well-being by allowing him to assume responsibility for his own care.  SELF-HELP BATH - Assisted Bed Bath - Used to provide hygienic care for clients who are confined to bed. - The nurse prepares bath equipment but provides minimal assistance. This assistance is usually limited to washing difficult-to-reach body areas such as the feet and back.  PARTIAL BED BATH - Consists of cleaning only body areas that would cause discomfort or odor if not washed. These areas are the face, axilla, hands, and perineal area. - The nurse or client may perform a partial bath depending on the client’s self-care ability. - May be performed with the client lying in bad or standing at the sink.  COMPLETE BED BATH - Provided to dependent clients confined to bed - The nurse washes the client’s entire body during a complete bed bath COMPLETE BAD BATH PROCEDURE  Preliminary Assessment - Identify the patient and assess the need - Check doctors order for any specific precautions - Assess the general condition of the patient - Assess the patient’s ability of self-help - Assess the patient’s mental status to follow directions - Check the patient’s preference for soap, powder, etc - Check whether the patient has taken the meal in the previous one hour - Find out the available articles in the unit - Provide privacy avoid draught and maintain proper light - Teach the patient and relatives about personal hygiene  Preliminary Assessment - Assess Physical or emotional factors (fatigue, sensitivity to cold, need for control, anxiety or fear) - Condition of the skin (color, texture and turgor, presence of pigmented spots, temperature, lesions, excoriations, abrasions, and bruises) - Presence of pain and need for adjunctive measures (analgesic) before bath. - Range of motion of the joints  Equipment 1. Basin with warm water 2. Soap and soap dish 3. Linens: bath blanket, towels, washcloth, clean gown 4. Clean Gloves, if appropriate 5. Personal hygiene: deodorant, lotions 6. Shaving equipment 7. Table for bathing equipment 8. Laundry bag  Procedure 1. Prior to performing the procedure, introduce self and verify the client’s identity. Explain to the client what you are going to do, why is it necessary, and how he or she can participate. Discuss with the client their preferences for bathing and explain any unfamiliar procedures. 2. Perform hand hygiene and observe other appropriate infection prevention procedures. 3. Provide for client privacy. 4. Prepare the client and environment. 5. Prepare the bed and position the client appropriately. 6. Make a bath mitt with the washcloth. 7. Wash the face. Wet and apply soap to forehead, face, over and behind ear and neck Clean eyes from inner to outer canthus Rinses sponge towel and allow patient to wipe face Dry with face towel, replace at head end of bed 8. Wash the arms and hands. Place towel lengthwise under the farthest arm if there is IV do not disturb it Take soapy bath mitt and soap the arm and axilla Massage the pressure areas Place the hand in basin of water to wash Rinse and dry well, paying attention to skin under breast Recover with towel 9. Wash the chest and abdomen. Chest Avoid unnecessary exposure Cover chest with towel and turn bath sheet down to abdomen Wet chest and apply soap in rotatory movement, paying attention to skin creases Remove soap thoroughly by wiping from neck to check Dry with bath towel Abdomen Fold top sheet up to suprapubic region cover the chest with bath towel Wet and clean abdomen with soap Clean umbilicus and dry with bath towel Cover the patient with top sheet and remove towels 10.Wash the legs and feet. Uncover the farthest leg and place towel under leg Apply soap to the leg and give special attention to the groin Massage the pressure points Place feet in basin of water to wash Rinse and dry well, paying special attention in between the toes Repeat the procedures on the near leg 11.Wash the back and the perineum. Back Turn the patient on side or left lateral position. Close to edge of bed, with back towards nurse Expose back including buttocks, spread bath towel on bed, close the patients back Wet the area and apply soap with rotatory movements clean and remove soap and dry the area Give massage by applying firm pressure with palms and fingers from sacrum to shoulder in sequence, covering whole back Help the patient to return to supine position Pubic Region Clean pubic region with wet large rag piece (for helpless patient) Permit patient to clean if so desired Discard rag pieces into large K-basin Give perineal care for helpful patient 12.Assist the client with grooming aids such as powder, lotion, or deodorant. Use powder sparingly. Release as little as possible into the atmosphere. Help the client put on a clean gown or pajamas. Assist the client to care for hair, mouth, and nails. Some people prefer or need mouth care prior to their bath. After Care Replace articles after cleaning Discard dirty water in sluice room Clean the bed linen if needed Offer a hot drink (coffee or tea) if permitted Position the patient for comfortable and proper alignment Hand wash Record the procedure in the nurse’s record with time, date, type and abnormalities noticed: client’s tolerance of the procedure (respiratory rate and effort, pulse rate, behaviors of acceptance or resistance, statements regarding comfort)  POSITIONING Patient positioning is a critical aspect of the nursing practice. It involves maintaining a patient’s good body alignment by constantly changing their position in a systematic way. It is the responsibility of nurses to ensure that the patients are positioned properly. Principles of patient positioning in nursing should be taken seriously by all nursing professionals. These principles are important for many reasons including airway management, ventilation, controlling unnecessary exposure, and most  PATIENT POSITIONING Patient positioning is a practice that involves maintaining a patient’s body in a neutral alignment by preventing hypertension and extreme lateral rotation so that immobility and injury can be prevented. Learning the rules for patient positioning in nursing is an important practice and a responsibility of the Registered Nurse.  PATIENT POSITIONING In surgery, things such as specimen collection and proper patient positioning offer optimal exposure to the surgical site and maintenance of the patient’s dignity by controlling any unnecessary exposure. Patient positioning is important for ensuring patient safety not just during a surgical procedure but also before and after. Optimal positioning is not just for ensuring the best possible access to a surgical site but also prevents long-term problems such as nerve damage or pressure ulcers.  Goals of Patient Positioning 1. Provide patient comfort and safety. Support the patient’s airway and maintain circulation throughout the procedure (e.g., surgery, examination, specimen collection, and treatment). Impaired venous return to the heart and ventilation-to-perfusion mismatching are common complications. Proper positioning promotes comfort by preventing nerve damage and by preventing unnecessary extension or rotation of the body.  Goals of Patient Positioning 2. Maintaining patient dignity and privacy. In surgery, proper positioning is a way to respect the patient’s dignity by minimizing exposure of the patient, who often feels vulnerable perioperatively.  Goals of Patient Positioning 3. Allows maximum visibility and access. Proper positioning allows ease of surgical access as well as for anesthetic administration during the perioperative phase.  Guidelines for Patient Positioning 1. Explain the procedure. Explain to the client why their position is being changed and how it will be done. Rapport with the patient will make them more likely to maintain the new position. 2. Encourage the client to assist as much as possible. Determine if the client can fully or partially assist. Clients that can assist will save strain on the nurse. It will also be a form of exercise, increasing the client’s independence and self-esteem. 3. Get adequate help. When planning to move or reposition the client, ask for help from other caregivers. Positioning may not be a one-person task. 4. Use mechanical aids. Bed boards, slide boards, pillows, patient lifts, and slings can facilitate the ease of changing positions. 5. Raise the client’s bed. Adjust or reposition the client’s bed so that the weight is at the nurse’s center of gravity level. 6. Frequent position changes. Note that any correct or incorrect position can be detrimental to the 7. Avoid friction and shearing. When moving patients, lift rather than slide to prevent friction that can abrade the skin making it more prone to skin breakdown. 8. Proper body mechanics. Observe good body mechanics for your and your patient’s safety. Position yourself close to the client. Avoid twisting your back, neck, and pelvis by keeping them aligned. Flex your knees and keep your feet wide apart. Use your arms and legs and not your back. Tighten abdominal muscles and gluteal muscles in preparation for the move. A person with the heaviest load coordinates the efforts of the nurse and initiates the count to 3. To ensure proper alignment and promote client comfort and safety, the nurse: 1. Make sure the mattress is firm and level yet has enough give to fill in and support natural body curvatures. 2. Ensure that the bed is clean and dry. 3. Place support devices in specified areas according to the client’s position. 4. Avoid placing one body part, particularly one with bony prominences, directly on top of another body part. 5. Avoid friction and shearing. 6. Plan a systematic 24-hour schedule for position changes. 7. Always obtain information from the client to determine which position is most comfortable and appropriate. BASIC BODY POSITIONS 1. PRONE POSITION 2. SUPINE POSITION 3. FOWLER’S POSITION; 4. LATERAL POSITION 5. SIMS POSITION 6. TRENDELENBURG POSITION  PRONE POSITION The patient lies on the abdomen with their head turned to one side and the hips are not flexed. Extension of hips and knee joints. Prone position is the only bed position that allows full extension of the hip and knee joints. It also helps to prevent flexion contractures of the hips and knees. Contraindicated for spine problems. The pull of gravity on the trunk when the patient lies prone produces marked lordosis or forward curvature of the spine, thus contraindicated for patients with spinal problems. Prone position should only be used when the client’s back is correctly aligned.  PRONE POSITION Drainage of secretions. Prone position also promotes drainage from the mouth and is useful for unconscious clients or those recovering from surgery on the mouth or throat. Placing support in prone. To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen. In surgery. Prone position is often used for neurosurgery in most neck and spine surgeries.  SUPINE POSITION Supine position, or dorsal recumbent, is wherein the patient lies flat on the back with head and shoulders slightly elevated using a pillow unless contraindicated (e.g., spinal anesthesia, spinal surgery). Variation in position. In supine position, legs may be extended or slightly bent with arms up or down. It provides comfort in general for patients under recovery after some type of surgery. Most commonly used position. Supine or dorsal recumbent is used for general examination or physical assessment.  SUPINE POSITION Watch out for skin breakdown. Supine position may put patients at risk for pressure ulcers and nerve damage. Assess for skin breakdown and pad bony prominences. Support for supine position. Small pillows may be placed under the head to lumbar curvature. Heels must be protected from pressure by using a pillow or ankle roll. Prevent prolonged plantar flexion and stretch injury of the feet by placing a padded footboard. Supine position in surgery. Supine is frequently used on procedures involving the anterior surface of the body (e.g., abdominal area, cardiac, thoracic area). A small pillow or donut should be used to stabilize the head, as an extreme rotation of the head during surgery can lead to occlusion of the vertebral artery.  FOWLER’S POSITION Fowler’s position, also known as semi-sitting position, is a bed position wherein the head of the bed is elevated 45 to 60 degrees. Variations of Fowler’s position include: ❖low Fowler’s (15 to 30 degrees) ❖semi-Fowler’s (30 to 45 degrees) ❖high Fowler’s (nearly vertical)  FOWLER’S POSITION Promotes lung expansion. Fowler’s position is used for patients who have difficulty breathing because, in this position, gravity pulls the diaphragm downward, allowing greater chest and lung expansion. Useful for NGT. Fowler’s position is useful for patients with cardiac, respiratory, or neurological problems and is often optimal for patients with a nasogastric tube. Prepare for walking. Fowler’s is also used to prepare the patient for dangling or walking. Nurses should watch out for dizziness or faintness during a change of position.  FOWLER’S POSITION Poor neck alignment. Placing an overly large pillow behind the patient’s head may promote the development of neck flexion contractures. Encourage the patient to rest without pillows for a few hours each day to extend the neck fully. Used in some surgeries. Fowler’s position is usually used in surgeries that involve neurosurgery or the shoulders Use a footboard. Using a footboard is recommended to keep the patient’s feet in proper alignment and to help prevent foot drops. Etymology. Fowler’s position is named after George Ryerson Fowler, who saw it as a way to decrease the mortality of  LATERAL POSITION In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed. Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability. An increase in flexion of the top hip and knee provides greater stability and balance. This flexion reduces lordosis and promotes good back alignment.  LATERAL POSITION Relieves pressure on the sacrum and heels. Lateral position helps relieve pressure on the sacrum and heels, especially for people who sit or are confined to bed rest in supine or Fowler’s position. Body weight distribution. In this position, most of the body weight is distributed to the lateral aspect of the lower scapula, the lateral aspect of the ilium, and the greater trochanter of the femur. Support pillows needed. To correctly and  SIMS POSITION Sims’ position or semi-prone position is when the patient assumes a posture halfway between the lateral and the prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee than is the lower one.  SIMS POSITION Prevents aspiration of fluids. Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids. Reduces lower body pressure. It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip. Perineal area visualization and treatment. It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area. Pregnant women comfort. Pregnant women may find the Sims position comfortable for sleeping. Promote body alignment with pillows. Support proper body  TRENDELENBURG POSITION Involves lowering the head of the bed and raising the foot of the bed of the patient. The patient’s arms should be tucked at their sides. Promotes venous return. Hypotensive patients can benefit from this position because it promotes venous return. Postural drainage. Trendelenburg’s position is used to provide postural drainage of the basal lung lobes. Watch out for dyspnea, some patients may require only a moderate tilt or a shorter time in this position during postural drainage. Adjust as tolerated.