BATHING A CLIENT

Definition: A bath given to a client confined in bed.

Purposes:
1. To cleanse, refresh and give comfort to the client who must rest in bed.
2. To remove transient microorganisms, body secretions and excretions, and dead skin cells.
3. To stimulate circulation and aid in elimination.
4. To promote sense of well-being.
5. To provide for an opportunity to inspect the client’s body for signs of abnormality.
6. To help the client have some form of movements and exercise.
7. To provide for an opportunity for nurse client interaction.
Special considerations:
1. To avoid unnecessary exposure and chilling:
a. expose, wash, rinse and dry only a part of the body at one time
b. avoid draft
c. use correct temperature of water
2. Observe the client’s body closely for physical signs such as rashes, swelling, discolorations,
pressure sores, burns, abnormal discharges, body lice, etc.
3. Identify what type of bath should be given to the client.
a. Cleansing baths (i.e. complete bed bath, self-help bed bath, partial bath, bag bath, towel bath,
tub bath, shower)
b. Therapeutic baths
4. Change bath water when it becomes cool or soapy.
5. Give special attention to the area behind the ears, axillae, under the breast, umbilicus
region, groin and spaces between fingers and toes.
6. Do the bath quickly but unhurriedly.
7. Use even, smooth but firm strokes.
8. Use adequate amount of water and change it as frequently as necessary.
9. If possible, do such procedures as vaginal douche, enema, shampoo, oral hygiene, etc. before
the bed bath.
Preparation of the Unit:
1. Inform and explain to the client the procedure.
2. Screen the bed, if in the general ward.
3. Adjust the temperature and ventilation of the room.
4. Remove unnecessary articles in the bed and clear up the working area.
5. Arrange all needed articles within reach.
6. Lower the back and knee rest depending on the condition and the comfort of the client.
7. Invite a family member or significant other to participate if requested by the client.
8. Offer the bedpan or urinal as desired. ci 7
9. Perform hand hygiene and observe infection prevention procedures.
Requisites:

 Pitcher with hot water

 Bath basin

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  2 Bath towels
 Soap in soap dish
 Bed linens (if needed)
 Newspaper or a piece of rubber or
 plastic sheet
 Face towel / wash cloth
 Bed screen (if in general ward)
 Talcum powder (optional)
 Deodorant or lotion (optional)
 Rubbing alcohol (optional)
 Clean gown or pajama
 Clean gloves (optional)

Procedure (COMPLETE BED BATH):

 Explain the procedure to the client- to gain his/ her trust and cooperation.
 Prepare all the necessary materials- to prevent muscle strain for the nurses.
Suggested actions Rationale
1. Position the bed at a comfortable working This will facilitate draping and change of
height. Loosen the top sheet. client’s position.

2. Lower the side rail on the side close to the Working close to an object prevents over-
nurse. Assist the client to move near the reaching which will cause muscle strain.
nurse’s side of the bed.

3. Place bath blanket over the top sheet.
Remove the top sheet from under the bath
blanker by starting at the client’s shoulders
and moving the linen down to the client’s
feet.
4. Fill the bath basin with one half to two
thirds full of comfortably warm water.
A bath blanket provides comfort, warmth and.
privacy for the chent.
Adequate amount of water in the basin
ensures good rinsing. The use of warm water
prevents chilling.

5. Spread the bath towel under the client’s This prevents wetting of bed linen; and towel
head and neck. The gown of client will be becomes available for drying of the face.
removed after face, ears and neck are
washed.

6. Wet the wash cloth or face towel and Squeezing out the excess water prevents
squeeze out the excess water. Wrap the wetting of the bed linen. Arranging the wash
wash cloth around the palm and fingers to cloth in this manner prevents the corners from
form a mitt. dragging over the client’s skin.

7. Wash the client’s face:
a. Wash the eyes with water only and dry
each eye well. Wipe from the inner
canthus outward and use a different portion of the
The bath should be started from the cleanest
area.
Wiping from the inner to the outer canthus
prevents secretions from entering the

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wash cloth for each eye. Soak any crusts on the
eyelid for 2-3 minutes with damp cloth before
cleansing eyes.
b. Ask client whether they would want to
use soap in their face.
c. Wash the face, ears and neck using circular
strokes Rinse the area two to three times then pat
it with towel to dry.
8. Remove the towel under the head. Remove also
the gown this time under cover of the top sheet or
the blanket.
9. Wash the client’s arms and hands.
a. Spread the towel lengthwise under the farther
arm.
b. Wash, rinse and dry the arm by elevating the
client’s arm and supporting the client’s wrist and
elbow. Use long, firm strokes from the wrist and
shoulder. Pay particular attention to the axilla.
c. Give special caution to clients with respiratory
problems.
d. Fold bath towel in half and place it on the bed
beside the patient. Place a wash basin on the
towel. Soak for 3-5 minutes, wash, and rinse
client’s hand in the basin. Pay particular attention
to the interdigital spaces.
e. Do the same with the nearer arm. Change the
water PRN.
Note: Exercise caution if an IV site is present.
10. Wash the client’s chest and abdomen.
a. Spread the towel over the chest and abdomen.
Fold bath blanket down to the client’s pubic area.
b. Lift bath towel off the chest, bathe the chest
and abdomen using long firm strokes. Give
nasolacrimal ducts. Transmission of
microorganism from one eye to the other is,
prevented by using different corners of the
wash cloth.
Soap lowers the surface tension of the water
and helps it to unite quickly with oil and dirt
on the skin. However, the face becomes drier
when soap is used, as this has a drying effect.
Rinsing 2 to 3 times removes the soap which
if left on the skin may cause itching and
irritation.
To maintain privacy.
Placing a towel protects the bed from
becoming wet.
Firm strokes from distal to proximal areas
increase venous blood return. The axilla
unlike other skin area, has a neutral reaction
which makes it less resistant to bacterial
growth. It also has numerous sweat glands
that secretes fatty and odorous substance as
well as sweat.
Powder is not recommended for clients with
respiratory problems due to potential adverse
effects.
Soaking the hands loosens dirt under the nails,
softens calluses and cuticles.
This keeps the client warm and prevents
unnecessary exposure of the chest.
Body areas with folds and creases are more likely
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special attention to the to accumulate dirt and bacteria.
area beneath the breast and the umbilicus. Rinse
and dry well.

c. Powder may be applied on the neck and under

the breast.

d. Replace bath blanket when chest and abdomen

have been dried.

11. Wash the legs and feet:

a. Expose the farthest leg by folding the bath

blanket toward the other leg. Be careful to keep
the perineum covered.

b. Place bath towel lengthwise under the leg.

Wash, rinse and the leg using long, smooth, firm Sweat evaporates less rapidly on these covered
strokes from the distal to the proximal area. Pay areas. Sweat and dirt favor bacterial growth,
particular attention to the inguinal and popliteal hence the need for thorough cleaning and drying.
areas.

c. Do the same with the nearer leg.

d. Flex both knees and drape. Place the basin on

the towel between the legs.

e. Lift farther foot with heel on the palm of the

hand and lower it slowly into the water with the
leg resting on the bend of elbow.
f. Soap, rinse and dry well between the toes, if the
basin is big enough, both maybe washed at the
same time. Change water and fill it half with new
warm fresh water.
Supporting the client’s leg properly prevents
muscle strain and undue pressure from the rim
of the basin
The interdigital space like the axilla has a neutral
or alkaline reaction which makes them less
resistant to bacteria.

Note: if skin is dry, moisturizer may be applied.

Moisturizers, when applied within 3 minutes
of bathing, prevents dryness and itching by
12. Obtain fresh, warm bath water whenever trapping existing water in the skin.
necessary.

13. Wash the back and then the perineum:

a. Assist the client to turn to her side with the

back towards the nurse; spread the bath towel This is to provide ease and convenience. Over
lengthwise on the bed alongside the back and reaching causes muscle strain.
buttocks.

b. Wash and dry the client’s back from the nape to

the buttocks, and the upper thighs using long, firm Firm strokes remove surface dirt better.

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strokes. Pay attention to the gluteal folds. Friction produced by rubbing produces heat
and stimulates circulation on the skin.
14. Perform a back massage using alcohol or
body lotion.

15. Turn client back to supine position and

determine if the client can wash the perineal area
independently. If the client is unable, drape
properly and wash the perineal area.

16. Remove the towel. Assist client in putting on

clean clothes, gown or pajama.

17. Replace bath towel with the top sheet.

18. Assist with hair care; make an occupied bed if

linens need changing.

19. Document:

 Type of bath given

 Skin assessment
 Nursing interventions done to maintain
 skin integrity
 Ability of the client to assist or
 participate with bathing
 Client’s response

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 BACK RUB
Purposes:
1. acts as a general body conditioner
2. relaxes and relieves tension
3. provides relief from pain and promotes sleep
4. stimulates blood circulation to the tissues and the muscles
5. provides an opportunity for the nurse to observe the skin for signs of breakdown
6. improves circulation and provides a means of communication with the client through
the use of touch.

Special consideration:
1. Contraindicated when client has had surgery or fracture of the ribs or vertebrae; burns, reddened areas
on skin or open wounds; status post coronary artery bypass.
2. Provide massage following a bath, before sleeping and at other times as necessary to achieve comfort
and relaxation.
3. Assess client’s vital signs (PR, RR, BP), signs of stress, and receptability of client to therapy.

Preparation of the Unit:

1. Explain the procedure and desired position to the client.
2. Assemble equipment/ materials needed.
3. provide privacy and reduce noise
4. Wash hands properly
5. Assess client’s heart rate, respiratory rate and blood pressure.

Requisites:
Bath towel
Lotion or powder, oil or rubbing alcohol
Bath Blanket ( optional )

Procedures:
 Once the client is in a prone position, perform the back massage.
Suggested actions Rationale
l. Move the client towards the near side of The back rub usually follows the client’s back
the bed. Assist the patient to prone is given again as part of evening care. The
position or side lying position with the back maybe rubbed any other time indicated
face away from you. to reduce skin problem.

2. Protect bed with towel, see that the client Towel prevents soiling of the sheets when the
is comfortable. solution spills off the hands.

3. Expose the back by separating the gown. Fold down the bed clothes to the middle area
of clients buttocks. This allows exposure of
the shoulder and the sacral area.

4. Pour small amount of rubbing alcohol or Alcohol having an astringent effect is good for
lotion or powder in the palm of your hand oily skin, while lotion is good for dry skin.
and rub your palms together. Explain that Rubbing the palms together creates friction

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as the lotion is applied your client will feel making it warm before application. This
cool or wet. reduces startled response and discomfort due
to muscle tension cause by cold application.

5. Take your position at the side of the bed This avoids straining muscles while doing the
with one foot forward; knees are slightly procedure.
flexed; arms extended.

6. With both hands at the client’s neck, use a

circular motion in the length of the neck
and out to each shoulder.

7. EFFLEURAGE the entire back. Apply
palms and fingers first to sacral area,
massaging in circular motion.
Stroke upward from the buttocks to neck.
Circle your hands over the shoulder blades
with smooth firm strokes.
Relaxation promotes rest and sleep.
A backrub at the end of the day may alleviate
tension and anxiety.
Continuous contact of skin’s surface is
soothing and stimulates circulation to tissues.

-Continue the massage to the upper arms

and laterally along the sides of the back
down to the iliac crest.

-Do not allow hands to leave the skin.

-Continue the massage pattern for at least

3 minutes.

8. Apply friction strokes next to the spine. This penetrates deeper muscles.
Using the thumbs, massage back, moving
from side to side in smooth and strong and
tiny circles starting at the neck and ending
at the waist.

9. PETRISSAGE the back and shoulders of Kneading increases circulation. Motion is

the client. soothing and relieving.

Knead skin gently by grasping tissue

between thumb and fingers. Knead upward
along one side of the spine from buttocks
to shoulders and around the nape of the
neck. Knead or stroke downward toward
the sacrum. Repeat along other side of
back.

10. OPTIONAL :

Use tapotement technique at the back. This method invigorates and stimulates tired
Place both palms together. With the small muscles.
fingers touching the client’s back, tap the

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back using brisk, vigorous rhythmic and
percussive movements. Hands m,ay be
used to alternately tap, cup, slap or
pummel the muscles.

11. Complete the massage by using light

effleurage to the entire back for an
additional 3 minutes. Tell the client that
you are ending the massage.

12. Wipe excess lotion from your client’s back Excess lotion can be an irritant.
with bath towel. Tie the gown and assist
client in putting on the pajamas.

13. Help client to comfortable position. Raise Comfortable position enhances back rub’s
side rails as needed. effect.

14. Replace the bath towel wit a top sheet
14. Dispose soiled towels and hand wash.
15. Assist client in putting on the gown.
15. Record: ,
Time, condition of the client's back
Any areas of muscle pain and tension
BP and Pulse.
Promotes infection control
The degree or relief depends on length of the
massage, Client’s ability to relax and degree
of discomfort before massage.
Gentle back massage may increase heart rate
and systolic blood pressure.

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