NCM 103

Fundamentals in Nursing Practice RLE

4b: Hair Shampoo and Cleansing Bed

Bath

Statement of Purpose: Supporting patients to maintain their hygiene needs while in hospital
is a fundamental aspect of nursing care. Helping patients to shampoo hair and cleanse their
body with soap and water is a valuable opportunity for nurses to also carry out a holistic
assessment. This module teaches proper hair shampoo and cleansing bed bath techniques.

CLO#1: Define the following terms related to hair shampoo.

1.1 Hair Shampoo- is a hair care product, typically in the form of a viscous liquid, that is
used for cleaning hair. It is used by applying it to wet hair, massaging the product into the
scalp and then rinsing it out.

1.2 Lice- are tiny, wingless insects that feed on human blood. Lice spreads from
person to person through close contact and by sharing belongings.

1.3 Alopecia- hair loss can affect just your scalp or your entire body, and it can be
temporary or permanent. There are many types of alopecia such as male or female
hair loss and alopecia areata.
1.4 Infestation- is the state of being invaded or overrun by pests or parasites. It can
also refer to the actual organisms living on or within a host.

1.5 Sebum- it is an oily, waxy substance produced by your body’s sebaceous glands.
It coats, moisturizes and protects your skin; a fatty lubricant matter secreted by
sebaceous glands of the skin

1.6 Nits- the egg or young form of a louse or other parasitic insect, especially the egg
of a head louse attached to a human hair

1.6 Pediculicide- an insecticide that kills lice

1.7 Seborrheic Dermatitis- is a common skin condition that mainly affects your scalp.
It causes scaly patches, inflamed skin and stubborn dandruff; a red dry, flaky, itchy
skin on the scalp and other parts of the body and is common but not contagious.

Seborrheic Dermatitis

1.8 Emulsification- the process of making two liquids into a colloidal suspension, in
which particles of one liquid are dispersed throughout the other but not dissolved in
it.

1.9 Delousing- removing of lice from the body, hair or clothing of a person
1.10 Dandruff- Small, white pieces of dead skin from the head that collect in the hair
or fall on the clothes

Dandruff

1.11 Ticks- are small bugs that survive by sucking the blood of humans and other
animals. They are parasites that can transmit disease between the animals and
people whom they feed.

1.12 Pediculosis- the state of being infested with lice; in humans may properly refer
to lice infestation of any parts of the body
CLO#2: Explain the importance of hair shampooing

Importance of hair shampoo:

1.1 improves well being

1.2 removes dirt particles and dead cells
1.3 promotes blood circulation on the head
1.4 treats unsightly infestation on the hair
1.5 improves appearance

CLO#3: Discuss the following:

Indications and Contraindications:

Indications:
1.1 immobilized patients
1.2 hair is dirty, dull, oily and tangled
1.3 Clients who are at risk for infection related to scalp laceration and insect
bites
1.4 when there’s excess perspiration or presence of blood or solutions on
patient’s hair

Contraindications:
1.1 patients who undergone surgery especially in areas near the head
1.2 patients with total hip injury
1.3 patients with neck injury
1.4 when hair is brittle and broken

Factors that influence hair shampoo:

1.1 age
1.2 environment
1.3 gender
1.4 race
1.5 beliefs

Principles involved in Hair Shampoo:

1.1 Anatomy and physiology - deals with different parts of the person’s
body and in hair shampoo we need to know the scalp and the hair so that
we know how it should be taken care properly.

1.2 Microbiology - the purpose of hair shampoo is to clean hair and scalp
to make it free from manifestation of parasites and to prevent scalp
infections caused by bacteria.

1.3 Physics - the nurse should apply friction in rinsing the head to remove
all chemicals applied thoroughly.
1.4 Chemistry - it deals with the chemicals which are needed in the
 procedure.

1.5 Psychology- explaining to the patient how it is done will establish

trust and confidence between the patient and the nurse performing hair
shampoo.

1.6 Sociology- the nurse should build rapport with the patient to have
a good interaction and less anxiety level of the patient.

1.7 Body Mechanics- the nurse should have body posture to prevent the
body from strain and bone or muscle aches.

Evidence-based guidelines in Hair Shampoo

Guidelines in performing hair shampoo
Before:
1. Check for the physician's order.
2. Explain the procedure to the patient.
3. Prepare the materials needed and inquire patient about preference of
shampoo.
4. Determine the procedure, the availability of equipment such as
shampoo.
5. Wash gloves when the patient's skin is not intact.
6. Remove pins and ribbons before shampooing.
During:
1. Protect the patient’s eyes and ears using damp cloth.
2. Ensure the patient’s comfort.
3. Position the client in hyperextension.
4. Use enough solution to make a good lather.
5. Ensure continuous drainage for shampoo and water.
6. Use warm water.
7. Be sure the room is comfortably warm when shampooing.
8. Give the patient a good scalp massage.
9. Converse and interact with the patient.
10. Rinse the patient’s hair and scalp thoroughly.
After:
1. Ask the patient how he/she feels.
2. Comb the patient’s hair with his/her preference.
3. Document by recording the result in the patient’s chart.

Common hair and scalp problems

-characteristics
-causes
-treatment
-nursing interventions

Common Hair and Scalp problems:

1. Head Lice- Characteristics: pediculosis capitis, commonly known as head lice, is a common
contagious infection due to human head lice. It is usually found in young children such as in
schools, day care centers and nurseries but can also affect adults. Itching and visible nits
 and sores are the common signs and symptoms of head lice. Contrary to common belief,
head lice are not able to jump or fly; they crawl and get transmitted from an infected person
to another through head to head contact
Causes: Head to head contact with an already infected person and can be
spread by sharing clothing or belongings.

Treatment:
1. Using a fine- toothed nit comb on wet hair can help remove lice and nits.
2. The infected person’s items such as clothing, beddings, pillows and stuffed toys should be
washed in at least 130 Fahrenheit or 54 Celsius hot soapy water.
3. Rinsing the hair with white vinegar is also done by some households after shampooing the
hair. White vinegar is deemed effective in dissolving the glue that attaches the lice or nits to
the hair shafts. After white vinegar, the hair should be washed with warm water.
Nursing Interventions:
1. Wash all bed linens, towels and clothes belonging to the patient separately in hot water.
2. For items that cannot be washed, such as toys or stuffed animals, seal them in a plastic bag
4- 5 weeks to kill any remaining lice or nymphs.

2. Pediculosis- Characteristics: is an infestation of the hairy parts of the body or clothing with
the eggs, larvae or adults of lice.
Causes (same as head lice)
Treatment (same as head lice)
Nursing interventions (same as head lice)
3. Dandruff- Characteristics: there are several reasons why dandruff occurs. To top the list, a
dry scalp from the winter air can cause the flakes. It is a common scalp condition in which small
pieces of dry skin flake off the scalp.
Causes: Dry scalp or excess secretions from sebaceous glands
Treatment:
Frequent washing of dandruff shampoo is the most important treatment for dandruff. Use
the shampoo to remove the scales as quickly as they form. The detergents in the shampoo
will cause smaller, less visible flakes to shed. Follow the direction on the dandruff shampoo
label. Using the pads of your fingers, gently rub the shampoo into your scalp. Leave the
shampoo on your head as directed as you rinse.

Nursing interventions:
Daily brushing and shampooing which medicated shampoo can sometimes suffice.

4. Seborrheic Dermatitis- Characteristics: considered a chronic form of eczema, is a red, itchy

and scaly reaction in the scalp. It can be considered a more severe form of dandruff, except the
scale is more marked and the scalp is often inflamed. It can be very itchy and can affect other parts
of the body, including the face, eyebrows, beard and central chest area. The inflammation is caused
by the body’s reaction to a yeast on the scalp.
Causes: Usually caused by a combination of genetic and environmental
factors.

Treatment:
1. Healthy lifestyles like managing stress and getting plenty of sleep can also improve skin.
Stress relief and lifestyle change which will have the biggest impact in seborrheic dermatitis.
2. Over the counter and prescription treatment for this skin disorder is aiming at removing
 scales, reducing itch and calming the inflammation that’s causing redness and swelling.

Nursing Interventions:
1. Advice patients to take a shower at least once a day. Shower more frequently if signs and
symptoms increase.
2. Advise patients to use warm water, not hot water.
3. Assess skin for severity of skin integrity compromise. The skin is the body’s first line of
defense against infection. Disruption of the integrity of skin increases the patient’s risk of
developing an infection. Purulent drainage from skin lesions indicates infection.
4. Encourage the patient to keep fingernails trimmed short. Long fingernails used for scratching
are more likely to cause skin trauma and aggravate itching.

5.Ticks- Characteristics: are small parasitic organisms that live in wooded areas and fields. These
arachnids need blood from humans or animals to survive. Ticks tend to be carriers of various serious
diseases which they may transmit to the people they bite. Examples of diseases are Lyme Disease,
Rocky Mountain Spotted Fever and tularemia. Symptoms may vary among the different diseases,
but they may include fever and chills, body aches, headaches, rashes and nausea. These symptoms
can occur in a person years after they were bitten.
Causes: Can be transmitted from animals

Treatment: One of the first signs will be a rash, accompanied by a fever.

Antibiotics are typically used to treat tick-borne illnesses, as many as bacterial.

Nursing Interventions:
1. Take a shower or bath within 2 hours of being outdoors.

2. Check skin closely after being in tick-prone areas, especially underarms, behind ears,
between legs, behind knees and in hair.

6. Alopecia- Characteristics: hair loss can affect just your scalp or your entire body and it can be
temporary or permanent. It can be the result of hereditary, hormonal changes, medical conditions
or a normal part of aging. Anyone can lose hair on their head, but it is more common in men.
Causes: This type of baldness is not usually caused by a disease. It is related
to aging, heredity and changes in the hormone testosterone.

Treatment:
1. May be treated using surgical methods such as hair transplant or implants.
2. Medications like Finasteride and Minoxidil can be used to treat male pattern baldness and
the latter is also a treatment for female pattern baldness.

Nursing Interventions:
1. Encourage the client to verbalize his/her fears and body- image concerns regarding
alopecia, especially if the client is a teenager or a young adult. For females,
encourage them to change their hairstyle or to wear head pieces or beautiful head
scarfs until their hair grows back.
2. If you want to cover your scalp, you can use hats, scarves or other head coverings.
You can wear a wig or any hairpiece.
CLO#4: Identify materials/ equipment used in Hair Shampoo

Materials needed for hair shampoo:

.basin of water, bath thermometer
. 2 bath towel and 2 washcloth
. shampoo and conditioner
. comb and brush
. cotton balls in container
. bath blanket and draw sheet
. bucket for used water
. footstool
. old newspaper to protect the floor

CLO#5: Demonstrate beginning skills in Hair Shampoo

Beginning skills (please refer to the procedure guide provided)

. Hair Shampoo

CLO#6: Document relevant information after performing Hair Shampoo

Documentation in Hair Shampoo

. Client’s reaction and nurse’s assessment findings

CLO#7: Define the following terms related to Cleansing Bed Bath

1.1 Cleansing Bed Bath- the act of washing the body with soap and water while the
patient is in bed

Cleansing Bed Bath

1.2 Personal Hygiene- refers to maintaining cleanliness of one’s body and clothing to
preserve overall health and well- being. It includes a number of different activities
related to the following general areas of self-care: washing or bathing, including
cleansing oneself after using the toilet; taking proper care of the mouth; grooming
and dressing; and keeping clothing clean.

1.3 Sebaceous Gland- are microscopic glands found in your hair follicles that secrete
sebum.

1.4 Epidermis- is the outermost layer of skin on your body. It protects your body
from harm, keeps your body hydrated, produces new skin cells and contains melanin,
which determines the color of your skin.

Epidermis and Dermis

1.5 Dermis- is the layer of skin that lies beneath the epidermis and above the
subcutaneous layer.. It is the thickest layer of the skin, and is made up of fibrous and
elastic tissue. Thus it provides strength and flexibility to the skin.

1.6 Massage- to rub and press someone’s body with regular repeated movements, in
order to relax them or reduce stiffness or pain in the joints or muscles.

1.7 Therapeutic Bath/ Medical Bath- requires a physician’s order stating the type of
bath, temperature of water, body surface to be treated and the type of medication
solutions to use.

1.8 Effleurage- derived from the French verb “effleur” which means to touch gently.
It is applied with light pressure commonly used to begin a massage treatment. It is
performed on many body parts using fingers and flat hands. It increases blood
circulation towards the heart, using long strokes to help increase temperature of the
soft tissue.
1.9 Tepid Sponge Bath- is the application of water to the patient’s skin surface to
promote dispersal of body heat when the body temperature is 39.5 Celsius.

1.10 Whirlpool Bath- it is a therapeutic bath in which all or part of the body is
exposed to forceful whirling currents of hot water.

All Body Body Part

1.11 Apocrine Gland- a sweat gland that secretes a viscous fluid into the hair
follicle.
 1.12 Tapotement- the use of various light, quick chopping, slapping or beating
strokes on the body during massage.

1.13 Friction Stroke- Deep circular movements with thumb pads or fingers

1.14 Three Handed Effleurage- smooth striking motion that gives impression of three
hands

CLO#8: Explain the importance of Cleansing Bed Bath

Importance of Cleansing Bed Bath

1.1. promotes circulation through the body
1.2 provides Range Of Motion exercise during the procedure
1.3 decrease the possibility of infection by removing dirt and debris,
secretion and perspiration

CLO#9: Discuss the Scientific Principles involved in Cleansing Bed Bath

Principles in Cleansing Bed Bath

 1.1 Human anatomy and Physiology- when giving a bath, it is important
to know the structure of the body in order to know how to give the wash with
care and to know which parts of the body harbor most organisms.
1.2 Microbiology- bathing cleanses the body of microorganism that infects
the superficial layer of the body, the skin and to avoid spread of
microorganisms
1.3 Physics and Chemistry- the knowledge about temperature will help the
nurse avoid situations like scolding and drilling the patient. It will help her
determine the proper and comfortable position in the bed. It will also help in
conserving energy when doing things like lifting the patient. It is important to
know the chemical properties of the different bathing paraphernalia to avoid
skin allergies, irritations and to avoid coughing with the use of things such as
powders.
1.4. Psychology and Sociology- bathing the hands of the patient makes
him feel comfortable, clean and relaxed. The patient should be ensured of
privacy during bathing. A member of the family can be taught how to give the
bed bath and perform other nursing duties in a competent manner.
1.5 Body Mechanics- proper body mechanics can help prevent strains and
backaches for both the patient and the nurse who gives a bath. It will also
help avoid accidents and injury.

CLO#10: Enumerate the different kinds of Bath

Kinds of Bath

1. Complete Bed Bath- is provided to dependent clients confined to bed. The nurse washes the
client’s entire body during a complete bed bath.

2. Partial Bed Bath- a bath consisting of cleaning only body areas that would cause discomfort
or odor if not washed thoroughly. These areas are the face, axillae, hands and perineal area.
The nurse or client may perform a partial bath depending on the client’s self-care ability.
Partial baths can be performed with the client lying in bed or while standing or seated at the
sink.
3. Tub Bath- clients frequently prefer and enjoy tub baths. A tub bath permits washing and
rinsing in the tub. Tub baths can also be therapeutic. Clients with limited physical ability
should be assisted with entering and exiting the tub.

4. Sponge Bath at the Sink- a bath in which someone is not placed in the water but is cleaned
with a wet, soapy sponge or cloth.

5. Shower- 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.
 6. Bag Bath/ Travel Bath- this bath is a commercially prepared product that contains 10 to 12
presoaked disposable washcloths that contain no-rinse cleanser solution. The package is
warmed in a microwave. The warming time is about 1 minute, but the nurse needs to
determine how long it takes to attain a desirable temperature. Each area of the body is
cleaned with a different cloth and then air dried. Because the body is not rubbed dry, the
emollient in the solution remains on the skin.

7. Self- Help Bath- clients confined to bed are able to bath themselves with help from the nurse
for washing for washing the back perhaps the feet.
8. Therapeutic Baths- are given for physical effects, such as to soothe irritated skin or to treat
an area. Medications may be placed in the water. A therapeutic bath is generally taken in a
tub ⅓ or ½ full and remains often 20-30 minutes.
9. Chlorhexidine Gluconate ( CHG ) Bath- daily bath using chlorhexidine gluconate to reduce
the spread of infections in hospitals. CHG baths are especially helpful in Intensive Care Units.

CLO#11: Differentiate the Cleansing Bed Bath And Tepid Sponge Bath

Difference: Cleansing Bed Bath and Tepid Sponge Bath

. Cleansing Bed Bath: type of bath that involve the use of soap and
that involves the use of soap and water on one’s head.
. Tepid Sponge Bath: is a type of bath which involve the use of a
sponge

CLO#12: Identify the Types of Massage:

Types of Massage:
1. Petrissage or Kneading- a massage technique that uses firm
pressure and works on specific muscles.

2. Effleurage- the use of gentle circular hand movements in

massage.

3. Friction Stroke- are specific manipulations performed. Forwards

and backwards on small areas of the body using only fingers or
thumbs.

4. Three handed effleurage- a smooth striking motion that gives

the impression of three hands.
 5. Tapotement- a type of massage in which the body is tapped in
a rhythmic manner with the tips of the fingers or the sides of
the hands, using short, rapid, repetitive movement.

Tapotement

CLO#13: Discuss Evidence Based guidelines and nursing responsibilities of a

nurse before, during and after Bed Bath.

Nursing Responsibilities and Guidelines in Performing Cleansing Bed Bath:

. provide privacy
. maintain safety
. keep the room temperature at normal level as the client get cold
. explain procedure to the client
. prepare all the necessary material
. us damp cloths to protect the eyes and cotton balls for the ear
. ask or inform the patient first before using the materials needed

CLO#14: List down the materials/ equipment used in Cleansing Bed Bath

. A Lined Tray containing:

. basin half-filled with tepid water
. 1 bath towel and washcloth
. new gown or cloths
. top sheet and bath blanket
. bath thermometer
. pail and basin for used water
CLO#15: Demonstrate Beginning Skills in Cleansing Bed Bath

. Beginning Skills ( Please refer to the procedure guide provided )

. Cleansing Bed Bath

CLO#16: Document relevant information after performing Cleansing Bed Bath

. Documentation in Cleansing Bed Bath

. Client’s reaction and nurse’s assessment findings