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01.01 Bed Bath

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Overview

  1. Purpose
    1. To ensure proper hygiene for patient and maintain proper skin care/condition
    2. Assess all areas of skin during bed bath
    3. Provide comfort measures for patient

Nursing Points

General

  1. Supplies Needed
    1. Bath Wipes OR:
      1. 10 washcloths
      2. Bath basin with warm water
      3. Body soap
    2. 5 towels
    3. Bath blanket
    4. New gown
    5. New linens
      1. See Linen Change lesson
    6. Bedside table
    7. Linen cart/bag

Nursing Concepts

    1. Steps & Nursing Considerations
      1. Gather supplies
        1. Ensure water is warm
        2. Have bedside table within reach with supplies
      2. Explain procedure to patient
      3. Perform hand hygiene
      4. Place bed at comfortable working height, lock wheel brakes, and place patient in appropriate position
        1. Laying flat if tolerated
        2. Be sure to pause enteral feedings when laying flat for prolonged periods of time
      5. Apply clean gloves
      6. Place a bath blanket over patient, remove gown
        1. Always protect the patient’s privacy and dignity
      7. Wash patient’s face first, discard wipe or cloth in appropriate receptacle
        1. Can allow client to perform independently if they desire
      8. Wash patient’s chest and abdomen then dry
        1. Keep privates covered with bath blanket, then re-cover after cleaning to keep warm
      9. Wash upper extremities. Start at hands → arms → armpits
        1. Once done, lay arms down on a clean towel
      10. Wash lower extremities starting at upper thigh and moving down to the feet.  Do not wash the perineum yet.
        1. Once done, lay legs down on a clean towel
      11. Perform perineal care. Allow independence if possible
      12. Apply lotion or powder if appropriate, then apply clean gown and remove bath blanket
      13. Turn patient to side, wash back
      14. Change linens
        1. See Linen Change lesson
      15. Return bed to low/locked position
      16. Ensure patient is comfortable
      17. Document procedure and patient response/tolerance
    2. Notes
      1. Wash extremities with long strokes toward the center of their body
      2. Make sure your water or wipes are still warm when you get to perineal care– can refresh water as needed
      3. Always work from clean to dirty
      4. Don’t reuse cloths on another part of the body
      5. Ensure linens are discarded in an appropriate cart or bag
      6. Do not massage legs if patient has a DVT or reddened areas of skin

Patient Education

  1. Purpose for procedure
  2. Who will be involved
  3. Ways you will protect their privacy

Reference Links

Video Transcript

In this video we’re going to go through technique for performing a bed bath. This seems really simple, but for some it can be very intimidating. Either way, we have to make sure we’re maintaining the patient’s dignity and privacy at all times.

To get started, you need to know if you have bath wipes or washcloths. If you’ll be using washcloths, make sure you have a basin with warm soapy water, at least 8 to 10 washcloths, 4 or 5 towels, and a bath blanket. If your facility doesn’t have a bath blanket, you can use a sheet or another towel. Also don’t forget about a clean gown for the patient and new linens for the bed.

First you’re going to remove the top sheet and blanket. Just remember, never place linens on the floor. Then you’re going to put your bath blanket or clean sheet over the patient, then carefully remove their gown from below. You may have to unsnap and untie the top of the gown before you start.

Now we can start cleaning – remember we always wash from clean to dirty, so we’re going to start with the patient’s face and eyes. If they are able, you can let them perform this step independently.

Then we move on to the chest and abdomen. Remember each time you switch locations, you should also switch washcloths! Pull the bath blanket or sheet down to just above their hips. Wash from top to bottom in long strokes. Make sure you get their belly button nice and clean, but don’t do peri care yet. When you’re done, cover them back up for dignity and also to keep them warm!

Then we move on to the upper extremities. If you have a helper, you can both work on the arms at the same time. Otherwise, do one arm, then the other. For the arms, you want to start at the hands and move towards the body. We’re working clean to dirty remember? So the last part you’ll do on the upper extremities is the armpits. And make sure you pick up their arm and wash all the way around – supporting at the joints. When the arms are clean, lay them down on a clean towel on the bed. Last thing you want is to lay their clean arm down on dirty sheets.

Now we’ll move to the lower extremities. In this case, you want to work from the thighs down to the feet – because the feet are definitely the dirtier part. Again – we’re not doing perineal care just yet. Work in long firm strokes going from distal to proximal – so towards the patient. Just remember if your patient has any red areas or has a DVT, we don’t massage those areas! So use a light touch instead. When you get to the feet, make sure you get in between the toes. If your patient is diabetic, make sure you DRY them well, as well! Then, just like the arms, lay the legs down on a clean towel when you’re done.

Now, we can perform perineal care. Again, if your patient is able, allow them some independence here. Otherwise, make sure you are cleaning front to back for women and pay close attention to any drainage or lesions in the area so that you can document it for your assessment later. Also – by this time your water might be cold, so it might be a good chance to refresh your basin with warm water!

Now, at this point the whole front is done, so we will apply any lotion or powder if appropriate and put on the new gown. Lay it over the bath blanket and snap it in place, then remove the bath blanket from under the gown.
The next step is going to be to turn the patient to the side and wash their back and bottom. If your patient cannot turn themselves, you’re going to need a helper here. Once you’ve finished washing their back, you can move on to changing their linens.

We have a whole other video on changing linens with a patient in the bed, so make sure you check that one out. We hope this was helpful for you, just remember to always move from clean to dirty.

Now, go out and be your best selves today! And, as always, happy nursing!

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