Bed and bath shampoo

BED BATH

DESCRIPTION

A complete bed bath cleans the skin, stimulates circulation, provides mild exercise, and promotes comfort. Bathing also allows assessment of skin condition, joint mobility, and muscle strength. Depending on the patient's overall condition and duration of hospitalization, he may have a complete or partial bath daily. A partial bath — including hands, face, axillae, back, genitalia, and anal region — can replace the complete bath for the patient with dry, fragile skin or extreme weakness and can supplement the complete bath for the diaphoretic or incontinent patient.

ASSESSMENT

PLANNING Prepare the necessary equipment/ materials for the procedure:

o Bath basino Bath blanketo Skin cleansero Towelo Washclotho Skin lotiono Orangewood sticko Gloveso Deodoranto Hospital-grade disinfectanto Optional: chlorhexidine-impregnated cloth, bath oil, perineal pad, abdominal (ABD)

pad, and linen-saver pad

IMPLEMENTATION

KAR PROCEDURE RATIONALEHEALTH EDUCATION

COMMUNICATION

1. Explain procedure to client and ask client about bathing preferences.

Promotes client’s cooperation.

ETHICO-MORAL RESPONSIBILITY

LEGAL RESPONSIBILITY

2. Prepare room for comfort and draw privacy curtains or close the door.

Ensures client’s privacy.

SAFE & QUALITY NURSING CARE

3. Offer client bedpan or urinal. Provide towel and washcloth.

This promotes client comfort during the procedure.


4. Perform hand hygiene. Apply disposable gloves as needed.

Hand washing is the single, most effective way for preventing the transmission of

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microorganisms and infectious diseases. Use of gloves serves as barrier for secretions.


5. Position the bed at a comfortable working height.

This promotes proper body mechanics and thus reducing strain on the nurse’s back.


Perform Complete or Partial Bath6. Lower side rail closest to you,

and assist client in assuming a comfortable position that maintains body alignment. Assist/move client toward side of bed closest to you.

Aids the nurse’s access to the client and maintains comfort throughout the procedure.


7. Loosen top covers beginning at foot of bed. Place bath blanket over top sheet. Fold and remove top sheet from under blanket.

Removal of top linens prevent them from becoming soiled or moist during the bath. Putting on bath blanket provides warmth and privacy.


8. If top sheet is to be reused, fold it for later replacement. If not, place it in laundry bag.

Proper disposal prevents the transmission of microorganisms


9. Remove client’s gown or pajamas.

Provides full exposure of body parts during bathing.


10. Pull side rail up. Fill washbasin two-thirds full with warm water. Have client test temperature by placing fingers in water.

Raising side rails maintains client’s privacy as the nurse leaves bedside. Warm water used during the bath promotes comfort, relaxes muscles, and prevents unnecessary chilling. Having the patient test water temperature prevents accidental burns.


11. Remove pillow if allowed and raise head of bed 30 to 45 degrees. Place bath towel under client’s head by asking the client to lift his head while the nurse supports the neck. Place second bath towel over client’s chest.

Removal of pillow makes it easier to wash client’s ear and neck. Placement of towels prevents soiling of bed linen and bath blanket.


12. Fold washcloth around fingers of your hand to form mitt. Immerse mitt in water and wring thoroughly.

Mitt retains water and heat better than loosely held washcloth.


13. Wash client’s eyes with plain warm water. Use different section of mitt for each eye. Move mitt from inner to outer canthus. Soak any crusts on

Soap irritates the eyes. Using separate sections of the mitt reduces transmission of infection. Bathing eye from inner to outer canthus prevents

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eyelid for 2 to 3 minutes with damp cloth before attempting removal. Dry eye thoroughly but gently.

secretions from entering the nasolacrimal duct.


14. Ask if client prefers to have soap used on face. Wash, rinse, and dry well client’s forehead, cheeks, nose, neck, and ears.

Soap tends to dry face, which is exposed to air more than any other body parts.


15. Remove bath blanket from client’s arm that is closest to you. Place bath towel lengthwise under arm.

Prevents soiling of bed.


16. Bathe client’s arm with soap and water using long, firm strokes from distal to proximal areas. Raise and support client’s arm above head (if possible) while washing axilla.

Soap lowers surface tension and facilitates removal of debris and bacteria when friction is applied during washing. Long, firm strokes stimulates circulation. Movement of arm exposes axilla and exercise joints normal range-of-motion.


17. Rinse and dry arm and axilla thoroughly. Apply deodorant or talcum powder, if used.

Alkaline residue of soap discourages the growth of normal skin bacteria while excess moisture can cause skin maceration or softening. Deodorant controls body odor.


18. Fold bath towel in half and lay it on bed beside client. Place basin on towel. Immerse client’s hand in water. Allow hand to soak for 3 to 5 minutes before washing hand and fingernails. Remove hand from basin and dry well.

Soaking softens cuticles and calluses of hand, loosens debris beneath nails, and enhances feeling of cleanliness. Thorough drying removes moisture in between fingers.


19. Raise side rail and move to other side of bed. Lower side rails and repeat steps 15 through 17 for other arm.

Raising the side rails ensures client safety.


20. Check temperature of bath water. Warm water maintains client comfort


21. Change the water as often as necessary.

To keep the water warm and clean.


22. Cover client’s chest with bath towel, and fold bath blanket down to umbilicus. Lift edge of towel away from client’s chest. Bathe client’s chest using long,

Draping prevents unnecessary exposure of body parts. Towel maintains warmth and privacy. Secretions and dirt collect easily in areas of tight

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firm strokes with mitted hand. Wash skinfolds under female clients’ breasts. Keep client’s chest covered between washing and rinsing. Dry well.

skinfolds which are susceptible to excoriation if breasts are pendulous .


23. Place bath towel(s) lengthwise over client’s chest and abdomen. Fold blanket down to just above client’s pubic region.

Prevents chilling and unnecessary exposure of body parts.


24. Lift bath towel. Bathe client’s abdomen with mitted hand. Stroke from side to side. Keep client’s abdomen covered between washing and rinsing. Dry well.

Prevents chilling and unnecessary exposure of body parts. Moisture and sediment that collect in skinfolds predispose the skin to maceration and irritation.


25. Assist client put on clean gown or pajama top.

Maintains client’s warmth and comfort.


26. Cover client’s chest and abdomen with top of bath blanket. Expose client’s nearer leg by folding blanket toward midline. Drape client’s perineum and other leg.

Prevents unnecessary exposure of body parts.


27. Bend client’s leg at knee by positioning your arm under client’s leg. Elevate leg from mattress slightly while grasping client’s heel, and slide bath towel lengthwise under leg. Ask client to hold foot still. Place bath basin on towel on bed, and secure its position next to the foot to be washed.

The towel prevents soiling of bed linen. Support of joint and extremity during lifting prevents strain on musculoskeletal structures. Sudden movement by client could spill bath water.


28. Raise he lower leg while supporting it with one hand and slide the basin under the lifted foot. Soak the foot while washing the leg.

Proper positioning of foot prevents pressure being applied from edge of basin against calf. Soaking softens calluses and rough skin.


29. Use long, firm strokes in washing from client’s ankle to knee and from knee to thigh, unless contraindicated. Dry well.

Promotes venous return.


30. Cleanse client’s foot, making sure to bathe between toes. Clean and clip nails as needed. Dry well. Apply lotion to dry skin. Do not massage any reddened

Secretions and moisture may be present in between toes. Application of lotion helps retain moisture and softens skin.

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area on client’s skin.SAFE & QUALITY NURSING CARE

31. Raise side rail and move to other side of bed. Lower side rail and repeat steps 26 through 29 for client’s other leg and foot.


32. Cover client with bath blanket, raise side rail for client’s safety, and change bath water.

Decreased bath water temperature can cause chilling. Clean waster reduces transmission of microorganisms


33. Lower side rail. Assist client in assuming a prone or side-lying position (as applicable). Place towel lengthwise along client’s side.

Exposes back and buttocks for bathing.


34. Keep client draped by sliding bath blanket over his or her shoulders and thighs. Wash, rinse, and dry back from neck to buttocks using long, firm strokes. Pay special attention to folds of buttocks and anus. Give client a back rub. Change bath water.

Maintains warmth, and prevents unnecessary exposure. Skinfolds near buttocks and anus may contain fecal secretions that harbour microorganisms.

Changing bath water prevents transfer of microorganisms from anal area to genitalia.


35. Apply disposable gloves if not done previously.

Prevents contact with microorganisms in body secretions.


36. Assist client in assuming a side-lying or supine position. Cover client’s chest and upper extremities with towel and lower extremities with bath blanket. Expose client’s genitalia only. Wash, rinse, and dry perineum.

Maintains client’s privacy. Clients who are capable of performing partial bath usually prefer to wash their own genitalia.


37. Dispose of gloves in receptacle. Prevents transmission of infection.


38. Apply additional body lotion or oil on client as desired.

Moisturizing lotion prevents dry, chapped skin.


39. Assist client in dressing. Comb client’s hair.

Promotes client’s body image.


40. Make client’s bed. Provides a clean environment and provides client comfort


41. Remove soiled linen and place it in laundry bag. Clean and

Prevents transmission of infection. Clean environment

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replace bathing equipment. Replace call light and client’s personal possessions. Leave room as clean and comfortable as possible.

promotes client’s comfort. Keeping call light and articles of care within reach promotes client’s safety.


42. Perform hand hygiene. Reduces the transmission of microorganisms.

EVALUATION

Observe client’s skin, paying particular attention to areas that were previously soiled, reddened, or that showed early signs of breakdown.

Observe client’s range of motion during the bath. Ask client to rate level of comfort. Record bath on flow sheet. Note level of assistance required. Record condition of client’s skin and any significant findings. Report evidence of alterations in client’s skin integrity.

NURSING CONSIDERATIONS

Clients whose level of independence and mobility change frequently may require more or less assistance during bathing

If available, be sure that clients with an IV or upper extremity injury have a gown with snap or tie sleeves. Thus there is easy access to upper extremities during hygiene

If a client us at risk for falls, be sure to raise side rails up before obtaining fresh water or other supplies. Remember side rails cannot be used as a restraint.

Clients with history of deep vein thrombosis (DVT) should not have their lower extremities washed with long firm strokes.

Do not massage any reddened area on client’s skin because massaging causes breaks in the skin surface capillaries and increased risk of skin breakdown.

If client becomes excessively fatigued and unable to cooperate or participate in bathing, reschedule bathing to a time when client is more rested

MAKING A WASHCLOTH MITT

To make a washcloth mitt, take a clean, dry washcloth and fold it in thirds lengthwise around your hand. Fold the top of the washcloth down and tuck it into the bottom of the mitt.

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Cleaning the eyes from inner to outer cantus.

BED SHAMPOO

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Washing of the arms from distal to proximal.

Performing foot care.

DESCRIPTION

Shampooing removes dirt and old oils and helps prevent skin irritation. Frequency of hair care depends on the length and texture of the patient's hair, the duration of hospitalization, and the patient's condition. Usually, hair should be shampooed according to the patient's normal routine. Typically, no more than 1 or 2 weeks should elapse between washings. Shampooing is contraindicated in patients with a recent craniotomy, depressed skull fracture, conditions necessitating intracranial pressure monitoring, or other cranial involvement.

PURPOSES To stimulate the blood circulation to the scalp through massage. To clean the hair and increase the client’s sense of well being

ASSESSMENT

Signs and symptoms of alterations in respiration as well as factors that influence the rate of respiration

Determine any previous activity that would interfere with accuracy of respiratory rate Determine the normal values for age groups as it varies

PLANNING

Prepare the necessary equipment/ materials to be used and checking their functionalityo Comb and brusho Hand towelo Liquid shampoo (or mild soap, such as castile)o Shampoo tray with tubingo Washclotho Three bath towelso Two bath blanketso Cottono Pail or plastic wastebasketo Container for watero One small pitcher or beakero Basino Linen-saver padso Gloveso Optional: hair conditioner or rinse

Gather the equipment on the patient's bedside stand.

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Before shampooing the patient's hair, adjust the room temperature and eliminate drafts to prevent chilling the patient. Next, obtain a shampoo tray or devise a trough if necessary.

IMPLEMENTATION

KAR PROCEDURE RATIONALE1. Perform hand hygiene and put on

gloves, as necessaryHand washing is the single, most effective way for preventing the transmission of microorganisms and infectious diseases.

2. Confirm the patient's identity using two patient identifiers according to your facility's policy

3. Explain the procedure to the patient

4. Cover the patient with a bath blanket. Then fanfold the linens to the foot of the bed, or remove them if they're scheduled to be changed.

5. Place a wastebasket on a linen-saver pad on the floor or on a footstool near the head of the bed.

The pail or container catches wastewater from the shampoo tray.

6. Fill large pitchers or containers with comfortably warm water and place them on the overbed table.

7. Lower the head of the bed until it's horizontal, and remove the patient's pillow, if allowed.

8. Fold the second bath blanket and tuck it under the patient's shoulders

to improve water drainage.

9. Cover the bath blanket and the head of the bed with a linen-saver pad

to protect them from moisture.

10. Place a bath towel and linen-saver pad together, and position them around the patient's neck and over his shoulders.

Doing so protects the patient from moisture and pads his neck against the pressure of the shampoo tray.

11. Place the shampoo tray under the patient's head with his neck in the U-shaped opening. Arrange the

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bath blanket and towel so the patient is comfortable.

12. Adjust the shampoo tray to carry wastewater away from the patient's head, and place the drainage tubing in the pail. Tuck a folded towel or drawsheet under the opposite side of the shampoo tray, if necessary.

to promote drainage

13. Put on gloves if necessary.14. Place cotton in the patient's ears to prevent moisture from

collecting in them.15. Hand the patient a washcloth to

place over his eyes.16. Carefully pour water over the

patient's hair. Don't overfill the shampoo tray.

To avoid spills,

17. Using your fingertips, rub shampoo into the patient's hair. Massage his scalp well to emulsify hair oils.

Vigorous rubbing stimulates the scalp and also helps the patient relax.

18. Pour water over the patient's hair until it's free from shampoo. Then reapply shampoo and rinse again. Apply conditioner or a rinse, if desired.

19. Remove the shampoo tray, and wrap the patient's hair in a towel. Remove the linen-saver pad from the bed, and return the bed to its original position.

20. Dry the patient's hair by gently rubbing it with a towel. Then comb, brush, and style it.

21. Remake the bed or change the linens, if needed, and remove the bath blanket.

22. Reposition the patient comfortably.

23. Remove and discard your gloves, if worn, and perform hand hygiene.

24. Remove and empty the pail. Clean and disinfect the shampoo tray, and return it to storage. Remove the pitchers from the bedside, and return the shampoo to the bedside stand.

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25. Perform hand hygiene.26. Document the procedure.

EVALUATION

Conduct ongoing assessments such as any scalp problems or intolerance to the procedure. Report any problems noted to the nurse in charge.

NURSING CONSIDERATIONS

If you don't have a shampoo tray and can't devise a trough, place pillows under the patient's shoulders to elevate his head, and use a basin. Because a standard basin doesn't have a drainage spout, empty it frequently to prevent overflow.

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Bed and bath shampoo

Science

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