Personal Hygiene : Bed Bath

BED BATH

Definition

Bathing the patient while he is in bed.

Purpose

            To cleanse the skin and thus increase elimination through it.

            To stimulate circulation through slightly active or entirely passive exercise

            To refresh the patient by relieving fatigue and discomfort.

General Instructions

            The temperature of the water should be 105^o - 110^oF (40^o - 44^oC)

            The water should be changed when it is cool or soapy.

            Be sure to remove all the soap as it is irritating to the skin

            Do not expose the patient unnecessarily

            Observe the patient's skin while bathing. Particularly if it is the first bath after admission. It offers an opportunity for the nurse to observe any rashes or pressure sores.

Equipment

            Mackintosh (long) and two bed sheets

            Soap in a soap tray

            Two sponging pads

            Towel - one

            Linen to change (Gown)

            Two jugs containing hot and cold water

            Basin

            Bucket

            Screen

            Urinal and bed pan

Procedure:

                  Close the window or door and screen the bed to prevent draught and to avoid exposure.

                  To collect the equipment next to the patients bed.

And arrange the items conveniently at the bedside.

            Explain the procedure to the patient and get his cooperation

            Protect the bed with mackintosh and sheet

            Remove the patients linen and cover the patient

            Take water in the basin and feel with the back of your hand. The temperature should be comfortably hot.

            With wet sponge pad, moisten the patient' s face first.

            Apply soap. Carefully wash patient' s face, ears, and front of the neck. Dry with the towel.

            Wash the left hand first and the right hand. Support patient' s arm by holding the wrist. Wash well between fingers if desired. The patient may place hands in basin.

            Remove the sheet up to the waist, ask the patients to keep the arms above his head. It will be easy to clean the axillae in this position. Clean chest and abdomen.

            Change water and turn the patient to the side and sponge his back. Give long firm strokes from back of neck to the buttocks. Watch for any redness over the pressure areas.

            Do the left leg first and then the right. Have the patient' s knee flexed so to facilitate washing. Give the bedpan and ask the patient to clean the genitals. If the patient is unable to do help to do it for him. Patient should be given privacy during this.

            The back care is done by applying alcohol, massage back, use long firm strokes starting form back of the neck out over the shoulders and down to the buttocks. Use also rotatory motion to increase the blood circulation. Extra attention to be given to the pressure areas

            Apply powder if indicated. This depends upon the condition of the skin. If the skin is wrinkled the application of powder is not advisable.

                  If the patient is having dribbling of urine, zinc cream is applied.

                  Role up the mackintosh and sheet when the patient is on the side. Then remove it from the other side. Put the soiled linen in the receptacle.

                  Dress up the patient and remove the top sheet.

                  The bed is tidied.

                  The patient is given a warm drink

                  Remove the articles from the bedside.

                  Clean and replace in respective places.

                  Send soiled linen for wash

Types of Therapeutic baths

Hot water tub bath: Immersion in hot water helps relieve muscle soreness and spasm. Water temperature should be 45 o to 46 o C.

Warm water tub bath: Bathing in warm water relieves muscle tension. Water temperature should be 43 o C.

Cool water bath: Bathing in tipid water helps to lower body temperature when the body temperature is over 40 o C (104 o F).

Water temperature should be 37 o C.

                  Sitz Bath:

Sitz bath : Cleanses and reduces inflammation of the perineal and anal areas of a patient who has undergone rectal or perineal surgery or in hemorrhoids or fissures. Water temperature should be 43 o C to 45 o C.

Cold sitz bath: Cold sitz bath is more effective in relieving pain in the postoperative period.

                  Back rub or back massage promotes relaxation, relieves, muscular tension and stimulates skin

circulation.  An effective back rub takes 3-5 minutes.

Care of pressure points and prevention of decubitus ulcer

Prevention of decubitus ulcer in their patients who are bedridden is a major responsibility of nurses working in a hospital.

When we walk or stand on our two feet, the weight of our body is borne by our feet. But when an individual is confined to bed, the weight of his body has to be borne by his back or sides. The skin of the soles of our feet is very tough and thick and it does not break easily in spite of the entire weight of the body being supported by it. The nature has designed the sole of the skin for weight bearing whereas the skin over the back of the body is not. When there is pressure on the skin of the back because of the weight of the body, the skin breaks and an ulcer develops.

Definition of Decubitus ulcer

A decubitus ulcer is a pressure sore resulting from prolonged confinement in bed.

Areas which are likely to be affected.

When a patient lies in supine position, the following areas are vulnerable to pressure sores.

Back of head Shoulder blades Elbows

Base of the spine Buttocks

Heels

When a patient is in lateral position the following areas will be affected.

Edge of ear Shoulders Knees Ankles

All or any of the protuberant parts of a bedridden patient may become liable to pressure sores.

Causes of decubitus ulcer

Local or external causes

            Pressure : When any body prominence presses upon the bed, the tissues lying between them, get reduced blood supply - If this condition prolongs, the superficial tissues necrosed, skin breaks down and formation of an ulcer takes place.

The following conditions cause prolonged pressure

            Leaving a patient in one position for a long time.

            Leaving a patient on a bedpan for a long while.

            Hard and lumpy mattress

            Pressure exerted by splints and plaster casts.

b. Friction :

            Friction from bedclothes or any other cause irritates the skin leading to inflammation.

            If you lie on a bed sheet, which has a rough seam in the middle of it, for a while, you will notice the impression of the seam on your back.

            You will also experience burning sensation and the part will be red in colour.

The following factors cause friction in a patient :

            Careless pulling of patient and his linen

            Giving and removing bed pan carelessly

            Leaving broad crumbs, orange seeds and food particles on the bed

            Creases in the bottom sheet

            General restlessness of patient

            Rubbing two skin surfaces together

c. Moisture : Moisture makes the skin swollen, unhealthy and

easily breakable.

        The following reasons result in moisture over the pressure areas:

Incontinence of faces and urine

Severe perspiration

Leaving a patient in wet linen

            Heat : Leaving a patient in one position for a long time, the part gets heated.

            Lack of cleanliness and irritating substances on the skin. e.g. perspiration, faeces, urine and vaginal discharge.

            Predisposing factor for decupitus ulcer

            Unconscious, helpless or acutely ill patients

These patients are unable to appreciate the weight of pressure and change their positions

            Paralysed patients (Paraplegic and quadriplegic patients). They have lost motor and sensory functions.

            Patients with incontinence (spinal injuries)

            Old people

            Very emaciated and malnourished people

            Patients with dehydration or oedema g. Very fat people

            Patients with disease affecting circulation e.g. heart diseases and anemia

            Patients with debilitating diseases such as cancer and tuberculosis

            Patients with metabolic disorders. eg. Diabetes

Prevention of decubitus ulcers

            Prevent Pressure :

            Establish a turning schedule for bedridden patients; turn hourly.

            Have a firm cot and foam mattress for bed-ridden patients - use extra pillows, pads and air rings to reduce pressure.

            Prevent friction :

            When changing position of your patient lift him and do not drag him on to bed.

            Keep sheets without wrinkles and seams.

            Keep bed clean and free from crumbs.

            If patient is restless, protect pressure points with soft pads.

            Prevent moisture : a. Keep dressings and bed dry and clean. b. Clean and dry the incontinent patients promptly.

            Prevent predisposing causes: a. Improve patient's health by means of good food, ventilation, sunlight and exercises. b. Encourage circulation through massage. c. Have patient to ambulate early.

            Observe early signs and symptoms of decubitus ulcers : a. Redness b. Dark discoloration. c. Bruising, d. Tenderness of the area. e. Burning sensation.

            Give good care to pressure points : Careful cleaning and massage should be carried out 3 or 4 times a day for all bedridden patients. For some patients, it is necessary to give care as often as every two hours.

A. Equipment

A bowl of warm water

Sponge cloth

Soap

Towel

Dusting powder

Spirit

B. Procedure

Explain procedure to patient - Arrange articles at the bedside.

Screen the bed

Wet the part with soapy hand massage the area in circular movements, so that the tissues under the skin gets increased circulation Remove soap by washing Dry the areas

Apply spirit over the area and massage well. Spirit helps to harden the skin.

Apply lightly dusting powder to keep the part thoroughly dry. Do this treatment to all pressure points.

If patient is incontinent, apply zinc cream instead of spirit and powder. This protects the skin from moisture. Leave patient comfortable after the procedure.

Treatment of decubitus ulcer

            Clean ulcers with aseptic precautions - Use antiseptics such as eusole or hydrogen peroxide.

            Apply medication ordered by the doctor. eg. Antibiotic ointment, shark liver oil, zinc oxide, or any other topical applications.

            Cover with sterile dressings and bandage

            Surgical fermentation, ultraviolet rays or heat lamp are helpful in healing

            Provide good nutrition

            Prevent secondary infections.