CALAMBA DOCTORS’ COLLEGE

Bachelor of Science in Nursing

Name: __________________________ Date:______________ Score: __________

BATHING AN ADULT CLIENT

PURPOSES
 To promote a sense of well-being
 To produce relaxation and comfort
 To prevent and eliminate unpleasant body odors
 To remove transient microorganisms, body secretions and excretions, and dead skin cells
 To stimulate circulation to the skin

ASSESSMENT
Assess
 Assess patient’s visual status, ability to sit without support, hand grasp, and range of motion
(ROM) of extremities. Determines degree of assistance patient needs for bathing.
 Assess for presence of equipment (e.g., IV line, oxygen tubing, Foley catheter) Affects how you
plan bathing activities and positioning. Helps determine how to set up supplies.
 Assess patient’s bathing preferences: frequency and time of day preferred, type of hygiene
products used, and other factors related to patient preferences. The patient participates in the plan
of care. Promotes patient’s comfort and willingness to cooperate. Includes cultural or personal hygiene
preferences into care.
 Ask if the patient has noticed any problems related to the condition of skin and genitalia: excess
moisture, inflammation, drainage or excretions from lesions or body cavities, rashes, or other
skin lesions. Provides you with information to direct physical assessment of skin and genitalia during
bathing. Also influences the selection of skincare products.
 Before or during the bath, assess the condition of the patient’s skin. Note the presence of
dryness, indicated by flaking, redness, scaling, and cracking. Provides a baseline for comparison over
time in determining if bathing improves the condition of the skin.
 Assess the patient’s knowledge of skin hygiene in terms of its importance, preventive measures
to take, and common problems. Determines patient’s learning needs.

DELEGATION CONSIDERATIONS
The skill of bathing and perineal care can be delegated to nursing assistive personnel (NAP). Direct the
NAP to:
• Avoid massaging reddened skin areas.
• Report early signs of impaired skin integrity, including redness or pale skin, to the nurse.
• Properly position patients with musculoskeletal limitations and indwelling catheters or
intravenous (IV) lines.
• Report patient fatigue, shortness of breath, or pain during hygiene care. • Report changes in the
patient’s skin to the nurse.

PLANNING
1. Review orders for specific precautions concerning the patient’s movement or positioning.
 Prevents injury to the patient during bathing activities. Determines the level of assistance required by
the patient.
2. Check for a health care provider’s therapeutic bath order; if there is an order, note the type
of solution, length of time for the bath, and body part to be attended.
Therapeutic baths are ordered for specific physical effect, which usually includes the promotion of
healing or soothing effects.
3. Identify the patient using two identifiers (i.e., name and birth date or name and account
number) according to facility policy.
Ensures correct patient. Complies with recommended National Patient Safety Goal (TJC, 2011).
4. Explain the procedure and ask the patient for suggestions on how to prepare supplies. If
partial bath, ask how much of the bath patient wishes to complete.
Promotes patient’s cooperation and participation.
5. Prepare equipment and supplies. If it is necessary to leave the room, be sure that the call
light is within the patient’s reach.
Avoids interrupting procedure or leaving patient unattended to retrieve missing equipment.

EQUIPMENT
 Basin or sink with warm water (between 43°C and 46°C [110°F and 115°F])
 Washcloths and bath towels (optional disposable cloths)
 Bath blanket
 Soap and soap dish or liquid soap (optional no-rinse solution)
 Toiletry items (deodorant, powder, lotion, cologne)
 Toilet tissue or wipes
 Clean hospital gown or patient’s own pajamas or gown
 Laundry bag
 Clean gloves (when the risk of contacting body fluids) • Washbasin

IMPLEMENTATION

STEPS/RATIONALE 1 2 3 4
1. Offer patient bedpan or urinal. Provide toilet tissue.
The patient feels more comfortable after voiding. Prevents interruption of the
bath.

2. Perform hand hygiene. If the patient has nonintact skin or skin is soiled
with drainage, excretions, or body secretions, apply clean gloves. Ensure
that patient is not allergic to latex.
Reduces transmission of microorganisms.

3. Verify that bed is in the locked position and raise the bed to a
comfortable working height. Lower side rail closest to you and assist the
patient into a comfortable supine position, maintaining body alignment.
Bring the patient toward the side closest to you.
Prevents the bed from moving. Helps you reach the patient without stretching
and reaching across the bed, thus minimizing strain on back muscles.

4. Place a bath blanket over the patient and loosen and remove the top
covers without exposing him or her. If possible, have the patient hold top
 of the bath blanket. Place soiled linen in laundry bag. Take care to not
allow the linen to touch your uniform. Optional: Use top sheet when bath
blanket is not available or the patient prefers.
A bath blanket provides warmth and privacy during the bath.

5. Remove the patient’s gown or pajamas.

a. If available, use a gown with ties or snaps on sleeves for patients with
IV line, upper-extremity injury, or limited ROM.
Provides full exposure of body parts during bathing.

b. If a Snap-on gown or gown with ties on arms is not used and the
patient has limited upper-extremity ROM or an IV access, remove the
gown from the unaffected side first.
Undressing the unaffected side first allows easier manipulation of the gown
over the body part with reduced ROM.

c. Remove gown from arm without IV line first. Then remove the gown
from the arm with an IV line. Remove IV tubing from the pole and
slide the IV container and tubing through the arm of the patient’s
gown. Rehang the IV container and check the flow rate. Regulate if
necessary.
Manipulation of IV tubing and container may disrupt flow rate. Do
not delegate regulation of IV flow rate to NAP.

6. Lower side rail, remove pillow if tolerated, and raise the head of bed 30
to 45 degrees if allowed. Place bath towel under patient’s head. Place a
second bath towel over the patient’s chest.
Aids your access to the patient. You do not have to reach across the bed, thus
minimizing strain on back muscles. Removal of pillows makes it easier to wash
the patient’s ears and neck. Placing towels prevents bed linen and bath blanket
from getting soiled or wet.

7. Wash face.
a. Ask if the patient is wearing contact lenses. Prevents accidental injury
to the eyes.

b. Fold washcloth around the fingers of your hand to form a mitt.

Immerse mitt in water and wring thoroughly.
Mitt retains water and heat better than a loosely held washcloth; keeps cold
edges from brushing against the patient and prevents splashing.

c. Wash the patient’s eyes with plain warm water. Use different sections
of mitt for each eye. Move the mitt from the inner to the outer canthus.
Soak any crusts on the eyelid for 2 to 3 minutes with a damp cloth
before attempting removal. Dry eyes thoroughly but gently.
Soap irritates the eyes. The use of separate sections of the mitt reduces
infection transmission. Bathing the eye from inner to outer canthus prevents
secretions from entering the nasolacrimal duct. Pressure can cause internal
injury.

d. Ask if the patient prefers to use soap on the face. Otherwise, wash,
rinse, and dry the forehead, cheeks, nose, neck, and ears without using
 soap. (Men may wish to shave at this point or wait until after a bath.)
Soap tends to dry the face, which is exposed to air more than other body parts.

8. Wash trunk and upper extremities.

a. Remove the bath blanket from the patient’s arm that is closest to you.
Place bath towel lengthwise underarm. Bathe arm with soap and water
using long, firm strokes from distal to proximal areas (fingers to axilla).
The towel prevents the soiling of the bed. Soap lowers surface tension and
facilitates the removal of debris and bacteria when friction is applied during
washing. Long, firm strokes stimulate circulation; moving distal to proximal
promotes venous return.

b. Raise and support arm above the head (if possible) to wash, rinse, and
dry axilla thoroughly. Apply deodorant or powder to underarms if
desired or needed.
Movement of arm exposes axilla and exercises normal ROM of joints. Alkaline
residue from soap discourages the growth of normal skin bacteria. Drying
prevents excess moisture, which can cause skin maceration or softening.
Respect the patient’s preference for use of hygiene products.

c. Move to another side of the bed and repeat Steps (a) and (b) with other
arms.
Provides for better access to patients and helps prevents back strain.

d.Place bath towel across patient’s chest so it covers chest and arms and
folds bath blanket down to umbilicus. While lifting the edge of the
towel away from the chest with one hand, bathe the chest with a
mitted washcloth on other hand using long, firm strokes. Take special
care to wash skinfolds under a female’s breasts. It is often necessary to
lift the breast upward while bathing underneath it. Keep the patient’s
chest covered between wash and rinse periods. Rinse and dry well.
Draping prevents unnecessary exposure of body parts. Towel maintains
warmth and privacy. Secretions and dirt collect easily in areas of tight skinfolds.
The skin under the breasts is vulnerable to excoriation if not kept clean and dry.

9. Wash hands and nails.

a. Fold the bath towel in half and lay it on the bed beside the patient.
Place basin on the towel. Immerse the patient’s hand in the water.
Allow hand to soak for 2 to 3 minutes before washing hand and
fingernails. Remove basin and dry hand well. Repeat for other hands.
Soaking softens cuticles and calluses of the hand, loosens debris beneath nails,
and enhances the feeling of cleanliness. Thorough drying removes moisture
between fingers.

10. Check the temperature of bathwater and change the water when cool
or soapy. Warm water maintains the patient’s comfort. Alkaline soap residue is
irritating to the skin and can decrease the normal protectiveness of acid ph.

11. Wash the abdomen.

a. Place bath towel lengthwise over chest and abdomen. (Two towels may
be needed.) Fold bath blanket down to just above the pubic region.
With one hand lift the bath towel. With mitted hand bathe and rinse
 abdomen, giving special attention to umbilicus and skinfolds of
abdomen and groin. Stroke from side to side. Keep abdomen covered
between washing and rinsing. Rinse and dry well.
Draping prevents unnecessary exposure of body parts. Towel maintains
warmth and privacy. Keeping skin folds clean and dry helps prevent odor and
skin irritation. Moisture and sediment that collect in skinfolds predispose skin
to maceration.

13. Apply a clean gown or pajama top. If an extremity is injured or

immobilized, dress the affected side first. (This step may be omitted
until completion of the bath; the gown should not become soiled during
the remainder of the bath.)
Maintains the patient’s warmth and comfort. Dressing the affected side first
allows easier manipulation of the gown over body parts with reduced ROM.

14. Wash the lower extremities.

a. Cover chest and abdomen with top of bath blanket. Cover legs with the
bottom of the blanket. Expose near leg by folding blanket toward the
midline. Be sure to keep your other leg and perineum draped.
Prevents unnecessary exposure.

b. Place bath towel under the leg, supporting leg at knee and ankle. If
appropriate, place the patient’s foot in the bath basin to soak while
washing and rinsing. (Bend patient’s leg at knee; and, while grasping
patient’s heel, elevate leg from mattress slightly and place bath basin on
a towel.) If the patient is unable to support the leg, cleaning can be
done by washing the feet thoroughly with a washcloth.
The towel prevents the soiling of bed linen. Support of joint and extremity
during lifting prevents strain on musculoskeletal structures. A sudden
movement by the patient could spill bathwater. Soaking softens calluses and
rough skin.

c. Wash leg using long, firm strokes from ankle to knee and from knee to
thigh. Do not rub or massage the back of the calf. Rinse and dry well.
Clean foot, making sure to bathe between toes. Rinse and dry toes and
feet completely. Clean and clip nails as needed. Remove and discard
towel.
Promotes circulation and venous return. Excess massage of the calf could
loosen
deep vein thrombus. Secretions and moisture may be present between toes,
predisposing the patient to maceration and breakdown.

d. Raise the side rail, move to the opposite side of the bed, lower the side
rail, and repeat Steps (b) and (c) for the other leg and foot. If the skin is
dry, apply moisturizer. When finished, cover the patient with a bath
blanket.

15. Cover patient with bath blanket, raise side rail for patient’s safety,
remove soiled gloves, and/or perform hand hygiene. Change bathwater.
Decreased bath water temperature causes chilling. Clean water reduces
microorganism transmission to perineal structures.
16. Washback. (This follows both female and male perineal care.)
a. Perform hand hygiene and apply clean pair of gloves if indicated.
Lower side rail. Assist patient into prone or side-lying position (as
applicable). Place towel lengthwise along the patient’s side and keep
him or her covered with a bath blanket.
Exposes back and buttocks for bathing while limiting exposure.

b. Keep patient draped by sliding bath blanket over shoulders and thighs
during bathing. Wash, rinse, and dry back from neck to buttocks using
long, firm strokes. Move from back to buttocks and anus. Pay special
attention to folds of buttocks and anus.
Cleaning buttocks and anus after back prevents contamination of water.

c. Perform hand hygiene and apply clean pair of gloves. Lower side rail.
Assist patient into prone or side-lying position (as applicable).
Place towel lengthwise along the patient’s side and keep him or her
covered with a bath blanket.
Exposes back and buttocks for bathing while limiting exposure.

d. If fecal material is present, enclose it in a fold of underpad or toilet

tissue and remove it with disposable wipes.
Skinfolds near the buttocks and anus may contain fecal secretions that
harbor microorganisms.

e.Clean buttocks and anus, washing front to back. Clean, rinse, and dry
the area thoroughly. If needed, place a clean absorbent pad under the
patient’s buttocks. Remove contaminated gloves. Raise side rail and
perform hand hygiene.
Cleaning motion prevents contaminating the perineal area with fecal
material or microorganisms

f. Return to bed and lower side rail; give a back rub. Promotes patient
relaxation. Make sure that a back rub is appropriate for your patient.
Back rubs are contraindicated in some cardiac patients.

18. Apply additional body lotion or oil to the patient’s skin as needed.
Moisturizing lotion prevents dry, chapped skin.

19. Remove soiled linen and place it in a dirty-linen bag. Clean and replace
bathing equipment. Wash hands.
Reduces transmission of microorganisms.

20. Assist patient in dressing. Comb patient’s hair. Women may want to
apply makeup. Help as needed.
Promotes patient’s body image.

21. Make the patient’s bed.

Provides a clean, comfortable environment.

22. Check the function and position of external devices (e.g., indwelling
urethral catheters, nasogastric tubes, IV lines).
Ensures that systems remain functional after bathing activities.
23. Place the bed in the lowest position.
Maintains patient safety by decreasing the height of the bed frame from the
floor.

24. Replace call light and personal possessions. Leave the room as clean and
comfortable as possible.
Prevents the transmission of infection. A clean environment promotes patient
comfort. Keeping call light and articles of care within reach promotes patient
safety.

25. Perform hand hygiene.

Reduces transmission of microorganisms.

EVALUATION

 Observe skin, paying particular attention to areas previously soiled, reddened, dry, or showing
early signs of breakdown.
 Techniques used during bathing leave skin clean and clear. Over time dry skin diminishes. If a
patient shows areas of redness, use the Braden scale to measure the risk for pressure ulcers.
 Observe ROM during bath. Measures joint mobility.
 Ask the patient to rate the level of comfort. Determines patient’s tolerance of bathing activities.
 Ask the patient to rate the level of fatigue. Determines patient’s tolerance of bathing activities.

UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS

1. Areas of excessive dryness, rashes, or pressure ulcers appear on the skin. • Complete pressure
ulcer assessment.
• Apply moisturizing lotions or topical skin applications per agency policy.
• Limit frequency of complete baths.
• Obtain a special bed surface if the patient is at risk for skin breakdown.
2. Patient becomes excessively fatigued or unable to cooperate or participate in bathing.
• Reschedule bathing to a time when the patient is more rested.
• Provide a pillow or elevate the head of the bed during bath for patients with breathing
difficulties.
• Notify health care provider if this is a change in patient’s fatigue level.
• Perform hygiene measures in stages between scheduled rest periods.

RECORDING AND REPORTING

 Report any breaks in skin or ulcerations to the nurse in charge or health care provider. These
are serious in patients with altered circulation to the lower extremities.
 Report intolerance of activity to patient’s nurse.
  Record procedure, amount of assistance provided, patient’s participation in care, condition
of the skin, and any significant findings (e.g., reddened areas, breaks in skin, inflammation,
ulcerations).

Remarks:

Signature over printed name

CLINICAL INSTRUCTOR STUDENT