Checklist Bed Bathing

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Name_______________________ Date___________ Instructor’s Name_____________________________

Performance Checklist: Skill 26-1 Bathing a Client S

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1. Assess client’s tolerance for activity, discomfort level, cognitive ability, musculoskeletal function, and the presence of equipment (e.g., intravenous [IV] or oxygen tubing) that may interfere with bathing hygiene.

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2. Assess client’s bathing preferences.

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3. Ask if client has noticed any problems related to condition of skin.

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4. Check physician’s therapeutic bath order for type of solution, length of time for bath, and body part to be attended.

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_____ 5. Review orders for specific precautions concerning client’s movement or positioning.

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6. Explain procedure and ask client for suggestions on how to prepare supplies. If partial bath, ask how much of bath client wishes to complete.

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7. Adjust room temperature and ventilation, close room doors and windows, and draw room divider curtain.

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8. Prepare equipment and supplies.

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9. Complete or partial bed bath a. Offer client bedpan or urinal. Provide towel and washcloth. b. Wash hands. c. Lower side rail closest to you, and assist client in assuming comfortable supine position, maintaining body alignment. Bring client toward side closest to you. Place hospital bed in high position. d. Loosen top covers at foot of bed. Place bath blanket over top sheet. Fold and remove top sheet from under blanket. If possible, have client hold bath blanket while with-drawing sheet.

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S _____ e. If top sheet is to be reused, fold it for replacement later. If not, dispose in laundry bag, taking care not to allow linen to contact uniform. _____ f. Remove client’s gown or pajamas. If an extremity is injured or has reduced mobility, begin removal from unaffected side. If client has IV access, remove gown from arm without IV first. Then remove gown from arm with IV. Remove IV from pole, and slide IV tubing and bag through the arm of client’s gown. Rehang IV container and check flow rate. _____ g. Pull side rail up. Fill washbasin twothirds full with warm water. Check water temperature, and also have client place fingers in water to test temperature tolerance. Place plastic container of bath lotion in bathwater to warm if desired. h. Lower side rail, remove pillow, and raise _____ head of bed 30 to 45 degrees if allowed. Place bath towel under client’s head. Place second bath towel over client’s chest. i. Fold washcloth around fingers of your _____ hand to form a mitt. Immerse mitt in water and wring thoroughly. _____ j. Inquire if client is wearing contact lenses. 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 eyelid for 2 to 3 minutes with damp cloth before attempting removal. Dry eye thoroughly but gently. k. Ask if client prefers to use soap on face. _____ Wash, rinse, and dry well forehead, cheeks, nose, neck, and ears. (Men may wish to shave at this point or after bath.) l. Remove bath blanket from client’s arm _____ closest to you. Place bath towel lengthwise under arm. _____ m. Bathe arm with soap and water using long, firm strokes from distal to proximal areas (fingers to axilla). Raise and support arm above head (if possible) while thoroughly washing axilla. n. Rinse and dry arm and axilla thoroughly. _____ If client uses deodorant, apply it.

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S _____ o. 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 basin and dry hand well. p. Raise side rail and move to other side of _____ bed. Lower side rail and repeat Steps 12 through 15 for other arm. _____ q. Check temperature of bathwater, and change water if necessary. _____ r. Cover client’s chest with bath towel and fold bath blanket down to umbilicus. With one hand, lift edge of towel away from chest. With mitted hand, bathe chest using long, firm strokes. Take special care to wash skin-folds under female client’s breasts. Keep client’s chest covered between wash and rinse periods. Dry well. s. Place bath towel lengthwise over chest _____ and abdomen. (Two towels may be needed.) Fold blanket down to just above pubic region. _____ t. With one hand, lift bath towel. With mitted hand, bathe abdomen, giving special attention to bathing umbilicus and abdominal folds. Stroke from side to side. Keep abdomen covered between washing and rinsing. Dry well. _____ u. Apply clean gown or pajama top. v. Cover chest and abdomen with top of _____ bath blanket. Expose near leg by folding blanket toward midline. Be sure perineum is draped. w. Bend client’s leg at knee by positioning _____ nurse’s arm under leg. While grasping client’s heel, elevate leg from mattress slightly 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 foot to be washed. _____ x. With one hand supporting lower leg, raise it and slide basin under lifted foot. Make sure foot is firmly placed on bottom of basin. Allow foot to soak while washing leg. If client is unable to hold leg, do not immerse; simply wash with washcloth. (Soaking may be contraindicated).

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S y. Unless contraindicated, use long, firm _____ strokes in washing from ankle to knee and from knee to thigh. Dry well. _____ z. Cleanse foot, making sure to bathe between toes. Clean and clip nails as needed. Dry well. If skin is dry, apply lotion. _____ aa. Raise side rail and move to other side of the bed. Lower side rail and repeat Steps 22 through 26 for other leg and foot. _____ bb. Cover client with bath blanket, raise side rail for client’s safety, and change bathwater. cc. Lower side rail. Assist client in assuming _____ prone or side-lying position (as applicable). Place towel lengthwise along client’s side. _____ dd. Keep client draped by sliding both blanket over 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 a back rub, and change the bathwater. _____ ee. Apply disposable gloves if not done previously. ff. Assist client in assuming side-lying or _____ supine position. Cover chest and upper extremities with towel and lower extremities with bath blanket. Expose only genitalia. (If client can wash, covering entire body with bath blanket may be preferable.) Wash, rinse, and dry perineum. Pay special attention to skinfolds. Apply water-repellent ointment to area exposed to moisture. _____ gg. Dispose of gloves in receptacle. _____ hh. Apply additional body lotion or oil as desired. ii. Assist client in dressing. Comb client’s _____ hair. Women may want to apply makeup. _____ jj. Make client’s bed. _____ kk. Remove soiled linen and place in dirtylinen bag. Clean and replace bathing equipment. Replace call light and personal possessions. Leave room as clean and comfortable as possible. _____ ll. Wash hands.

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S 10. Tub bath or shower a. Consider client’s condition, and review _____ orders for precautions concerning client’s movement or positioning. _____ b. Schedule use of shower or tub. _____ c. Check tub or shower for cleanliness. Use cleaning techniques outlined in agency policy. Place rubber mat on tub or shower bottom. Place disposable bath mat or towel on floor in front of tub or shower. d. Collect all hygienic aids, toiletry items, _____ and linens requested by client. Place within easy reach of tub or shower. _____ e. Assist client to bathroom if necessary. Have client wear robe and slippers to bathroom. f. Demonstrate how to use call signal for _____ assistance. g. Place “occupied” sign on bathroom door. _____ h. Fill bathtub halfway with warm water. _____ Check temperature of bath water, then have client test water, and adjust temperature if water is too warm. Explain which faucet controls hot water. If client is taking shower, turn shower on and adjust water temperature before client enters shower stall. Use shower seat or tub chair and provide if needed. _____ i. Instruct client to use safety bars when getting in and out of tub or shower. Caution client against use of bath oil in tub water. _____ j. Instruct client not to remain in tub longer than 20 minutes. Check on client every 5 minutes. k. Return to bathroom when client signals, _____ and knock before entering. l. For client who is unsteady, drain tub of _____ water before client attempts to get out of it. Place bath towel over client’s shoulders. Assist client in getting out of tub as needed and assist with drying. m. Assist client as needed in donning clean _____ gown or pajamas, slippers, and robe. (In home setting client may put on regular clothing.) _____ n. Assist client to room and comfortable position in bed or chair. _____ o. Clean tub or shower according to agency policy. Remove soiled linen and place in dirty-linen bag. Discard disposable equipment in proper

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

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12. Observe range of motion during bath.

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13. Ask client to rate level of comfort.

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14. Record bath on flow sheet. Note level of assistance required.

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15. Record condition of skin and any significant findings.

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16. Report evidence of alterations in skin integrity to nurse in charge or physician.

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receptacle. Place “unoccupied” sign on bathroom door. Return supplies to storage area. p. Wash hands.

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