Question

I. How would you prepare to give Madam Augustina a bed bath (bed bath).

A. Indicate three (3) purpose for the tasks above

B. List the requirements with rationale for the tasks.

C. Write the steps and rationale in carrying out each procedure D. Write the nurses’ note for the procedures carried out.

Answer 1

Ans . Indicate purpose of bed bath :-

Cleanse the skin :-   Bathing remove dirt, perspiration, sebum, some bacteria, and slough off dead skin cells.

Stimulate blood circulation :- Good circulation is promoted through the use of warm water and gentle stroking of the extremities.

Improved self-image.

Reduce bed order.

1. To prevent bacteria spreading on skin.

2. To clean the client’s body.

3. To stimulate the circulation.

4. To improve general muscular tone and joint.

5. To make client comfort and help to induce sleep.

6. To observe skin condition and objective symptoms.

Ans. B. Equipments required:

1. Basin (2): for without soap (1)

: for with soap (1)

2. Bucket (2): for clean hot water (1)

: for waste (1)

3. Jug (1)

4. Soap with soap dish (1)

5. Sponge cloth (2): for wash with soap (1)

: for rinse (1)

6. Face towel (1) : for dry the face

7. Bath towel (2) : for covering over mackintosh (1)

: for covering over client’s body (1)

8. Gauze piece (2-3)

9. Mackintosh (1)

10. Trolley (1)

11. Thermometer (1) : for check temperature

12. Old newspaper

13. Paper bag (2): for clean gauze (1)

: for waste (1)

Ans c. Procedure: complete bed bath

1. Confirm Dr.’s order Check client identification and condition.

Rationale : 1. The bath order may have changed.

2. In some instances a bed bath may be harmful for a client, who is in pain, hemorrhaging, or weak. Ns need to defer the bath.

2. Explain the purpose and procedure to the client. If he or she is alert or oriented, question the client about personal hygiene preferences and ability to assist with the bath.

Rationale : 1. Providing information fosters cooperation.

2. Encourage the client to assist with care and to promote independence.

3. Gather all required equipments.

Rationale : Organization facilitates accurate skill performance

4. Wash your hands and put on gloves.

Rationale : To prevent the spread of organisms. Gloves are optional but you must wear them if you are giving perineal and anal care.

5.Bring all equipments to bed-side.

Rationale : Organization facilitates accurate skill performance

6. Close the curtain or the door.

Rationale : 1. To ensure that the room is warm.

2. To maintain the client’s privacy.

7.Put the screen or curtain.

Rationale : To protect the client’s privacy.

8.Prepare hot water (60℃).

Rationale : Water will cool during the procedure.

9. Remove the client’s cloth. Cover the client’s body with a top sheet or blanket. If an IV is present on the client’s upper extremity, thread the IV tubing and bag through the sleeve of the soiled cloth. Rehang the IV solution. Check the IV flow rate.

Rationale : 1. Removing the cloth permits easier access when washing the client’s upper body.

2. Be sure that IV delivery is uninterrupted and that you maintain the sterility of the setup.

10.Fill two basins about two-thirds full with warm water(43-46℃or 110-115F).

Rationale : Water at proper temperature relaxes him/her and provides warmth. Water will cool during the procedure.

11.Assist the client to move toward the side of the bed where you will be working. Usually you will do most work with your dominant hand.

Rationale : Keep the client near you to limit reaching across the bed.

12. Face, neck, ears:

1) Put mackintosh and big towel Ⓐunder the

client’s body from the head to shoulders. Place

face towel under the chin which is also covered

the top sheet.

Rationale : To prevent the bottom sheet from making wet.

2) Make a mitt with the sponge towel and moisten

with plain water.

Rationale : Soap irritates the eyes.

3) Wash the client’s eyes. Cleanse from inner to

outer corner. Use a different section of the mitt to

wash each eye.

Rationale : Washing from inner to outer corner prevents

sweeping debris into the client’s eyes. Using a

separate portion of the mitt for each eye prevents

the spread of infection

4) Wash the client’s face, neck, and ears.

Use soap on these areas only if the client prefers.

Rinse and dry carefully.

Rationale : Soap is particularly drying to the face.

13. Upper extremities:

1) Move the mackintosh and big towel , A to under the client’s far arm.

Rationale :  To prevent sheet from making wet.

2) Uncover the far arm.

3) Fold the sponge cloth and moisten.

4) Wash the far arm with soap and rinse. Use long strokes: wrist to elbow→ elbow to shoulder→ axilla→ hand.

Rationale : 1. Washing the far side first prevents dripping bath water onto a clean area.

2. Long strokes improve circulation be facilitating venous return

5) Dry by face towel

6) Move the mackintosh and big towel , A to under the near arm and uncover it.

7) Wash, rise, and dry the near arm as same as procedure.

14. Chest and abdomen:

1) Move the mackintosh and bath towel , A to under the upper trunk.

2) Put another bath towel , to over the chest

3) Fold the sponge towel and moisten

4) Wash breasts with soap and rinse. Dry by the big

towel covering.

5) Move the bath towel covering the chest to abdomen.

6)Fold the sponge cloth and moisten.

7) Wash abdomen with soap, rinse and dry

8) Cover the trunk with top sheet and remove the bath towel from the abdomen.

Rationale : 1. Mackintosh and bath towel prevent sheet from wetting

2. Bath towel provides warmth and privacy

15. Exchange the warm water.

Rationale : Cool bath water is uncomfortable. The water is probably unclean. You may change water earlier if necessary to maintain the proper temperature.

16. Lower extremities:

1) Move the mackintosh and bath towel , A to under the far leg. Put pillow or cushion under the bending knee. Cover the near legg with bath towel .

2) Fold the sponge cloth and moisten.

3) Wash with soap, rinse and dry.Direction to wash: from foot joint to knee→ from knee to hip joint

4) Repeat the same procedure as on the near side.

5) Cover the lower extremities with top sheet Remove the cushion, mackintosh and big towel.

Rationale : Pillow or cushion can support the lower leg and makes the client comfort.

17. Turn the client on left lateral position with back towards you.

Rationale : To provide clear visualization and easier contact to back and buttocks care

18.Back and buttocks:

1) Move the mackintosh and big towel under the trunk.

2) Cover the back with big towel

3) Fold the towel and moisten. Uncover the back.

4) Wash with soap and rinse. Dry with big towel .

5) Back rub if needed.

6) Remove the mackintosh and big towel .

Rationale : Skin breakdown usually occurs over bony prominences. Carefully observe the sacral area and back for any indications.

19. Return the client to the supine position.

Rationale : To make sustainable position for perineal care

20. Perineal care:

Rationale : Clean the perineal area to prevent skin irritation and breakdown and to decrease the potential odor.

21.Assist the client to wear clean cloth.

Rationale : To provide for warmth and comfort

22.After bed bath:

1) Make the bed tidy and keep the client in comfortable position.

2) Check the IV flow and maintain it with the speed prescribed if the client is given IV.

Rationale : 1. These measures provide for comfort and safety

2. To confirm IV system is going properly and safely

23. Document on the chart with your signature and report any findings to senior staff.

Rationale : 1. Documentation provides coordination of care

2. Giving signature maintains professional accountability.

Ans. D. Record the care that has been undertaken, along with any abnormal finding and ensure you update the patient’s care plan. Contact the tissue viability specialist if you have any concerns about the patient’s skin.