Nursing, Personal Care Attendant (PCA)

Bed Baths



Bed Baths: Bed Baths may be required for various reasons. Your client may be too ill to get up temporarily, or this could be a long-term, chronic condition.

Ask your client if she needs to use the bathroom: After completing SWIPES, ask your client if she needs to use the bathroom before beginning her bath. Lower the side rail on the side of the client you will be working from. The other rail should stay up for client safety. It can also be used to help a client brace or pull on if they need to turn or reposition during the bath.

Cover the client, and bedclothes, with a bath blanket: Cover the client, and bedclothes, with a bath blanket. Remove the top bed linens while keeping the client covered with the bath blanket. Remove any clothes the client is wearing while keeping the bath blanket in place and not exposing the client. "This blanket will keep you covered and warm while I help you with your bath. I'm removing the linens so that they don't get wet, okay?" The bath basin should be no more than two thirds full to reduce spillage. Feel of the water in the basin to make sure the temperature is comfortable. Ask the client to feel it and adjust as necessary. Change water that is soapy or cold. "Does the water feel too hot or cold? I'll be happy to adjust it for you."

Clean the client's face: Clean the client's face with the warm, wet cloth without using soap. Do this first, wiping gently around the eyes, from the inner corner to the outer. Wipe each eye with a different part of the washcloth. This may be something the client can do for their self. They may also wash the ears and neck at this time. Dry the face, neck and ears using a patting motion with a clean soft towel. Encourage your client to do as much of the washing as possible. Give your client the warm, soaped, washcloth and plenty of time. Expose only the part of the body that is being washed. Leave the rest of the body covered with the bath blanket, protecting the client's privacy and body temperature. You can use this time to perform ROM joint exercise and gently massage each limb while washing the exposed area. Avoid using force or over-extending joints or limbs during the task.

Wash the arms: To wash the arms place a towel under the exposed and extended limb. Cup the client's elbow in your hand and let the client's wrist rest at your elbow so that you are supporting the extremity. Wash the arm, shoulder, underarm, and forearm. Use long firm strokes with the washcloth. Rinse the extremity and dry. With the basin sitting on a towel, help the client put her hand in the water. Wash it well, and perform nail care if needed. Dry the hand with massaging movements. Place the arm you have just washed back under the bath blanket. Repeat the process on the other arm. "I am going to wash your arms. Let me know if the water gets too cool and I will replace it."

Washing your client's chest: To wash your client's chest, place a bath towel across the chest area. Reach under the towel and bring the bath blanket down to the waist. Make sure the towel stays in place while you are removing the blanket, preserving the client's dignity and privacy. Lift the towel just enough to wash the chest area while the client is still covered. Rinse and pat the chest dry. Make sure the area under the breasts is thoroughly dry. Leave the towel covering the chest while you wash the abdomen. Fold the bath blanket down to the pubic area. Wash, rinse, and dry the abdomen. Put the bath blanket back up to the shoulders. Cover both arms, and remove the towel covering the chest from underneath.

Washing your client's legs and toenails: To wash the legs uncover one leg without exposing the genitals. Place a towel under the foot and leg that you are going to wash first. If possible, bend the knee, supporting the leg with one arm. Wash the leg with long strokes. Rinse the leg. If possible, wash the foot in the basin of water. You may do toenail care during this part of the process. Remember to get between the toes and beneath the toes in all folds and crevices. If you cannot maneuver the foot into the basin, use your washcloth and pay attention to all areas of the foot and toes. Dry the foot and toes thoroughly. Cover with the bath blanket and repeat these steps on the other leg. "After I wash your feet I will need to trim your toenails, okay?" At this point, you will need to change the water and test the temperature again before proceeding. "I need to change your bath water. I'll be right back so we can finish up."

WWashing the back and buttocks: To wash the back and buttocks, help your client turn toward the side rails that are up. If possible, the client should grasp the side rail for stability. Remove the bath blanket from the back and buttocks. Spread a bath towel along the bed, close to the client's back to catch drips. Wash the back starting at the back of the neck and shoulders, and work toward the buttocks with long, firm, strokes. Continue to the lower part of the buttocks. Rinse the back and buttocks and pat dry. Use lotion to give your client a backrub. If possible, encourage the client to do his own perineal care. Provide privacy, asking him to signal you when finished. Give your client ten minutes of privacy, and check on his progress. If the client cannot complete this task, you will need to provide the perineal care. Make sure the room is tidy and that dirty linens have been removed. If needed, raise the side rail. Wash your hands.