Bathing
Performing a Complete or Partial Bed Bath
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Safety
- Observe standard precautions, including wearing clean gloves. Other personal protective equipment (PPE) may be necessary, depending on the patient’s condition.
- Check the floors for spills, and make sure equipment is working properly.
- Assess and control the bathwater temperature, especially for patients with reduced sensation,.
- Avoid hot or excessively cold water, and use a mild cleansing agent that minimizes irritation.
- Do not soak the feet of a patient with diabetes or peripheral vascular disease.
- Follow the package instructions when warming a disposable bath-in-a-bag product.
- To avoid injuring the eyes, ask the patient if he is wearing contact lenses.
- During the bath, assess for signs of warmth, redness, swelling, tenderness, and pain in the lower extremities, because these might be early signs of deep vein thrombosis (DVT).
- Avoid using force and friction when bathing a patient. Do not massage reddened areas, especially over bony prominences. Massage of the legs is also contraindicated, because a blood clot may be present and could become dislodged. Do not use massage for pressure ulcer prevention.
- If one of a patient’s extremities is injured or immobilized, dress the affected side first.
Equipment
(Roll cursor over items to see labels)
Washcloths and bath towels
Bath blanket
Cleansing product for bath
Toiletry items (deodorant, lotion)
Clean hospital gown or patient's own pajamas or gown
Linen bag
Clean gloves
Washbasin two-thirds full of warm water
Disposable bath-in-a-bag product if a basin and water bath is not performed
Eye patches or shields and nonallergenic tape (for an unconscious patient)
PrintableDelegation
The skill of a complete or partial bed bath, or a bath using a disposable bath-in-a-bag product, can be delegated to nursing assistive personnel (NAP). Before delegating, be sure to teach about the following:
- Not massaging reddened skin areas during bathing
- Not soaking the feet or trimming the toenails if contraindicated for the patient
- Reporting to you any changes in the skin or perineal area and any signs of impaired skin integrity
- Proper positioning of a male or female patient with musculoskeletal limitations or an indwelling Foley catheter or other equipment, such as intravenous tubing
Preparation
- Assess the patient’s tolerance for bathing and activity, comfort level, cognitive ability, and musculoskeletal function. Determine whether the patient has shortness of breath. If partial bathing out of bed or a self-bath is to be performed, assess the patient’s fall risk status.
- Assess the patient’s visual status, ability to sit without support, hand grasp, and range of motion (ROM) of the extremities.
- Assess for the presence and position of external medical devices or equipment.
- Assess the patient’s bathing preferences, including frequency, time of day, and hygiene products used.
- Ask if the patient has noticed any problems related to the condition of the skin and genitalia.
- Before or during the bath, assess the condition of the patient’s skin. Note any dryness, indicated by flaking, redness, scaling, and cracking, and any excessive moisture, inflammation, or pressure ulcers.
- Identify risks for skin impairment, or use a pressure ulcer assessment tool.
- Review orders for specific precautions concerning the patient’s movement or positioning.
- Gather all necessary equipment and supplies.
- Adjust the room temperature and ventilation for the patient’s comfort.
- Explain the procedure, and ask the patient for suggestions on how to prepare supplies. If a partial bath is planned, ask how much of the bath the patient wishes to complete.
Follow-up
- Observe the skin, paying particular attention to areas that were previously soiled, reddened, flaking, scaling, or cracking, or that showed early signs of breakdown. Also, inspect areas normally exposed to pressure.
- Observe the patient’s range of motion during bathing.
- Ask the patient to rate his or her level of comfort (on a scale of 0 to 10).
- Ask if the patient feels fatigued.
- Report signs of altered skin integrity to the nurse in charge or to the health care provider.
Documentation
- Record the procedure, including how much the patient participated and how the patient tolerated the procedure.
- Record the condition of the skin and any significant findings, such as reddened areas, bruises, nevi, and joint or muscle pain.
- Report any evidence of altered skin integrity, breaks in a suture line, or increased wound secretion to the nurse in charge or to the health care provider.
Review Questions
1. Which instruction would the nurse give when asking nursing assistive personnel (NAP) to give a complete bed bath to a patient?
Do not massage any reddened areas on the patient's skin. 
Be sure to wash the patient's face with soap. - Disconnect the intravenous tubing when changing the gown.
- Wear gloves if necessary.
CORRECT. The nurse should instruct the NAP not to massage any reddened areas on the patient’s skin.
INCORRECT. When washing the face, the NAP should ask the patient if he or she wants soap to be used.
INCORRECT. Intravenous tubing should not be disconnected when changing the patient's gown.
INCORRECT. The NAP should be instructed to wear gloves when bathing a patient.
2. The nurse has washed a patient’s abdomen. Which area should the nurse wash next?
INCORRECT. The feet are washed after the legs.
INCORRECT. The face is washed at the beginning of a bath.
INCORRECT. The chest is washed before the abdomen.
CORRECT. The legs should be washed after the abdomen.
3. A patient is being given a bed bath. The nurse realizes that another washcloth is needed to complete the bath. What is one way in which the nurse can ensure the patient's safety?
- Use the call light to ask someone else to bring a washcloth.
- Raise all four side rails on the patient's bed.
- Make sure the call light is within the patient's reach.
- Raise the bed to its highest position.
INCORRECT. This option is not particularly realistic. The nurse can take steps to ensure the patient's safety while leaving the room to retrieve the washcloth.
INCORRECT. Raising all four side rails on the bed is considered a restraint and raises the risk of falling.
CORRECT. Placing the call light within easy reach reduces the likelihood that the patient will fall while trying to get out of bed in the nurse's absence.
INCORRECT. The patient's bed should be in the locked, low position, to minimize the risk of falling if the patient tries to get out of bed.
4. Which patient should not have his or her feet soaked during a complete bed bath?
- A patient with arthritis
- A patient who has just complained of shoulder pain
- A patient with diabetes mellitus
- A patient who is nauseated
INCORRECT. Soaking the feet is not contraindicated in a patient with arthritis.
INCORRECT. Soaking the feet is not contraindicated in a patient with shoulder pain.
CORRECT. Soaking the feet is contraindicated in a patient with diabetes mellitus, because such patients may have reduced sensation in the feet.
INCORRECT. Soaking the feet is not contraindicated in a patient who is nauseated.
5. The nurse is bathing a patient who is unconscious. What should the nurse do to ensure safe care of the patient’s eyes?
- Remove eye crusts with soapy water.
- Avoid closing the patient's eyes.
- Use eye patches or shields taped in place.
- Tape the patient's eyelids closed.
INCORRECT. Soap should not be used to cleanse the eyes.
INCORRECT. The eyes should be closed gently, using the back of a fingertip.
CORRECT. An eye shield or patch should be placed over each eye and taped in place.
INCORRECT. Tape should not be used on the eyelids.
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