Bathing advice for contractured patient

[Kaychell]

Yesterday was my first clinical at the nursing home. I observed a contractured bedbound patient being given a bed bath. The aide bathing the pt, did a quick bath and had some difficulties bathing the patients contractured hands without causing a significant amount of pain. I would like to select this patient to take care of next week. I'm looking for any suggestions you all might have on bathing the inside of the pt's hands without causing a lot of pain. One hand is significantly contracted (fingers balled into a fist). Do you all have any tips or suggestions? I would like to be able to give a really therapeutic bath to this patient.

[njmomstudent]

My first clinical involved a severly contracted patient. She was mostly unable to communicate as well. I made it a point to sit and talk with her very calmly and explain why I was there etc. Her husband visits on a daily basis, and I made sure to explain everything over and over, and repeat what I was doing whicle adding in, I'm getting you cleaned up before your husband gets here. That seemed to relax her more so I could atleast open her hands and adduct her arms just enough to squeeze my hand in to get to her axilla. Everytime I spoke to her I started with her name Mrs. X, then would proceed to ask her if she could help me get her washed and relax a bit. If she did loosen up for me I would tell her thank you, that helps so much, we want to make sure and get you ready for your husbands visit. I just kept reiterating everything, thanking her, asking her if she was okay or in pain. Even though she had very limited communication, you could tell she was in there and thankful for the care. She thanked me numerous times surprisingly and let me do oral care which she hadn't let anyone do for a long time. She smiled alot that day with the care and attention she received, even though everyone had described her as combative and irritable. One of the hardest parts was incontinence care because her legs were contracted as well with her legs constantly crossed. Its easiest to do all parts from behind while they are on thier side in that situation. My patient would not flex her hips at all, so you really have to "do the best you can" in alot of these situations. I hope that helps a bit. She also appreciated therapeutic touch. I rubbed the top of her back and shoulders and held her hands quite a bit. She also like grasping onto a thick rolled up washcloth too instead of having her nails digging into her palms.

[Forever Sunshine, ASN, RN]

Use a gauze roll or washcloth (dry) and put it in her palm. We have a treatment order for a patient with a contracture like this.

Get talking to her, help her with breakfast, allow her to warm up to you and trust you. Once she allows you to bathe her, use warm water as nobody likes a cold bath.

Ask to see if the patient could receive pain medication 1/2 hour before you start the bath.