Bed Baths, I dread giving them. - page 8

OK, so now I'm going to split my 0.6 FTE on our small rural hospital 6 bed CCU/Stepdown unit half and half, 12 hour days and 12 hour nights, since some rare weekday dayshifts opened up. I'm keeping... Read More

  1. by   twotrees2
    awesome post

    Quote from Flatbelly
    It takes me 30 minutes to give a complete bedbath, but I work with experienced CNAs who manage to give a bedbath in about 20 minutes. If the pt is very heavy, has severe contractions, is on a vent or for any other reason can't cooperate, it of course takes longer. We do, however, use no-rinse soap, just lather it up and dry the skin with towels. Very dirty pts also need more time, especially when their hair has to be washed.
    Ask the patient if he/she has a problem with nudity, you'll be surprised how many of them don't mind being stark naked, as long as it's only you in their room This makes the job a lot easier and quicker. Be tactful, some pts are... ashamed to admit they are ashamed, you have to 'feel' them.

    Some tips (I assume I don't need to explain the basics of bedmaking, precautions, ect.):

    1. Turn the heat up, I set in on 80! Don't forget to turn it down when you are finished. Pause tube feeding, check all IVs and caths, so that nothing gets ripped out while giving the bath. Don't ask how I know this

    2. Get the clean linens, the gown and the bathing supplies. Assume the worst, get the barrier creams, powder ect. even if you think they may not be needed, it's very annoying when you have to run out of the room for things, especially when bathing a pt in isolation. Some things may pop out during the bath, you can't always check beforehand. Pts who need bedbaths often have skin in bad condition.

    I use at least 10 washcloths, so that I don't have to rinse them in the basin, just throw them into the 'dirties' bag. Fill the basin with very warm (almost hot) water as it cools on the washcloth, place everything you need within reach. A lot of washcloths also means you don't have to change the water, or change it only once when it becomes too cold. Put all washcloths in the basin in advance.
    I double glove for patients that passed stool.

    3. Close the door. If it's not a single pt room, draw the bed curtains. Get the bed up as high as you need.

    4. Do oral care first, as it can be done without lowering the head of the bed. Ditto for washing the face and hands. Include the forgettables - the neck, throat, ears. The gown does not have to be taken off for this. If possible, let the pt do this him-/herself. People feel better when not treated as complete invalids. I use a separate washcloths for the
    - face (no soap)
    - hands
    - throat, neck and ears

    5. Lower the head, remove blanket and sheet, wash the front of the body, including legs (1 washcloth) and armpits (separate washcloths for each pit). If the pt wants to be covered up with a bath sheet, break up the job into 2 parts: upper body first, lower second. Don't forget to clean the area under the breasts. If I have a big breasted lady, I put some powder underneath the breasts. I also put some powder on the armpits, unless the pt wants deodorant/antiperspirant or nothing at all. Ask before you do anything and always check the skin before applying anything. I've had some pts develop a horrible rash after using the antiperspirant provided by the hospital

    6. Pericare. If the pt is incontinent and has a soiled diaper, some stool may work its way up, you will need a few washcloths for this job. Tuck the front of the diaper under the buttocks, so not to smear the stool. Remove as much stool as you can with toilet paper, except when the skin is irritated - dragging dry paper over irritated skin can make it worse. Get into all the nooks and crannies, dry completely and use powder only in the skin folds. Some pts may need to have a protective or barrier cream applied.

    7. Roll pt to his/her side, wash back and legs (1 washcloth), buttocks and anus last (1 washcloth, more if stool is present). Roll up the sheets, place new ones under the pt, put a new diaper (if needed) under the pt. Use creams mentioned above if necessary. We don't use any creams on pts with healthy skin.

    8. Roll pt to other side, pull sheets and diaper into proper position, roll pt to his/her back, close diaper, dress pt in a clean gown.

    9. Cover pt, place a towel under his/her feet, wash the feet.

    10. Cover feet, tuck the corners of the sheet and blanket under mattress.

    11. Comb the pt's hair. It's better to do rise the head of the bed for this.

    12. Lower the bed and pull up the rails. Clean up and turn the heat down.

    Of course, if the pt is getting up after the bath instead of staying in bed, leave the bedmaking for later.

    I like giving bedbaths, as it is the time I make best contact with the pt. If the pt doesn't want to or can't talk back, I talk to him/her anyway and always try to explain what I am about to do and why. Except, of course, in the case of pts I already know. If it's evident the pt is getting tired or irritated by my talking, I shut up

    I always try to use lotion, it gives the pt a feeling of luxury in the rather dismal place a hospital can be. Applying lotion doesn't take long, and the massage associated with it is soothing, especially on the back. I put the bottle of lotion in warm water when I prepare the bedbath, co it's not cold when applied. I carry a extra bottle in my cart, as lotion is among the things that disappear from the pyxis faster than Speedy Gonzales can run. Soap does too!

    If the pt is very smelly and a regular bedbath doesn't remove the funk, we use a bit (only a bit!) of iodine in the bathwater. It really helps! We often have neglected pts from bad nursing homes, homeless pts - some of them so dirty you wouldn't believe The homeless usually come from the ER where they had a quick shower, but these showers are really 'quick' and only remove the worst stuff.

    If the pt has dentures, remove, clean and place them in the denture cup before the bath. This way they are ready to be put back in the pt's mouth when you're finished bathing. I've had some pts sleep with their dentures in, mainly because the night shift CNA forgot to remove them So check this.

    It takes time to become an expert My first bedbath took me over an hour! And I'm still far from being an expert. Never plan your day to the minute, a bedbath can be full of surprises that will eat up time: dressings that have to be changed, additional stool coming out when a pt with diarrhea coughs (always right after you change the sheets) and the rest of the usual stuff that is supposed to be expected, but hoped not to happen. For the same reason, leave the extras, like braiding the hair, for later, when you're done with all of your patients.