Chapter 31

Hygiene
Procedures Checklist
BATHING
Procedure 31-1 Bathing an Adult or Pediatric Client
Performed
Preparation Yes No Mastered Comments
1. Assess:
Condition of the skin
Fatigue
Presence of pain and need for
adjunctive measures before the
bath
Range of motion of the joints
Any other aspect of health that
may affect the client’s bathing
process
2. Assemble equipment and supplies:
Basin or sink with warm water
Soap and soap dish
Linens: bath blanket, two bath
towels, washcloth, clean gown or
pajamas or clothes as needed,
additional bed linen and towels,
if required
Gloves, if appropriate
Personal hygiene articles
Shaving equipment for male
clients
Table for bathing equipment
Laundry hamper
3. Determine:
The purpose and type of bath the
client needs
Self-care ability of the client
Any movement or positioning
precautions specific to the client
Other care the client may be
receiving
Client’s comfort level with being
bathed by someone else
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Prepare the client and the
environment:
Invite a family member or significant
other to participate, if desired.
Close windows and doors to ensure
the room is a comfortable
temperature.
Offer the client a bedpan or urinal, or
ask whether the client wishes to use
the toilet or commode.
Encourage the client to perform as
much personal self-care as possible.
During the bath, assess each area of
the skin carefully.
For a Bed Bath
5. Prepare the bed and position the
client appropriately.
Position the bed at a comfortable
working height. Lower side rail on
the side close to you. Keep the other
side rail UP. Assist the client to move
near you.
Place bath blanket over top sheet.
Remove the top sheet from under the
bath blanket by starting at client’s
shoulders and moving linen down
towards client’s feet. Ask the client to
grasp and hold the top of the bath
blanket while pulling linen to the foot
of the bed.
Note: If the bed linen is to be reused,
place it over the bedside chair. If it is
to be changed, place it in the linen
hamper.
Remove client’s gown while keeping
the client covered with the bath
blanket. Place gown in linen hamper.
6. Make a bath mitt with the
washcloth.
7. Wash the face.
Place towel under client’s head.
Wash the client’s eyes with water
only, and dry them well. Use a
separate corner of the washcloth for
each eye. Wipe from the inner to the
outer canthus.
Ask whether the client wants soap
used on her face.
Wash, rinse, and dry the client’s face,
ears and neck.
Remove the towel from under the
client’s head.
8. Wash the arms and hands.
Place a towel lengthwise under the
arm away from you.
Wash, rinse, and dry the arm by
elevating the client’s arm and
supporting the client’s wrist and
elbow.
Apply deodorant or powder if
desired.
Optional: Place a towel on the bed
and put a washbasin on it. Place the
client’s hands in the basin. Assist the
client as needed to wash, rinse, and
dry her hands, paying particular
attention to the spaces between her
fingers.
Repeat for hand and arm nearest you.
9. Wash the chest and abdomen.
Place bath towel lengthwise over
chest. Fold bath blanket down to the
client’s pubic area.
Lift the bath towel off her chest, and
bathe her chest and abdomen with
your mitted hand, using long, firm
strokes. Rinse and dry well.
Replace the bath blanket when the
areas have been dried.
10. Wash the legs and feet.
Expose the leg farthest from you by
folding the bath blanket towards the
other leg, being careful to keep the
perineum covered
Lift leg and place the bath towel
lengthwise under the leg. Wash, rinse,
and dry the leg, using long, smooth,
firm strokes from the ankle to the
knee to the thigh.
Reverse the coverings and repeat for
the other leg.
Wash the feet by placing them in the
basin of water.
Dry each foot.
Obtain fresh, warm bathwater now or
when necessary.
11. Wash the back and then the
perineum.
Assist the client into a prone or sidelying
position facing away from you.
Place the bath towel lengthwise
alongside the back and buttocks while
keeping the client covered with the
bath blanket as much as possible.
Wash and dry the client’s back,
moving from the shoulders to the
buttocks, and upper thighs, paying
attention to the gluteal folds.
Perform a back massage now or after
completion of bath.
Assist the client to the supine position
and determine whether the client can
wash the perineal area independently.
If the she cannot do so, drape the
client and wash the area.
12. Assist the client with grooming aids
such as powder, lotion, or deodorant.
Use powder sparingly. Release as
little as possible into the atmosphere.
Help the client put on a clean gown or
pajamas.
Assist the client to care for hair,
mouth, and nails.
For a Tub Bath or Shower
13. Prepare the client and the tub.
Fill the tub about one-third to onehalf
full of water at 43–46C
(110–115F).
Cover all intravenous catheters or
wound dressings with plastic
coverings, and instruct the client to
prevent wetting these areas, if
possible.
Put a rubber bath mat or towel on the
floor of the tub if safety strips are not
on the tub floor.
14. Assist the client into the shower or
tub.
Assist the client taking a standing
shower with the initial adjustment of
the water temperature and water flow
pressure, as needed.
Explain how the client can signal for
help, leave the client for 2–5 minutes,
and place an “occupied” sign on the
door.
15. Assist the client with washing and
getting out of the tub.
Wash the client’s back, lower legs,
and feet, if necessary.
Assist the client out of the tub.
16. Dry the client, and assist with
follow-up care.
Follow step 12.
Assist the client back to her room.
Clean the tub or shower in
accordance with agency practice,
discard the used linen in the laundry
hamper, and place the “unoccupied”
sign on the door.
17. Document:
Type of bath given
Skin assessment, such as
excoriation, erythema, exudates,
rashes, drainage, or skin
breakdown
Nursing interventions related to
skin integrity
Ability of the client to assist or
cooperate with bathing
Client response to bathing
Educational needs regarding
hygiene
Information or teaching shared
with the client or their family
Variation: Bathing Using a Hydraulic Bathtub Chair
Bring the client to the tub room in a
wheelchair or shower chair.
Fill the tub and check the water
temperature with a bath thermometer.
Lower the hydraulic chair lift to its
lowest point, outside the tub.
Transfer the client to the chair lift and
secure the seat belt.
Raise the chair lift above the tub.
Support the client’s legs as the chair
is moved over the tub.
Position the client’s legs down into
the water and slowly lower the chair
lift into the tub.
Assist bathing the client, if
appropriate.
Reverse the procedure when taking
the client out of the tub.
Dry the client and transport her to her
room.
PERINEAL–GENITAL CARE
Procedure 31-2: Providing Perineal–Genital Care
Performed
Preparation Yes No Mastered Comments
1. Assess for the presence of:
Irritation, excoriation,
inflammation, swelling
Excessive discharge
Odor, pain, or discomfort
Urinary or fecal incontinence
Recent rectal or perineal surgery
Indwelling catheter
2. Determine:
Perineal–genital hygiene
practices
Self-care abilities
Whether the client is
experiencing any discomfort in
the perineal–genital area
3. Assemble equipment and supplies:
Perineal–genital care provided in
conjunction with the bed bath
Bath towel
Bath blanket
Clean gloves
Bath basin with water at 43–46C
(110–115F)
Soap
Washcloth
Special perineal–genital care
Bath towel
Bath blanket
Clean gloves
Cotton balls or swabs
Solution bottle, pitcher, or
container filled with warm water
or a prescribed solution
Bedpan to receive rinse water
Moisture-resistant bag or
receptacle for used cotton swabs
Perineal pad
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how he or she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Prepare the client.
Fold the top bed linen to the foot of
the bed and fold the gown up to
expose the genital area.
Place a bath towel under the client’s
hips.
5. Position and drape the client and
clean the upper inner thighs.
For Females
Position the female in a back-lying
position with the knees flexed and
spread well apart.
Cover her body and legs with the bath
blanket. Drape the legs by tucking the
bottom corners of the bath blanket
under the inner sides of the legs.
Bring the middle portion of the base
of the blanket up over the pubic area.
Put on gloves, and wash and dry the
upper inner thighs.
For Males
Position the male client in a supine
position with knees slightly flexed
and hips slightly externally rotated.
Put on gloves, and wash and dry the
upper inner thighs.
6. Inspect the perineal area.
Note particular areas of inflammation,
excoriation, or swelling, especially
between the labia in females or the
scrotal folds in males.
Also note excessive discharge or
secretions from the orifices, and the
presence of odors.
7. Wash and dry the perineal–genital
area.
For Females
Clean the labia majora. Then spread
the labia to wash the folds between
the labia majora and the labia minora.
Use separate quarters of the
washcloth for each stroke, and wipe
from the pubis to the rectum. For
menstruating women and clients with
indwelling catheters, use clean wipes,
cotton balls, or gauze. Take a clean
ball for each stroke.
Rinse the area well.
Dry the perineum thoroughly.
For Males
Wash and dry the penis, using firm
strokes.
If the client is uncircumcised, retract
the prepuce to expose the glans penis
for cleaning. Replace the foreskin
after cleaning the glans penis.
Wash and dry the scrotum. The
posterior folds of the scrotum may
need to be cleaned in Step 9 with the
buttocks.
8. Inspect perineal orifices for
intactness.
Inspect particularly around the
urethra in clients with indwelling
catheters.
9. Clean between the buttocks.
Assist the client to turn onto the side
facing away from you.
Pay particular attention to the anal
area and posterior folds of the
scrotum in males. Clean the anus with
toilet tissue before washing it, if
necessary.
Dry the area well.
For post-delivery or menstruating
females, apply a perineal pad as
needed, from front to back.
10. Document:
Any unusual findings, such as
redness, excoriation, skin
breakdown, discharge, or
drainage
Any localized areas of tenderness
FOOT CARE
Procedure 31-3: Providing Foot Care
Performed
Preparation Yes No Mastered Comments
1. Assess:
Skin surfaces for cleanliness,
odor, dryness, and intactness
Each foot and toe for shape, size,
presence of lesions, areas of
tenderness, and ankle edema
Skin temperatures of the two feet
for circulatory status and the
dorsalis pedis pulses
Self-care abilities
2. Determine:
History of any problems with
foot odor; foot discomfort; foot
mobility; circulatory problems
Usual foot care practices
3. Assemble equipment and supplies:
Washbasin containing warm
water
Pillow
Moisture-resistant disposable pad
Towels
Soap
Washcloth
Toenail-cleaning and trimming
equipment
Lotion or foot powder
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how he can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Prepare the equipment and the client.
Fill the washbasin with warm water at
about 40–43C (105–110F).
Assist the ambulatory client to a
sitting position in a chair, or the bed
client to a supine or semi-Fowler’s
position.
Place a pillow under the bed client’s
knees.
Place the washbasin on the moistureresistant
pad at the foot of the bed for
a bed client, or on the floor in front of
the chair for an ambulatory client.
For a bed client, pad the rim of the
washbasin with a towel.
5. Wash the foot and soak it.
Place one of the client’s feet in the
basin and wash it with soap.
Rinse the foot well to remove soap.
Rub callused areas of the foot with
the washcloth.
If the nails are brittle or thick, and
require trimming, replace the water
and allow the foot to soak for 10–20
minutes.
Clean the nails as required with an
orange stick.
Remove the foot from the basin and
place it on the towel.
Repeat for second foot.
6. Dry the foot thoroughly and apply
lotion or foot powder.
Blot the foot gently with the towel to
dry it thoroughly, particularly
between the toes.
Apply lotion or lanolin cream.
Apply foot powder, if applicable.
Repeat for second foot.
7. If agency policy permits, trim the
nails of the first foot while the
second foot is soaking.
8. Document any foot problems
observed.
ORAL CARE
Procedure 31-4: Brushing and Flossing the Teeth
Performed
Preparation Yes No Mastered Comments
1. Assess:
The extent of the client’s selfcare
abilities
The client’s usual mouth care
practices
Inspect lips, gums, oral mucosa,
and tongue for deviations from
normal.
For presence of oral problems
such as tooth caries, halitosis,
gingivitis, or loose or broken
teeth
The client for bridgework or
dentures.
2. Assemble equipment and supplies:
Brushing and flossing
Towel
Disposable gloves
Curved basin (emesis basin)
Toothbrush
Cup of tepid water
Dentifrice (toothpaste)
Mouthwash
Dental floss, at least two pieces
20 cm (8 in) in length
Floss holder (optional)
Cleaning artificial dentures
Disposable gloves
Tissue or piece of gauze
Denture container
Clean washcloth
Toothbrush or stiff-bristled brush
Dentifrice or denture cleaner
Tepid water
Container of mouthwash
Curved basin (emesis basin)
Towel
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Prepare the client.
Assist the client to a sitting position
in bed, if health permits. If not, assist
the client to a side-lying position with
the head turned.
5. Prepare the equipment.
Place the towel under the client’s
chin.
Put on clean gloves.
Moisten the bristles of the toothbrush
with tepid water and apply the
dentifrice to the toothbrush.
Use a soft toothbrush and the client’s
choice of dentifrice.
For the client who must remain in
bed, place or hold the curved basin
under the client’s chin, fitting the
small curve around the chin or neck.
Inspect the mouth and teeth.
6. Brush the teeth.
Hand the toothbrush to the client, or
brush the client’s teeth as follows:
Hold the brush against the teeth
with the bristles at a 45-degree
angle The tips of the outer
bristles should rest against and
penetrate under the gingiva
Move the bristles up and down,
using a vibrating or jiggling
motion from the sulcus to the
crowns of the teeth.
Repeat until all outer and inner
surfaces of the teeth and sulci of
the gums are cleaned.
Clean the biting surfaces by
moving the brush back and forth
over them in short strokes.
If the tongue is coated, brush it
gently with the toothbrush.
Hand the client the water cup or
mouthwash to rinse the mouth
vigorously. Then ask the client to spit
the water and excess dentifrice into
the basin.
Repeat the preceding steps until the
mouth is free of dentifrice and food
particles.
Remove the curved basin and help the
client wipe her mouth.
7. Floss the teeth.
Assist the client to floss
independently, or floss the teeth as
follows:
Wrap one end of the floss around
the third finger of each hand.
To floss the upper teeth, use your
thumb and index finger to stretch
the floss. Move the floss up and
down between the teeth from the
tops of the crowns to the gum
and along the gum lines as far as
possible. Make a “C” with the
floss around the tooth edge being
flossed. Start at the back on the
right side and work around to the
back of the left side, or work
from the center teeth to the back
of the jaw on either side.
To floss the lower teeth, use your
index fingers to stretch the floss
and follow instructions as above.
Give the client tepid water or
mouthwash to rinse the mouth and a
curved basin in which to spit the
water.
Assist the client in wiping the mouth.
8. Remove and dispose of equipment
appropriately.
Remove and clean the curved basin.
Remove and discard the gloves.
9. Document assessment of the teeth,
tongue, gums, and oral mucosa.
Variation: Artificial Dentures
Procedure
1. Remove the dentures.
Put on gloves.
If the client cannot remove the
dentures, take the tissue or gauze,
grasp the upper plate at the front teeth
with your thumb and second finger,
and move the denture up and down
slightly.
Lower the upper plate, move it out of
the mouth, and place it in the denture
container.
Lift the lower plate, turning it so that
the left side, for example, is slightly
lower than the right, to remove the
plate from the mouth without
stretching the lips. Place the lower
plate in the denture container.
Remove a partial denture by exerting
equal pressure on the border of each
side of the denture, not on the clasps,
which can bend or break.
2. Clean the dentures.
Take the denture container to a sink.
Using a toothbrush or special stiffbristled
brush, scrub the dentures with
the cleaning agent and tepid water.
Rinse the dentures with tepid running
water.
If the dentures are stained, soak them
in a commercial cleaner.
3. Inspect the dentures and the
mouth.
Observe the dentures for any rough,
sharp, or worn areas that could irritate
the tongue or mucous membranes of
the mouth, lips, and gums.
Inspect the mouth for any redness,
irritated areas, or indications of
infection.
Assess the fit of the dentures.
4. Return the dentures to the mouth.
Offer some mouthwash and a curved
basin to rinse the mouth. If the client
cannot insert the dentures
independently, insert the plates one at
a time. Hold each plate at a slight
angle while inserting it, to avoid
injuring the lips.
5. Assist the client as needed.
Wipe the client’s hands and mouth
with the towel.
If the client does not want to or
cannot wear the dentures, store them
in a denture container with water.
Label the cup with the client’s name
and identification number.
6. Remove and discard gloves.
7. Document all assessments and
include any problems.
Procedure 31-5: Providing Special Oral Care
Performed
Preparation Yes No Mastered Comments
1. Assess:
Inspect lips, gums, oral mucosa,
and tongue for deviations from
normal.
Identify presence of oral
problems such as tooth caries,
halitosis, gingivitis, loose or
broken teeth.
Assess for gag reflex, when
appropriate.
2. Assemble equipment and supplies:
Towel
Curved basin (emesis basin)
Disposable clean gloves
Bite-block to hold the mouth
open and teeth apart (optional)
Toothbrush
Cup of tepid water
Dentifrice or denture cleaner
Tissue or piece of gauze to
remove dentures (optional)
Denture container, as needed
Mouthwash
Rubber-tipped bulb syringe
Suction catheter with suction
apparatus (optional)
Foam swabs and cleaning
solution for cleaning the mucous
membranes
Petroleum jelly (Vaseline)
Procedure
1. Explain to the client and the family
what you are going to do and why it
is necessary.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Prepare the client.
Position the unconscious client in a
side-lying position, with the head of
the bed lowered.
Place the towel under the client’s
chin.
Place the curved basin against the
client’s chin and lower cheek to
receive the fluid from the mouth.
Put on gloves.
5. Clean the teeth and rinse the mouth.
If the client has natural teeth, brush
the teeth. If the client has artificial
teeth, clean them as described in the
variation component of Procedure 31-
4.
Rinse the client’s mouth by drawing
about 10 mL of water or alcohol-free
mouthwash into the syringe and
injecting it gently into each side of
the mouth.
Watch carefully to make sure that all
the rinsing solution has run out of the
mouth into the basin. If not, suction
the fluid from the mouth.
Repeat rinsing until the mouth is free
of dentifrice, if used.
6. Inspect and clean the oral tissues.
If the tissues appear dry or unclean,
clean them with the foam swabs or
gauze and cleaning solution,
following agency policy.
Picking up a moistened foam swab,
wipe the mucous membrane of one
cheek. If no foam swabs are
available, wrap a small gauze square
around a tongue blade and moisten it.
Discard the swab or tongue blade in a
waste container and, with a fresh one,
clean the next area.
Clean all the mouth tissues in an
orderly progression, using separate
applicators: the cheeks, roof of the
mouth, base of the mouth, and
tongue.
Observe the tissues closely for
inflammation and dryness.
Rinse the client’s mouth as described
in step 5.
Remove and discard gloves.
7. Ensure client comfort.
Remove the basin, and dry around the
client’s mouth with the towel.
Replace artificial dentures, if
indicated.
Lubricate the client’s lips with
petroleum jelly. If the client is on
oxygen therapy, do not use petroleum
jelly, because it can cause burns to
the skin and mouth. Use another
mouth care product that does not have
petroleum in it.
8. Document:
Assessment of the teeth, tongue,
gums, and oral mucosa
Any problems such as sores or
inflammation and swelling of the
gums
HAIR
Procedure 31-6: Providing Hair Care for Clients
Performed
Preparation Yes No Mastered Comments
1. Assess:
Condition of the hair and scalp
Evenness of hair growth over the
scalp
Self-care abilities
2. Determine:
History of recent chemotherapy,
hypothyroidism, radiation of the
head, unexplained hair loss, and
growth of excessive body hair
Usual hair care practices and
routinely used hair care products
Whether wetting the hair will
make it difficult to comb
3. Assemble equipment and supplies:
Clean brush and comb
A wide-toothed comb is usually
used for many black-skinned
people, because finer combs pull
the hair into knots, and may
break the hair.
Towel
Hair oil preparation, if
appropriate
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Position and prepare the client
appropriately.
Assist the client who can sit to move
to a chair. If health permits, assist a
client confined to a bed to a sitting
position by raising the head of the
bed. Otherwise, assist the client to
alternate side-lying positions, and do
one side of the head at a time.
If the client remains in bed, place a
clean towel over the pillow and the
client’s shoulders. Place it over the
sitting client’s shoulders.
Remove any pins or ribbons in the
hair.
5. Remove any mats or tangles
gradually.
Mats can usually be pulled apart with
fingers or worked out with repeated
brushings.
If the hair is very tangled, rub alcohol
or an oil, such as mineral oil, on the
strands, to help loosen the tangles.
Comb out tangles in a small section
of hair toward the ends. Stabilize the
hair with one hand, and comb
towards the ends of the hair with the
other hand.
6. Brush and comb the hair.
For short hair, brush and comb one
side at a time. Divide long hair into
two sections by parting it down the
middle from the front to the back. If
the hair is very thick, divide each
section into front and back
subsections, or into several layers.
7. Arrange the hair as neatly and
attractively as possible, according
to the individual’s desires.
8. Document assessments and special
nursing interventions.
Variation: Hair Care for African-American Clients
Procedure
Position and prepare the client.
Untangle the hair first, if
appropriate.
Use fingers to reduce hair breakage
and discomfort. Move fingers in a
circular motion, starting at the roots
and gently moving up to the tip of the
hair.
Comb the hair
Apply hair oil preparation as the
client indicates.
Using a large and open-toothed comb,
grasp a small section of hair and,
holding the hair at the tip, start
untangling at the tip and work down
towards the scalp.
Oil
Warm the mixture.
Pour it into the hair and gently
massage.
Comb the hair.
Remove excess oil with a towel.
Oiling the hair
Part the hair in sections.
Place a small amount of hair oil on
the scalp.
Ask if the client would like his or her
hair braided.
Procedure 31-7: Shampooing the Hair of a Client Confined to
Bed
Performed
Preparation Yes No Mastered Comments
1. Assess:
Determine routinely used
shampoo products
Any scalp problems
Activity tolerance of the client
2. Determine:
Whether a physician’s order is
needed before a shampoo can be
given
The type of shampoo to be used
The best time of day for the
shampoo
3. Assemble equipment and supplies:
Comb and brush
Plastic sheet or pad
Two bath towels
Shampoo basin
Washcloth or pad
Bath blanket
Receptacle for the shampoo
water
Cotton balls (optional)
Pitcher of water
Bath thermometer
Liquid or cream shampoo
Hair dryer
Procedure
1. Explain to the client what you are
going to do, why it is necessary, if
appropriate, and how he can
cooperate.
2. Wash hands and observe other
appropriate infection control
procedures as needed.
3. Provide for client privacy.
4. Position and prepare the client
appropriately.
Assist the client to the side of the bed
from which you will work.
Remove pins and ribbons from the
hair, and brush and comb it to remove
any tangles.
5. Arrange the equipment.
Put the plastic sheet or pad on the bed
under the head.
Remove the pillow from under the
client’s head, and place it under the
shoulders, unless there is some
underlying condition.
Tuck a bath towel around the client’s
shoulders.
Place the shampoo basin under the
head, putting a folded washcloth or
pad where the client’s neck rests on
the edge of the basin. If the client is
on a stretcher, the neck can rest on the
edge of the sink, with the washcloth
as padding.
Fanfold the top bedding down to the
waist, and cover the upper part of the
client with the bath blanket.
Place the receiving receptacle on a
table or chair at the bedside. Put the
spout of the shampoo basin over the
receptacle.
6. Protect the client’s eyes and ears.
Place a damp washcloth over the
client’s eyes.
Place cotton balls in the client’s
ears, if indicated.
7. Shampoo the hair.
Wet the hair thoroughly with the
water.
Apply shampoo to the scalp. Make a
good lather with the shampoo while
massaging the scalp with the pads of
your fingertips.
Rinse the hair briefly, and apply
shampoo again.
Make a good lather and massage the
scalp as before.
Rinse the hair thoroughly this time to
remove all the shampoo.
Squeeze as much water as possible
out of the hair with your hands.
8. Dry the hair thoroughly.
Rub the client’s hair with a heavy
towel.
Dry the hair with the dryer. Set the
temperature at “warm.”
Continually move the dryer to
prevent burning the client’s scalp.
9. Ensure client comfort.
Assist the person confined to bed to a
comfortable position.
Arrange the hair using a clean brush
and comb.
10. Document the shampoo and any
assessments.
HEARING AIDS
Procedure 31-8: Removing, Cleaning, and Inserting a Hearing
Aid
Performed
Preparation Yes No Mastered Comments
1. Assess:
For the presence of
inflammation, excessive wax,
drainage, or discomfort in the
external ear
2. Determine:
If the client has experienced any
problems with the hearing aid
and hearing aid practices
3. Assemble equipment and supplies:
Client’s hearing aid
Soap, water, and towels, or a
damp cloth
Pipe cleaner or toothpick
(optional)
New battery (if needed)
Procedure
1. Explain to the client what you are going to do, why it is necessary,
andhow he can cooperate
2. Wash hands and observe other appropriate infection control procedures.
3. Provide for client privacy.
4. Remove the hearing aid.
Turn the hearing aid off and lower the volume.Remove the earmold by rotating it slightly forward and
pulling it outward. If the hearing aid is not to be used for several days, remove the battery. Store the
hearing aid in a safe place, and label with client’s name. Avoid exposure to heat and moisture.
5. Clean the earmold.
Detach the earmold if possible.
Disconnect the earmold from the
receiver of a body hearing aid, or
from the hearing aid case of behindthe-
ear and eyeglasses hearing aids
where the tubing meets the hook of
the case. Do not remove the earmold
if it is glued or secured by a small
metal ring.
If the earmold is detachable, soak it in
a mild soapy solution. Rinse and dry
it well. Do not use isopropyl alcohol.
If the earmold is not detachable, or is
for an in-the-ear aid, wipe the
earmold with a damp cloth.
Check that the earmold opening is
patent. Blow any excess moisture
through the opening, or remove
debris using a pipe cleaner or
toothpick.
Reattach the earmold if it was
detached from the rest of the hearing
aid.
6. Insert the hearing aid.
Determine from the client if the
earmold is for the left or the right ear.
Check that the battery is inserted in
the hearing aid. Turn off the hearing
aid, and make sure the volume is
turned all the way down.
Inspect the earmold to identify the ear
canal portion.
Line up the parts of the earmold with
the corresponding parts of the client’s
ear.
Rotate the earmold slightly forward,
and insert the ear canal portion.
Gently press the earmold into the ear
while rotating it backward.
Check that the earmold fits snugly by
asking the client if it feels secure and
comfortable.
Adjust the other components of a
behind-the-ear or body hearing aid.
Turn the hearing aid on, and adjust
the volume according to the client’s
needs.
7. Correct problems associated with
improper functioning.
If the sound is weak or there is no
sound:
Ensure that the volume is turned
high enough.
Ensure that the earmold opening
is not clogged.
Check the battery.
Ensure that the ear canal is not
blocked with wax.
If the client reports a whistling sound
or squeal after insertion:
Turn the volume down.
Ensure that the earmold is
properly attached to the receiver.
Reinsert the earmold.
8. Document pertinent data.
MAKING BEDS
Procedure 31-9 : Changing an Unoccupied Bed
Performed
Preparation Yes No Mastered Comments
1. Assess:
The client’s health status, to
determine that the person can
safely get out of bed
The client’s pulse and
respirations, if indicated
Note all the tubes and equipment
connected to the client.
2. Assemble equipment and supplies:
Two flat sheets, or one fitted and
one flat sheet
Cloth drawsheet (optional)
One blanket
One bedspread
Waterproof drawsheet or
waterproof pads (optional)
Pillowcases for the head pillows
Plastic laundry bag or portable
linen hamper, if available
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Place the fresh linen on the client’s
chair or overbed table; do not use
another client’s bed.
5. Assess and assist the client out of bed.
Make sure that this is an appropriate
and convenient time for the client to
be out of bed.
Assist the client to a comfortable
chair.
6. Strip the bed.
Check bed linens for any items
belonging to the client, and detach the
call bell or any drainage tubes from
the bed linen.
Loosen all bedding systematically,
starting at the head of the bed on the
far side and moving around the bed
up to the head of the bed on the near
side.
Remove the pillowcases, if soiled,
and place the pillows on the bedside
chair near the foot of the bed.
Fold reusable linens, such as the
bedspread and top sheet on the bed,
into fourths. First, fold the linen in
half by bringing the top edge even
with the bottom edge, then grasp it at
the center of the middle fold and
bottom edges.
Remove the waterproof pad and
discard it, if soiled.
Roll all soiled linen inside the bottom
sheet, hold it away from your
uniform, and place it directly in the
linen hamper.
Grasp the mattress securely, using the
lugs, if present, and move the
mattress up to the head of the bed.
7. Apply the bottom sheet and
drawsheet.
Place the folded bottom sheet with its
center fold on the center of the bed.
Make sure the sheet is hem-side down
for a smooth foundation. Spread the
sheet out over the mattress, and allow
a sufficient amount of sheet at the top
to tuck under the mattress.
Miter the sheet at the top corner on
the near side and tuck the sheet under
the mattress, working from the head
of the bed to the foot.
If a waterproof drawsheet is used,
place it over the bottom sheet so that
the center fold is at the center line of
the bed and the top and bottom edges
extend from the middle of the client’s
back to the area of the mid-thigh or
knee. Fanfold the uppermost half of
the folded drawsheet at the center or
far edge of the bed, and tuck in the
near edge.
Lay the cloth drawsheet over the
waterproof sheet in the same manner.
Optional: Before moving to the other
side of the bed, place the top linens
on the bed hem-side up, unfold them,
tuck them in, and miter the bottom
corners.
8. Move to the other side and secure
the bottom linens.
Tuck in the bottom sheet under the
head of the mattress, pull the sheet
firmly, and miter the corner of the
sheet.
Pull the remainder of the sheet firmly
so that there are no wrinkles.
Complete this same process for the
drawsheet(s).
9. Apply or complete the top sheet,
blanket, and spread.
Place the top sheet, hem-side up, on
the bed so that its center fold is at the
center of the bed and the top edge is
even with the top edge of the
mattress.
Unfold the sheet over the bed.
Optional: Make a vertical or a
horizontal toe pleat in the sheet to
provide additional room for the
client’s feet.
Vertical toe pleat: Make a fold in
the sheet 5–10 cm (2–4 in)
perpendicular to the foot of the
bed.
Horizontal toe pleat: Make a fold
in the sheet 5–10 cm (2–4 in)
across the bed near the foot.
Follow the same procedure for the
blanket and the spread, but place the
top edges about 15 cm (6 in) from the
head of the bed to allow a cuff of
sheet to be folded over them.
Tuck in the sheet, blanket, and spread
at the foot of the bed, and miter the
corner, using all three layers of linen.
Leave the sides of the top sheet,
blanket, and spread hanging freely,
unless toe pleats were provided.
Fold the top of the top sheet down
over the spread, providing a cuff.
Move to the other side of the bed, and
secure the top bedding in the same
manner.
10. Put clean pillowcases on the pillows
as required.
Grasp the closed end of the
pillowcase at the center with one
hand.
Gather up the sides of the pillowcase,
and place them over the hand
grasping the case. Then grasp the
center of one short side of the pillow
through the pillowcase.
With the free hand, pull the
pillowcase over the pillow.
Adjust the pillowcase so that the
pillow fits into the corners of the case
and the seams are straight.
Place the pillows appropriately at the
head of the bed.
11. Provide for client comfort and
safety.
Attach the signal cord so that the
client can conveniently use it.
If the bed is currently being used by a
client, either fold back the top covers
at one side or fanfold them down to
the center of the bed.
Place the bedside table and the
overbed table so that they are
available to the client.
Leave the bed in the high position if
the client is returning by stretcher, or
place in the low position if the client
is returning to bed after being up.
12. Document and report pertinent
data.
Variation: Surgical Bed
Procedure
Strip the bed.
Place and leave the pillows on the
bedside chair.
Apply the bottom linens as for an
unoccupied bed. Place a bath blanket
on the foundation of the bed, if this is
agency practice.
Place the top covers on the bed as you
would for an unoccupied bed. Do not
tuck them in, miter the corners, or
make a toe pleat.
Make a cuff at the top of the bed as
you would for an unoccupied bed.
Fold the top linens up from the
bottom.
On the side of the bed where the
client will be transferred, fold up the
two outer corners of the top linens so
they meet in the middle of the bed
forming a triangle.
Pick up the apex of the triangle, and
fanfold the top linens lengthwise to
the other side of the bed.
Leave the bed in high position with
the side rails down.
Lock the wheels of the bed if the bed
is not to be moved.
Procedure 31-10: Changing an Occupied Bed
Performed
Preparation Yes No Mastered Comments
1. Assess:
Note specific orders or
precautions for moving and
positioning the client.
Determine presence of
incontinence or excessive
drainage from other sources
indicating the need for protective
waterproof pad.
Assess skin condition and need
for special mattress, footboard, or
heel protectors.
2. Assemble equipment and supplies:
Two flat sheets, or one fitted and
one flat sheet
Cloth drawsheet (optional)
One blanket
One bedspread
Waterproof drawsheet or
waterproof pads (optional)
Pillowcases for the head pillows
Plastic laundry bag or portable
linen hamper, if available
Procedure
1. Explain to the client what you are
going to do, why it is necessary, and
how she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedures.
3. Provide for client privacy.
4. Remove the top bedding.
Remove any equipment attached to
the bed linen, such as a signal light.
Loosen all the top linen at the foot of
the bed, and remove the spread and
the blanket.
Leave the top sheet over the client, or
replace it with a bath blanket as
follows:
Spread the bath blanket over the
top sheet.
Ask the client to hold the top
edge of the blanket.
Reaching under the blanket from
the side, grasp the top edge of the
sheet and draw it down to the
foot of the bed, leaving the
blanket in place.
Remove the sheet from the bed
and place it in the soiled linen
hamper.
5. Change the bottom sheet and
drawsheet.
Assist the client to turn on the side
facing away from the side where the
clean linen is.
Raise the side rail nearest the client.
If there is no side rail, have another
nurse support the client at the edge of
the bed.
Loosen the foundation of the linen on
the side of the bed near the linen
supply.
Fanfold the drawsheet and the bottom
sheet at the center of the bed, as close
to the client as possible.
Place the new bottom sheet on the
bed, and vertically fanfold the half to
be used on the far side of the bed as
close to the client as possible. Tuck
the sheet under the near half of the
bed, and miter the corner if a contour
sheet is not being used.
Place the clean drawsheet on the bed
with the center fold at the center of
the bed. Fanfold the uppermost half
vertically at the center of the bed, and
tuck the near side edge under the side
of the mattress.
Assist the client to roll over toward
you onto the clean side of the bed.
Have the client roll over the fanfolded
linen at the center of the bed.
Move the pillows to the clean side for
the client’s use. Raise the side rail
before leaving the side of the bed.
Move to the other side of the bed, and
lower the side rail.
Remove the used linen and place it in
the portable hamper.
Unfold the fanfolded bottom sheet
from the center of the bed.
Facing the side of the bed, use both
hands to pull the bottom sheet so that
it is smooth, and tuck the excess
under the side of the mattress.
Unfold the drawsheet fanfolded at the
center of the bed and pull it tightly
with both hands. Pull the sheet in
three sections:
Face the side of the bed to pull
the middle section.
Face the far top corner to pull the
bottom section.
Face the far bottom corner to pull
the top section.
Tuck the excess drawsheet under the
side of the mattress.
6. Reposition the client in the center
of the bed.
Reposition the pillows at the center of
the bed.
Assist the client to the center of the
bed. Determine what position the
client requires or prefers, and assist
the client to that position.
7. Apply or complete the top bedding.
Spread the top sheet over the client,
and either ask the client to hold the
top edge of the sheet or tuck it under
the shoulders. The sheet should
remain over the client when the bath
blanket or used sheet is removed.
Complete the top of the bed.
8. Ensure the continued safety of the client.
Raise the side rails. Place the bed in
the low position before leaving the
bedside.
Attach the signal cord to the bed linen
within the client’s reach.
Put items used by the client within
easy reach.
9. Bed making is not normally
recorded.