Bathing an Adult Client

Definition: The removing of accumulated oil, perspiration, dead skin cells, and some bacteria.
Purpose:

 To remove transient microorganisms, body secretions and excretions, and dead skin cells
 To stimulate circulation to the skin
 To promote a sense of well-being
 To produce relaxation and comfort
 To prevent and eliminate unpleasant body odors
Equipment/ Supplies:

1. Basin or sink with warm water (between 43°C and 46°C [110°F and 115°F])
2. Soap and soap dish
3. Linens: bath blanket, two bath towels, washcloth, clean gown or pajamas or clothes as
needed, additional bed linen and towels, if required
4. Clean gloves, if appropriate (e.g., presence of body fluids or open lesions)
5. Personal hygiene articles (e.g., deodorant, powder, lotions)
6. Shaving equipment
7. Table for bathing equipment
8. Laundry bag
Assessment Rationale:

 Physical or emotional factors (e.g., Provides for patient’s safety.

fatigue, sensitivity to cold, need for
control, anxiety or fear)

 Condition of the skin (color, texture and
turgor, presence of pigmented spots,
temperature, lesions, excoriations,
abrasions, and bruises). Areas of erythema
(redness) on the sacrum, bony
prominences, and heels should be
assessed for possible pressure sores
Provides baseline for comparison of skin
integrity over time
Risk factors increase the likelihood of injury
to the skin because of pressure, impaired
tissue synthesis, softening of or friction on
tissues, and impaired circulation

 Presence of pain and need for adjunctive

measures (e.g., an analgesic) before the Patient comfort and reduces further pain
bath

 Range of motion of the joints A patient who has decreased activity

 Any other aspect of health that may affect
the client’s bathing process (e.g.,
mobility, strength, cognition)
tolerance or mobility (e.g., chest pain or
shortness of breath) may have limited ability
to bathe. Having the patient assist as much as
possible increases mobility and sense of
control.
 Need for use of clean gloves during the PPE prevent the spread of microorganisms
bath
Nursing Diagnosis:

 Risk for infection

 Activity intolerance
 Impaired skin integrity
 Bathing/self-care deficit
 Impaired physical mobility
 Risk for impaired skin integrity
 Deficient knowledge regarding skin care
Planning:
1. Expected outcomes following completion of procedure:
 Skin is free of excretions, drainage, or odor.
 Skin shows decreased redness, cracking, flaking, and scaling.
 Joint ROM remains same or improves from previous Measurement
 Patient expresses sense of comfort and relaxation
 Patient tolerates bath without fatigue or chilling
 Patient describes benefits and techniques of proper hygiene and skin care.
2. Gather equipment and supplies.
3. Adjust room temperature and ventilation
4. Explain procedure and ask patient for suggestions on how to prepare supplies. If partial
bath, ask how much of bath patient wishes to complete.
5. If it is necessary to leave the room, be sure that call light is within reach of patient.
Implementation Rationale
Preparation

Before bathing a client, determine (a) the purpose and type of bath the client needs; (b) self-
care ability of the client; (c) any movement or positioning precautions specific to the client; (d)
other care the client may be receiving, such as physical therapy or x-rays, in order to
coordinate all aspects of health care and prevent unnecessary fatigue; (e) client’s comfort level
with being bathed by someone else; and (f) necessary bath equipment and linens. Caution is
needed when bathing clients who are receiving IV therapy. Easy-to-remove gowns that have
Velcro or snap fasteners along the sleeves may be used. If a special gown is not available, the
nurse needs to pay special attention when changing the client’s gown after the bath (or
whenever the gown becomes soiled). In addition, special attention is needed to reassess the IV
site for security of IV connections and appropriate taping around the IV site. The nurse should
use universal precautions when bathing a client, particularly when performing perineal care. It
is not necessary, however, to wear gloves while providing a bath and the nurse should use
clinical judgment when deciding to wear gloves and offer an explanation to the client
(Downey & Lloyd, 2008).
Performance

1. Prior to performing the procedure, Identifying the patient ensures the right
introduce self and verify the client’s patient receives the intervention and helps
 identity using agency protocol. Explain to
the client what you are going to do, why it
is necessary, and how he or she can
participate. Discuss with the client their
preferences for bathing and explain any
unfamiliar procedures to the client.
2. Perform hand hygiene and observe other
appropriate infection control procedures
3. Provide for client privacy by drawing the
curtains around the bed or closing the
door to the room. Some agencies provide
signs indicating the need for privacy
4. Prepare the client and the environment.
prevent errors. Discussion promotes
reassurance and provides knowledge about
the procedure. Dialogue encourages patient
participation and allows for individualized
nursing care.
Hand hygiene and PPE prevent the spread of
microorganisms. PPE is required based on
transmission precautions.
Hygiene is a personal matter

 Invite a family member or significant Patient comfort and encourage family

other to participate if desired or requested participation in patient’s care
by the client.
 Close windows and doors to ensure the Air currents increase loss of heat from the
room is a comfortable temperature body by convection.
 Offer the client a bedpan or urinal or ask Warm water and activity can stimulate the
whether the client wishes to use the toilet need to void. The client will be more
or commode comfortable after voiding, and voiding before
cleaning the perineum is advisable
 Encourage the client to perform as much This promotes independence, exercise, and
personal self-care as possible. self-esteem.
 During the bath, assess each area of the Provides baseline for comparison of skin
skin carefully integrity over time
For a Bed Bath
5. Prepare the bed and position the client
appropriately.
This avoids undue reaching and straining and
 Position the bed at a comfortable working promotes good body mechanics. It also
height. Lower the side rail on the side ensures client safety.
close to you. Keep the other side rail up.
Assist the client to move near you.
 Place bath blanket over top sheet. Remove The bath blanket provides comfort, warmth,
the top sheet from under the bath blanket and privacy.
by starting at client’s shoulders and
moving linen down toward client’s feet. Note: If the bed linen is to be reused, place it
Ask the client to grasp and hold the top of over the bedside chair. If it is to be changed,
the bath blanket while pulling linen to the place it in the linen hamper, not on the floor.
foot of the bed.
 Remove client’s gown while keeping the This provides uncluttered access during the
client covered with the bath blanket. Place bath and maintains warmth of the patient.
gown in linen hamper. Maintains the patient’s modesty
6. Make a bath mitt with the washcloth A bath mitt retains water and heat better than
a cloth loosely held and prevents ends of
washcloth from dragging across the skin.
For the triangular method and

A B C D
Figure 1 Making a bath mitt, triangular method. A, Lay your hand on the washcloth; B, fold the top
corner over your hand; C, fold the side corners over your hand; D, tuck the second corner under the
cloth on the palm side to secure the mitt.

For the rectangular method of making a bath mitt.

A B C

Figure 2. Making a bath mitt, rectangular method. A, Lay your hand on the washcloth and fold one
side over your hand; B, fold the second side over your hand; C, fold the top of the cloth down and
tuck it under the folded side against your palm to secure the mitt.
7. Wash the face. Begin the bath at the cleanest area and work
downward toward the feet
 Place towel under client’s head Placement of towels prevents soiling of bed
linen and bath blanket.
 Wash the client’s eyes with water only Using separate corners prevents transmitting
and dry them well. Use a separate corner microorganisms from one eye to the other.
of the washcloth for each eye. Wipe from the inner to the outer canthus

 Using 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
the face.
This prevents secretions from entering the
nasolacrimal ducts.
Soap has a drying effect, and the face, which
is exposed to the air more than other body
parts, tends to be drier
 Wash, rinse, and dry the client’s face,
ears, and neck. Apply appropriate
emollient.
 Remove the towel from under the client’s
head.
8. Wash the arms and hands. (Omit the arms
for a partial bath.)
 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. Use long, firm
strokes from wrist to shoulder, including
the axillary area.
 Apply deodorant or powder if desired.
Special caution is needed for clients with
respiratory alterations.
 Optional: Place a towel on the bed and put
a washbasin on it. Place the client’s hands
in the basin.
 Repeat for hand and arm nearest you.
Exercise caution if an IV infusion is
present, and check its flow after moving
the arm. Avoid submersing the IV site if
the dressing site is not a clear, transparent
dressing.
9. Wash the chest and abdomen. (Omit the
chest and abdomen for a partial bath.
However, the areas under a woman’s
breasts may require bathing if this area is
irritated or if the client has significant
perspiration under the breast.)
 Place bath towel lengthwise over chest.
Fold bath blanket down to the client’s
pubic area.
Move sequentially through the bath to make it
less tiring for the patient and more efficient
for the nurse.
Use of emollients is recommended to restore
and maintain skin integrity (Voegeli, 2008a;
Watkins, 2008; Brown & Butcher, 2005).
Prevents soiling of clean linens during bed
change and cross contamination to
other body sites
It protects the bed from becoming wet.
Firm strokes from distal to proximal areas
promote circulation by increasing venous
blood return.
Powder is not recommended due to the
potential respiratory adverse effects.
Many clients enjoy immersing their hands in
the basin and washing themselves. Soaking
loosens dirt under the nails. Assist the client
as needed to wash, rinse, and dry the hands,
paying particular attention to the spaces
between the fingers.
clear transparent dressing will keep water
from an IV site; however, a gauze dressing
becomes contaminated when it becomes wet
with the water.
Exposing, washing, rinsing, and drying one
part of the body at a time avoids unnecessary
exposure and chilling.
Secretions and dirt collect easily in areas of
tight skinfolds. Skin under breasts is
vulnerable to excoriation if not kept clean and
dry.
Keeps the client warm while preventing
unnecessary exposure of the chest.
 Lift the bath towel off the chest, and bathe
the chest and abdomen with your mitted
hand using long, firm strokes. Give
special attention to the skin under the
breasts and any other skin folds,
particularly if the client is overweight.
Rinse and dry well.
 Replace the bath blanket when the areas
have been dried.
10. Wash the legs and feet. (Omit legs and
feet for a partial bath.)
 Expose the leg farthest from you by
folding the bath blanket toward 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. Pay particular attention to
the spaces between the toes. If preferred,
wash one-foot after that leg before
washing the other leg.
 Obtain fresh, warm bathwater now or
when necessary.
Because surface skin cells are removed
with washing, the bathwater from dark-
skinned client’s may be dark, however,
this does not mean the client is dirty.
Lower the bed and raise the side rails
when refilling the basin.
11. Wash the back and then the perineum.
 Assist the client into a prone or side-lying
position facing away from you. Place the
bath towel lengthwise alongside the back
and buttocks while keeping the client
Exposing, washing, rinsing, and drying one
part of the body at a time avoids unnecessary
exposure and chilling.
Secretions and dirt collect easily in areas of
tight skinfolds. Skin under breasts is
vulnerable to excoriation if not kept clean and
dry.
Keeps the client warm while preventing
unnecessary exposure
Covering the perineum promotes privacy and
maintains the client’s dignity
Washing from the distal to proximal areas
promotes circulation by stimulating venous
blood flow.
Keeps the client warm while preventing
unnecessary exposure
Placing the feet in the basin of water is an
additional comfort measure for the patient. It
facilitates thorough washing of the feet and
between the toes and aids in removing debris
from under the skin.
Secretions and moisture are often present
between toes, predisposing patient to
maceration and skin breakdown.
Water may become dirty or cold.
This ensures the safety of the client.
This provides warmth and undue exposure.
 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
 Remove and discard gloves if used.
 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 client
cannot do so, drape the client as shown in
Providing Perineal-Genital Care and
wash the area.
12. Assist the client with grooming aids such
as powder, lotion, or deodorant.
 Use powder sparingly. Release as little as This will avoid irritation of the respiratory
possible into the atmosphere
 Help the client put on a clean gown or
pajamas.
For a Tub Bath or Shower
13. Prepare the client and the tub.
Maintains the principle of “clean to dirty.”
The sacral area is a common site of pressure
sores.
Prolonged pressure on the sacral area or other
bony prominences may compromise
circulation and lead to development of
decubitus ulcer
Prevents transferring microorganisms
from anal to genital area—cleansing
the gluteal and anal areas contaminate the
washcloth, towel, and water. Maintains
standard precautions during the bath and
prevents soiling of clean linens during bed
change and cross contamination to
other body sites.
backrub improves circulation to the tissues
and is an aid to relaxation. A backrub may be
contraindicated in patients with
cardiovascular disease or musculoskeletal
injuries. Use of emollients is recommended to
restore and maintain skin integrity (Voegeli,
2008a; Watkins, 2008; Brown & Butcher,
2005). Skin barriers protect the skin from
damage caused by excessive exposure to
water and irritants, such as urine and feces
(Voegeli, 2008a).
Provides for clear visualization of perineal
area
Dry skin results in reduced pliability and
cracking. Moisturizers help to prevent skin
breakdown. Prevents body odor
tract by powder inhalation. Excessive powder
can cause caking, which leads to skin
irritation.
Assist the client to care for hair, mouth, and
nails. Some people prefer or need mouth care
prior to their bath.
 Fill the tub about one-third to one-half full
of water at 43°C to 46°C (110°F to
115°F).
 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. Some clients need a chair to sit on
in the shower because of weakness. Hot
water can cause older people to feel faint
due to vasodilation and decreased blood
pressure from positional changes.
 If the client requires considerable
assistance with a tub bath, a hydraulic
bathtub chair may be required
 Explain how the client can signal for help,
leave the client for 2 to 5 minutes, and
place an “occupied” sign on the door. For
safety reasons, do not leave a client with
decreased cognition or clients who may be
at risk (e.g., history of seizures, syncope).
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. If the
client is unsteady, place a bath towel over
the client’s shoulders and drain the tub of
water before the client attempts to get out
of it.
16. Dry the client, and assist with follow-up
care.
 Follow step 12.
 Assist the client back to his or her bed.
 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.
Sufficient water is needed to cover the
perineal area.
Dressing becomes contaminated when it
becomes wet with the water.
These prevent slippage of the client during the
bath or shower.
Reduce the risk of falling and ensure safety
Adjust water temperature prevents accidental
burns. Older adults and clients with
neurological alteration (e.g., spinal cord
injury) are at high risk for burns as a results of
reduced sensation. Use of assistive devices
facilitates bathing and minimize physical
exertion.
Reduce the risk of falling and ensure safety
Ensure safety and maintains privacy
Bathrooms should be equipped with signaling
devices in case client feels faint or weak or
needs immediate assistance. Clients prefer
privacy during bath, provided that it is safe to
do so.
Reduce the risk of falling and ensure safety
These are hard to reach areas and patient may
need assistance with these areas
Draining the water first lessens the likelihood
of a fall. The towel prevents chilling.
Maintains warmth to prevent chilling
Maintains relaxation gained from bathing
Prevents transmission of infection and
maintains clean environment
Evaluation:

 Note the client’s tolerance of the procedure (e.g., respiratory rate and effort, pulse rate,
behaviors of acceptance or resistance, statements regarding comfort).
 Conduct appropriate follow-up, such as determining:
o Condition and integrity of skin (dryness, turgor, redness, lesions, and so on).
o Client strength. Note range of motion and circulation, movement, and sensation for
all extremities.
o Percentage of bath done without assistance.
 Relate to prior assessment data, if available.
Recording and Reporting:

Type of bath given (i.e., complete, partial, or self-help). This is usually recorded on a flow
sheet.
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 participate with bathing.
Client response to bathing. Also, document the need for reassessment of vital signs if
appropriate.
Educational needs regarding hygiene.
Information or teaching shared with the client or their family.
Reference:
Berman, A., Synder, S. J., Koizer, B., Erb’s, G. (2016). Kozier & Erb’s Fundamentals of
nursing: Concepts, process, & practice (10th ed.). New Jersey: Pearson Education

Hilton, P. (2004). Fundamental Nursing Skills. Whurr Publishers Ltd

Perry, Anne., Potter, P., & Ostendorf, W. (2014) Clinical Nursing Skills & Techniques (8 th
ed.). Mosby, Inc., and Elsevier Inc.

Rosdahl, C., & Kowalski, M. (2012). Textbook of Basic Nursing (10th ed.). Wolters Kluwer
Health Lippincott Williams & Wilkins.

Treas, L., Wilkinson, J. (2014). Basic Nursing Concepts, Skills & Reasoning. A. Davis
Company

Taylor, C., Lillis, C., LeMone, P., Lynn, P. (2011). Fundamental of Nursing The art and
Science of Nursing Care (7th Ed.). Lippincott Williams & Wilkins

Yoost, B., Crawford, L. (2016). Fundamentals of Nursing- E-Book: Active Learning for
Collaborative Practice. Elsevier