Partial Bath or Sponge Bath
A partial bed bath consists of bathing the face, hands, axillae, back, buttocks, genital area, and under the breasts of female clients. This bath may be given as a partial bed bath or may be performed by the client while sitting in the bed or while in the bathroom (Fig. 50-8). A partial bath is given on days when the client does not receive or cannot tolerate a complete bed bath. Some clients are able to bathe themselves (except for the back). Encourage every client to do as much as possible for himself or herself; the person will exercise muscles and become more self-sufficient. The steps are similar to the complete bed bath, but bathing only the necessary areas of the body.
If the client is going to do his or her own sponge bath, help to set up the equipment needed. Remember to include the nurse call signal or pager. Check frequently to make sure the client is not feeling faint or does not need anything. You can assist with washing the back, if the client desires this. (The nurse can then assist the client to sit in the chair while the bed is being made.)
Complete Bed Bath
Give complete bed baths for clients who are comatose, catatonic, or unable to leave their bed because of therapeutic restriction. Careful preparation and planning are essential. (Do not leave the unit for forgotten equipment after the bath is started.) If the bath is interrupted, the water will become cold, and the client may become chilled. In addition, the client may become overtired.
FIGURE 50-8 · Some clients prefer to do their own partial bath at the bedside or in the bathroom.
Key Concept The bed bath provides you an opportunity to look closely at the condition of the client’s body Record the type of bath given and any significant observations.
Follow the steps in In Practice: Nursing Procedure 50-12 for the client who cannot move without assistance and requires a complete bed bath. Adjust this procedure to allow the person to do as much as is possible, considering his or her condition.
Specialized Baths
The sitz bath is a type of special bath in which the client’s buttocks are submerged in water. This is used after rectal surgery and sometimes after childbirth.
Therapeutic baths are frequently used to treat skin disorders. Medications or substances such as oatmeal are added to the water. Many times, these therapeutic baths are given in a whirlpool tub.
Another type of specialized bath is called the towel bath. Research has shown that simply giving a bath with a dry or damp towel helps improve circulation, offers some cleansing, and increases energy. In this procedure, a basin of water is not used. Instead, a dry or damp towel is rubbed against the client’s dry body, thereby creating friction. Friction produces warmth in the area, causing blood vessels to dilate. Dilation of the vessels, in turn, helps improve circulation and promotes a revitalized feeling in the client. Gentle to mild pressure in rubbing the body is all that is required. In some cases, lotion is used—called a lotion bath. While giving a towel or lotion bath, inspect the client’s skin and bony prominences for irritation, redness, swelling, or discharge. Usually, the nurse wears gloves for these baths.
Nursing Alert Certain conditions, such as hemorrhage, heart attack, and thrombophlebitis, contraindicate (negate the use of) friction or rubbing.
If a quick, efficient way of cleaning the body is needed, a bath in a bag (Bag Bath) is available. This bath system requires no water or soap. (It is also handy for backpackers or travelers and others who do not have access to shower facilities.)
Giving Perineal Care
Perineal care, bathing the genitalia and surrounding area, is commonly referred to as “peri care.” Some clients may be embarrassed, but this is part of total client care, even if a client is of the opposite sex. Maintain a professional, matter-of-fact attitude. If the client can manage his or her own needs, provide a wet washcloth, soap, rinse water, and a towel. Instruct the client to bathe the genitalia. You may need to speak in simple terms so the client understands the instructions. For example, you may say, “I’ll give you a washcloth so you can wash between your legs.” Remind the uncircumcised male client to retract the foreskin to cleanse the penis.
FIGURE 50-9 · (A) Cleanse the female’s vulva and perineum using downward strokes. (B) The male’s penis is cleansed from the tip toward the base. If the male is uncircumcised, the foreskin is retracted and the area under it is cleansed.
Perineal care is given to all clients. Those who have had perineal surgery or women who have delivered a baby will need special perineal care. Special perineal care is needed in some other cases as well. Examples include clients who are psychotic and unable to care for themselves, confused, very obese, paralyzed, or in a complete body cast, or those who have a urinary tract or vaginal infection.
Teach female clients to cleanse from front to back with tissue or sponges (Fig. 50-9A). The male client should cleanse from the tip of the penis toward the body (Fig. 50-9B). A perineal bottle (“peribottle”) is frequently used for women, although it may also be used for men. The peribottle is most commonly used in obstetrics and gynecology. This bottle is filled with warm tap water, sterile water, or saline, and the client thoroughly sprays the perineum, while sitting on the toilet or bedpan. This helps to keep the perineal area free of infection. Sometimes, cotton balls or sponges moistened with an antiseptic agent are used. In Practice: Nursing Procedure 50-13 outlines steps in giving perineal care.
Nursing Alert Client Education Teach the client to use each cotton ball or sponge only once. Teach the client to wipe the outside areas first, saving the last sponges for the urethral area.
SKIN INFESTATIONS
Care of the Client With Pediculosis
Pediculosis is the term for infestation by lice, tiny oval, gray insects that suck blood from the person they infest. Pediculosis also causes intense itching. Usually lice are found on hairy body parts. The eggs, called nits, look like dandruff, but are solid specks, not flakes. They cling tightly to hair shafts and are hard to remove or destroy. A special finetoothed pediculosis comb helps remove lice and nits. Lice spread disease. They cause itching, and the resulting scratches may become infected. They spread via clothing, bedding, and combs and brushes. Look for signs of skin irritation and lice when admitting any client to the healthcare facility.
Head lice (pediculosis capitis) are found in the hair and on the scalp. Body lice (pediculosis corporis) are found on the body and clothing. “Crab lice” are found on other hairy body parts, especially in the pubic area (pediculosis pubis). If scratches are noted in these areas of the client’s body, look for nits on the body or in the hair.
Both nits and adult lice can be destroyed by a routine treatment, often with a special shampoo or a shower with a specially medicated soap. If you observe lice in a client, report it to your team leader immediately. The healthcare provider will order specific treatment.
Scabies
Scabies is a common contagious condition caused by the itch mite. It usually occurs in warm, protected areas of the body, such as skin folds. The skin lesions cause intense itching (pruritus) and are easily spread from person to person. Treatment is similar to that for pediculosis.
Nursing Alert If you are shampooing or bathing a client with suspected pediculosis or scabies, wear a gown to protect your clothing. Do not touch the outside of the gown with bare hands. Wear gloves.
Nursing Alert If it is determined that a client has a parasitic skin infestation, it is vital to alert the family They will need to consult the primary healthcare provider to learn how to eliminate the parasites from their home. In the case of a school child, the school must also be notified.
The nurse must be alert for any skin, hair, or nail disorders when giving routine daily care. Any unusual condition must be reported immediately.
KEY POINTS
• Oral hygiene promotes comfort, cleanliness, and nutrition.
• Personal hygiene is important to the client’s self-esteem and health. Encourage the client to provide as much personal hygiene and self-care as possible.
• It is vital to inspect the client’s skin carefully on admission to a facility, and daily to make sure there are no signs of irritation or skin breakdown.
• Careful documentation and reporting are vital if you observe any reddened areas or skin breakdown.
• Special skin care is required for clients with any evidence of skin irritation or breakdown.
• Certain conditions, such as hemorrhage, heart attack, and thrombophlebitis, contraindicate vigorous rubbing of the skin or scalp.
• Shampooing the client’s hair allows you to inspect the scalp for disease, parasitic infestation, or injury, and to remove debris.
• Different types of hair require different methods of care.
• The skin is one of the body’s defenses against disease and infection. It must be kept clean and free of discharge or secretions.
• The backrub relaxes the client and provides an opportunity for you to observe the client’s skin.
• The shower or tub bath provides cleansing and is relaxing for the client.
• Clients need some level of skin cleansing daily.
• The bed bath provides an opportunity for you to observe the condition of the client’s skin.
