Lesson 10: Activities of Daily Living (Bathing/Shampoo/Perineal Care)

Objectives•Explain the importance of bathing

•Describe what factors determine the type, time, and frequency of bathing a resident

•Name what parts of the body are washed during a partial bath

•Explain why perineal care is so important

•Describe what observations can be made during bathing

•Identify the recommended temp for bathing

•Explain the benefits of a back rub

•Demonstrate draping and undraping, back rub, shower, bed bath, and perineal care, bed shampoo

Bathing

• Keeps skin healthy and prevents skin problems

• State Reg.: Resident bathed as frequently as needed, but at least 2 x week

• ~cleans skin of perspiration, dirt, germs• ~increases circulation to skin• ~promotes comfort and well being

Bathing• Time, frequency & type of bath depends on resident’s

preferences and condition (past habits, current health/abilities)

Types of baths: a. Complete bed bath- unable to leave the bed involves

washing entire bodyb. Partial bath- done between complete baths, involves

washing: face, hands, underarms, and then perineal area(done at least daily)

c. Tub bath/whirlpool- relaxing method for those that can tolerate sitting in water

d. Shower- must be strong enough to move or be moved. Often with use of a shower chair for safety or resident’s preference

BathingObserve and report:

a. Color changes of lips, skin, nail beds, and white of the eyes

b. Rashes, dry skin, bruises, broken skin, reddened areas, abnormal skin temp

c. Drainage, bleeding, complaints of pain or itching

d. Excessive hair loss***Always offer toileting needs before beginning, regardless of type of bath***

Bed Bath• Privacy- door, curtain, drape• Start with eyes (inner to outer corner)• Wash and rinse face, neck, ears and behind ears• Remove gown• Far arm, Near arm-hands up to armpit/shoulder• Chest & Abdomen• Far leg, Near leg-hip to toes• Change water, wash hands, new gloves, new cloths• Cath Care (meatus to 4 inches down catheter tubing),

otherwise peri care (front only)• Change water, wash hands, new gloves, new cloths• Lateral position, clean anal area front to back• Change water, wash hands, new gloves, new cloths• Wash from neck to buttocks, supine, help dress or gown

Perineal Care• Cleaning the genital and anal area to prevent infection and

odor and improve resident’s comfort

• Routine part of complete bed bath, but also as needed between baths especially for: incontinence, diarrhea, and skin irritation or discharge

When performing peri care:a. Provide privacy and dignity. Drape.b. Standard Precautions. Clean front to backc. Clean catheter from meatus outd. Retract and clean foreskin of uncircumcised malee. Separate labia of femalef. Provide comfort with warm water, being gentle, and rinsing

well.g. Know when to change gloves, water, & washcloths

Whirlpool/Tub Bath• Procedure depends on whirlpool/tub type• In general there will usually be a lift bath

trolley or a tub chair designed specifically for the tub

• Clean with washcloth and soap and rinse using shower handle

• Will need 3 washcloths and 2 towels• If tub has a reservoir, be sure to fill it first• Still follow same order as bed bath

*Head to Toe, Clean to Dirty, Inward, Outward

Bed Shampoo

• Shampooing hair should be done at least 1 time a week

• Done in bed if they are not able to get out of bed to shower

• Follow RCP #33

Back Rubs• Offered after a bath and before bedtime• Keep skin healthy and prevent skin breakdown• Stimulate circulation and relieve tension

*Bedridden resident’s need more frequently*

When giving a back rub:a. Use lotion to reduce frictionb. Keep nails shortc. Check skin before beginning back rubd. Use good body mechanicse. Use long, smooth strokes up spine to shoulders to relax

musclesf. Use short, circular strokes down sides of back from

shoulders to lower back to stimulate circulationg. For 3-5 minutes

Bathing• Have resident do as much as possible to promote

independence

• Check water temp before resident checks itISDH used to recommend temp at point of use between

100º-120ºF; bath temp approx. 105ºF• Never leave unattended in bathing/shower room

• Clean tub/shower and shower chair before & after each use

• Always help resident in and out of shower to prevent falls

• Wash from cleanest to dirtiest

• Dry skin by patting with a towel

Lesson 10: Activities of Daily Living (Bathing/Shampoo/Perineal Care)

Objectives

•Explain the importance of bathing•Describe what factors determine the type, time, and frequency of bathing a resident•Name what parts of the body are washed during a partial bath•Explain why perineal care is so important•Describe what observations can be made during bathing•Identify the recommended temp for bathing•Explain the benefits of a back rub

•Demonstrate draping and undraping, back rub, shower, bed bath, and perineal care