1. 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

2. 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

3. 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 body a.Partial bath- done between complete baths, involves washing: face, hands, underarms, and then perineal area (done at least daily) a.Tub bath/whirlpool- relaxing method for those that can tolerate sitting in water a.Shower- must be strong enough to move or be moved. Often with use of a shower chair for safety or resident’s preference

4. Bathing Observe and report: a.Color changes of lips, skin, nail beds, and white of the eyes a.Rashes, dry skin, bruises, broken skin, reddened areas, abnormal skin temp a.Drainage, bleeding, complaints of pain or itching a.Excessive hair loss ***Always offer toileting needs before beginning, regardless of type of bath***

5. 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

6. 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 back c.Clean catheter from meatus out d.Retract and clean foreskin of uncircumcised male e.Separate labia of female f.Provide comfort with warm water, being gentle, and rinsing well. g.Know when to change gloves, water, & washcloths

7. 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

8. 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

9. 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 friction b.Keep nails short c.Check skin before beginning back rub d.Use good body mechanics e.Use long, smooth strokes up spine to shoulders to relax muscles f.Use short, circular strokes down sides of back from shoulders to lower back to stimulate circulation g.For 3-5 minutes

10. Bathing Have resident do as much as possible to promote independence Check water temp before resident checks it ISDH 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

11. 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