CHAPTER3

Bedsore Dressing
a oo
SNOILVGNNOJ ONISYNN JO seinpeoold puD sejdiouud
61
Preparation of the Nurse
Perform hand hygiene.
Maintain surgical asepsisduring the procedure

STEPS OF PROCEDURE AND RATIONALE

Stps Ratfonale
a Assist the patient to a comfortable position that u For proper dressing and easy access to the wound
provides easy access to the wound area area
a Put on clean disposable gloves and loosen the tape u Gloves protect the nurse from contaminated
on the old dressings. If necessary, use an adhesive dressings and prevent the spread of microorganisms
remover to help remove the tape Adhesive tape remover helps reduce patients
discomfort during removal of the dressing
oCarefully remove the soiled dressings. If any part of u Cautious removal of the dressing is more comfortable
the dressing sticks to the underlying skin, use small for the patient. Sterle saline provides for easier
amounts of sterile saline to help loosen and remove removal of the dressing and prevents tissue damage
the tape
a After removing the dressing, note the presence, u The presence of drainage should be documented.
amount, type, color and odor of any drainage on the Proper disposal of soiled dressings and used gloves
dressings. Place soiled dressings in an approprlate prevents the spread of microorganisms
waste receptacle. Remove your gloves
Using sterile technique, prepare a sterile work area Suppliesare within easy reach and sterility is

and open the needed supplies maintained

o Open the sterile cleaning solution. Depending on a Sterilty ofdressings and solution is maintained
the amount of solution required, the solution might
be poured directly over gauze sponges for small
cleaning jobs or in a container for larger wounds
a The use of sterlle gloves maintains surgical asepsis
Don sterilegloves
a Clean the wound from top to bottom and from the a Cleaningoccurs from theleast to most contaminated
center to the periphery, Following this pattern, use area. Using a single gauze for each wipe ensures that
new gauze for each wipe, placing the used gauze in theprevlously cleaned area is not contaminated
the waste receptacle., Do not touch any surface with again
the gloves or forceps

is cleaned, dry the area using a The growth of microorganisms may be retarded
Once the wound
gauze sponge in the same manner. Apply ointment andthe healing process is improved with the use of
or any other treatments if ordered ointments or other applications
a Applya layer ofdry sterile dressing over the wound u Primary dressing serves as a wick for drainage
a Place a second layer of gauze over the wound site Asecond layer provides for increased absorption of
drainage
o Applya surgical-pad over the gauze at the siteas the The dressing acts as additional protection for the
outermost layer of the dressing Wound against microorganisms
o Remove and discard sterile gloves, Apply tape to Tapeiseasier to apply after gloves has been removed
secure the dressings
u After securing the dressing, label dressing with date uRecording date and time provides communicatlon
and time, Remove all remaining equipment, place anddemonstratesadherence to plan of care. Proper
the patient in a comfortable position. Perform hand patient and bed positioning promotes safety, Hand
hygiene hygienepreventsthe spread of microorganisms
62 DOCUMENTATION

AFTER CARE AND

Remove all the articles.

a sterilization.
for
Clean the articles and send
a
equipment.
Replace the remaining appearance and drainage.
wound site,
Record theprocedure with

Points to Remem ber

for size, appearance and drainage.
a Inspectthe woundthe wound.
a Do not reach over
and form center to the periphery.
a Clean the wound from top to bottom
a Use a new gauze for each wipe.
CHAPTERR 4

Bed Bath

wwaw
12
DEFINITION
Bed bath refers to the procedure of giving bath to a patient who is confined to bed and is not phvsicalkr au

capable of self-care. mentally

PURPOSES OF BED BATH

a To clean the body.
a To increase elimination through skin.
aTo stimulate circulation.
aTo provide comfort and sense ofwell-being to the patient.
aTo provide active and passive exercises.
aTo relieve fatigue and induce sleep

INDICATIONS
Patient with impaired motor function, e.g. spinal cord injury.
Patient with altered level of conscious.
Confused or disoriented patient.
Patient in a state ofcoma.
Seriously ill patient.
Patient on mechanical ventilator.
Postoperative patient.
Patient with cast and traction.

PRELIMINARY ASSESSMENT
Preparation of the Patient
Assess the patient's need for bathing.
Check the patient's ability for self-care.
Ensure that the patient had meal before one hour.
Explain the procedure to the patient and his relatives to win his confidence and cooperation
Check for any specific precautions regarding the movement and positioning of the patient as per doctors orde
Observe of the skin to detect early signs of bedsore.
Give comfortable position to the client.
Bring the patient to the edge of the bed nearer to the nurse.
Kemove extra pillows and back rest, keep one pillow under the
9 Offera bed pan or urinal, patient's head, if condition permits.
Remove the top linen,
if necessary.
patient's
Tray containing articles for bed bathclothes
and cover with bath blanket.
is depicted in
Figure
1.

FIG. 1: Tray containing articles for bed bath

Preparation of Articles and their Purposes
Articles
Purposes
a Aclean tray containing for aTo take water for bath
bathbasin-2
a Sponge clothes-2
One to apply soap and the other to clean the skin (Fig. 2)

7
FIG. 2: Folding sponge cloth for bed bath
Smallbowl-1 T o keep the sponge cloth
Small bowl with wisp of wet
cotton T o clean the eye
swab
Soap with soap dish T o remove dirt from the skin
Bath towel-1 To dry the skin
Facetowel T o dry the face
Bath blanket T o cover the patient
Jugs-2 T o keep hot and cold water
Oil/powder T o treat the pressure points

Nail cutter Tocut the nails

Comband oil T o comb the hair

Kidney tray and paper bag T o collect the waste

Mackintosh and towel Toprevent bed from getting soiling
Bucket-1 T o discard the waste water

o A set of patient's clothes aTo change the clothing

Screen T o provide privacy

To discard the soiled linen
Ahamper bag
Bath thermometer T o check the temperature of the water

Environment
Preparation of the
Arrange all the articles conveniently,
OUnit should be neat and tidy,
Provide privacy by placing a screen.
o Close windows and doors and switch off fan/AC.

Preparation of the Nurse

o Nurse should have the knowledge about the procedure.
O She should wash her hands before and after the procedure.
S h e should maintain proper body mechanics.
14
RATIONALE
STEPS OF PROCEDURE AND

Steps Rationale
Toprevent cross infection
aWash the hands lead to skin burns
Mix hot and cold water in the basin Increasetemperature can
and check the temperature of
water
tolerance
(43°C-46C or 110 F-115°F) for
the
by placing elbow in water or using
bath thermometer
Ensures privacy and prevents chills for the patient (Fig. 3)
Remove patients clothing's and cover
with a bath blanket or bed sheet, expose
only that part of the body which is to be
cleaned

FIG.3: Removal of desired area cloth for bed bath; rest body is
covered with bath blanket

Put on gloves, ifnecessary o Glovesare necessary if there is potential contact with blood or

body fluids
This prevents chilling and keeps the bath blanket dry
Lay atowel across the patient's chest and
on top of bath blanket

Wipe one eye from the inner canthus to a Moving from the inner to the outer aspect prevents carrying
the outer canthus using wisp of cotton debris towardthe nasolacrimalduct (Fig.4)
dipped in clean water, Use separate
cotton for each eye

FIG.4: Cleaningeyes with the help of cotton wisp dipped in clean

water
Clean the patient's face, neck and ears.
Avoid soap on the face if the patient
Soap may have drying effect and may be avoided as a matter
of personal preference
prefers (Fig.5)

FIG.5: Cleaning the face, neck and ears of patient

Contd
15
Rationale
3 Expose the patient's far arm and place u The towel helps to keep the bed dry. Washing the far side first
towel across the chest diagonally, Using eliminates contaminating a clean area once it is washed. Long,
firm strokes, wash arm and then axilla, firm strokes are relaxing and more comfortable
lifting the arm as necessary to access
axillary region
a Place a towel on the bed next to the
patient's hand and put basin on it.
a Placing the hand in the basin of water is an additional comfort
measure for the patient
Soak the patients hand in basin. Wash,
rinse, if necessary and dry hand. Apply
appropriate emollient. Repeat actions for
the arm nearer to you
a Spread a towel under the patient's chest. To avoid unnecessary exposure and chilling, skin fold areas
Lower bath blanket to the patient's may be sources of odor and skin breakdown if not cleaned and
umbilical area wash, rinse, if necessary dried properly
and dry chest. Keep chest covered with
towel between the wash and rinse. Pay
special attention to skin folds under the
breasts
Lower bath blanket to perineal area. T o avoid unnecessary exposure and chilling, skin fold areas
Place a towel over the patient's chest. may be sources and skin breakdown if not cleaned and
ofodor
Wash, rinse and dry abdomen. Carefully dried properly
inspect and cleanse umbilical area and
any abdominal folds
Change waterif cold, dirty or soapy

Back of patient: To promote comfort and increase blood circulation

Turn patientto side lying or prone
position and expose back
O Place towel lengthwise alongside back
of patient
O Apply soap on the back and wipe it
O Do back massaging with oil or powder
(follow the steps of back care)

Change water
Turn patient back to supine position
Legs aSupporting the patient's foot and leg helps reduce strain and
o Place towel lengthwise under farther discomfort for the patient. Placing the foot in a basin of water
leg away tfrom you iscomfortable and allows for thorough cleaning of the feet
O Bend leg at knee, supporting under Promote blood circulation
leg and ask patient to hold position.
If patient is unable to do it, ask
another nurse/tamily member to
support leg-Use long, firm strokes
to wash from distal to proximal/from
ankle to knee and knee to thigh
O Wash, rinse and dry the extremity
o Fold towel and place beneath foot
of the patient. Place basin with
water under the foot and clean
with sponge cloth and dry the foot
properly"
OEncourage patient to clean perineal area DPromote patient's independence
with mitten. Discard it into a kidney tray

Contd
16
Rationale
Steps the patient's warmth and comfort
a This provides for
Position patientina comfortable
manner

clean gown
and helpthe patient put on a sense of well being
a To provide a
towel and
a Protect the pillow with a
hair
groom the patients of microorganisms
aTo prevent the spread
gloves and
aChange bed linen,
remove

perform hand hygiene

DOCUMENTATION
AFTER CARE AND
comfortable.
and make him
Put the patient'sclothes skin condition and patients
response.

R e c o r d the procedure
including the time,
and water and
unit. the used articles with soap
Tidy up the Discard the wastes
and clean
T a k e all the articles
to the utility room.
replace them in proper places.

Wash the hands

SCIENTIFIC PRINCIPLES

Anatomy and Physiology

lining the body openings.
T h e skin is the
continuation ofthe membranous
dermis.
and
S k i n is made up oftwo layers: epidermisfound in the skin.
glands are of well-
Sebaceous glands and sweat
and creates a sense
D stimulates n e r v e endings
with variety of n e r v e s . Bathing
b
regulation (Fig.
The skin is innervated organ and body temperature
excretion, sense
functions as anorgan ofsecretion,
beingskin
Sebaceous (oil)gland

Pore Hair

Epidermis
Sweat-
gland
Nerve- -Dermis
ending

Blood-
vessels
Subcutaneous
layer
Hair follicle
Erector pili

FIG. 6: Structure of skin

17

Microbiology
Manybacteria are found normally on the skin between the superficial horny cells.
aPerspiration helps to protect the body from invasion of bacteria.
aBacteria and yeasts decrease rapidly on dry healthy skin.
The urse must wash her hands before and after the procedure to prevent cross infection.
a proper distance from the patients face to avoid transmission of diseaseby
a Nurse should hold
droplet infection.
her head at a

Physics and Chemistry

of the warm water
Wateris a goodconductorof heat, so the heat maybe conveyed to the skin by the application
debris the skin.
Soap lowers the surface tension of water and helps it to unite quickly with the fat and
on

a Soap has high capillarity, so that it spreads readily over a surface.

Before starting the sponge the patient should be moved to the working side of the bed to avoid strain and fatigue.
constituent of sweat is urea.
T h e acidity of the sweat is protection against bacterial infection, chief organic
a

Sweatwith high sugar content is an excellent medium for microorganisms.

Psycholog9y
Explain the procedure to the patient to get the cooperation.
Provide privacy throughout the procedure. It gives psychological comfort to the patient.

a Communicate to the patient while sponging.

Points to Remem ber

blood supply to digestive organ and interfere
a Avoid bathing a patient immediately after a meal as it depletes the
with the digestion.
o Use bath blanket to prevent drought.
to skin burn.
Temperature of the water should be (43°C-46°C or 110°F-115°F) prevent
Remove the soap completely to avoid the drying effects
of soap on the patient's skin.