RETDEM SCRIPT: BATHING THE CLIENT IN BED

Good morning, everyone, I am Darren Cadiente and I’m going to perform today my return
demonstration bathing the client in bed
For a brief rationale, bathing removes accumulated oil, perspiration, dead skin cells and some
bacteria. It stimulates circulation through a warm or hot bath – dilating superficial arterioles and
bringing more blood and nourishment to the skin. Furthermore, it produces a sense of well-
being. It is refreshing and relaxing that frequently improves morale, appearance and self-
respect.
Bathing the client in bed starts with assessment, then the nursing diagnosis, followed by the
planning then implementation and the evaluation.
For the assessment, we begin the procedure by assessing the patient’s tolerance for
bathing like activity tolerance, comfort level and cognitive ability. This determines the patient's
ability to perform and tolerate bathing and acquired level of assistance.
Next, assess the patient's vital status. This determines the degree of assistance that the patient
may need for the bathing.
Third, assess the presence of equipment such as IV line, foley catheter etc. This affects how
you plan bathing and positioning. It also helps you to determine how to set up supplies.
Then, assess the patient's preferences for bathing like its frequency, type of hygienic products
used etc. This helps to promote patient’s comfort and willingness to cooperate.
Next assessment is to ask if the patient has noticed any problems related to the condition of
skin and genitalia. This provides you information to direct physical assessment of skin and
genitalia and influences selection of skin care products.
Then, assess the condition of the patient's skin before or during bath, noting presence of
dryness if applicable. This provides a baseline for comparison over time in determining whether
bathing improves a patient's skin.
Lastly, assess a patient's knowledge of skin hygiene in terms of its importance. This determines
the patient's learning needs.
For the nursing diagnosis, absence of bathing increases the risk of a patient in compromised
human dignity, impaired skin integrity and self-care deficit. Bathing promotes hygiene and well-
being.
For the planning phase, review orders for specific precautions concerning patient’s movement
and positioning. This prevents injury to patients during bathing and determines the level of
assistance needed.
Lastly, prepare all the necessary equipment and supplies needed for the procedure. This
includes washcloths and bath towels, bath blankets, soap and soap dishes, toiletry items, toilet
tissue or wipes, warm water, clean hospital gown, laundry bag, clean gloves when necessary
and washbasin. This avoids interrupting procedure or leaving the patient unattended to retrieve
missing supplies.
For the implementation phase, prior to the procedure, I will introduce myself to the client and
identify my client’s identity through agency protocol. I will explain the procedure to be
performed, why it is important and how he/she participates in the procedure. This alleviates the
patient's anxiety and helps to gain the patient's trust and cooperation for the procedure.
Then, I will provide my client privacy. This alleviates fear and anxiety, protecting his/her dignity.
Then, I will offer a patient bedpan or urinal, providing toilet tissue. Because the patient feels
more comfortable after voiding and prevents interruption.
Then, I will perform a thorough hand hygiene, this reduces transmission of infection and
prevents patients from latex allergy when applicable.
Next, I will verify that the bed is in a locked position and raise the bed to a comfortable working
height. This prevents the bed from moving, helping the nurse to reach the patient without
stretching or reaching across, minimizing strain on back muscles.
Then, I will place the blanket over the patient and loosen it. Remove top covers without
exposing my patient. If applicable, I will let my patient hold the top of the bath blanket and place
soiled linen in the laundry bag. Because a bath blanket provides warmth and privacy during
bathing.
Then, I will remove the patient's gown or pajamas taking into consideration possible equipment
attached to the patient’s arms. This provides full body exposure during the bathing process.
Next, I will pull the side rail up, lowering the bed temporarily to the lowest position and raise it to
a comfortable height on return after filling the washbasin with water 2/3 full.
Place the basin and supplies on an over-bed table, check the water temperature and place the
patient's fingers to check the patient's tolerance. If desired, place a plastic container of bath
lotion in bath water to warm. This provides the patient's safety and comfort during bathing.
Then, lower the side rail, remove the pillow if tolerated and raise the head of bed 30-45 degrees
if allowed. Place the bath towel under the patient's head and the second bath towel over the
patient's chest. This aids access to your patient, minimizing strain on back muscles. Placing a
bath towel prevents bed linen and bath blankets from getting wet.
Wash the patient's face. Ask if the patient has contact eyes. Fold washcloth around fingers of
your hand to form a mitt. Wash the patient's eyes with plain warm water and ask if the patient
prefers soap on the face. Soap and clean, running water to remove dirt, oil, and unwanted
debris from your face.
Wash the trunk and upper extremities. Remove the bath blanket from the patient's arm that is
closest to you. Raise and support the arm above head, if possible, to wash, rinse and dry axilla
thoroughly. Move to the other side of bed and repeat the mentioned steps with another arm.
Place the bath towel across the patient chest so it covers the chest and arms and fold the bath
blanket down to the umbilicus. Rinse and dry well. Secretions and dirt collect easily in areas of
tight skinfolds. Skin under breast is vulnerable to excoriation if not kept clean and dry.
Then, wash hands and nails. Fold the bath towel in half and lay it on bed beside the patient.
Place the basin on a towel. Immense patient’s hands in water, allowing to soak for 2-3minutes
before washing hand and fingernails. Remove the basin and dry the hand well. Repeat on the
other hand. Soaking softens cuticles and calluses of hand, loosens debris on nails. Thorough
drying removes moisture between fingers.
Then, check the temperature of bath water and change water when cool and soapy. Warm
water maintains patient comfort. Alkaline soap residue is irritating to skin and can decrease acid
pH normal protectiveness.
Next step, wash the abdomen. Place the bath towel lengthwise over the chest and abdomen.
Fold the bath blanket down to just above pubic region. Lift a bath towel with one hand. With the
mitted hand, bathe and rinse the abdomen, giving special attention to umbilicus and skinfolds of
abdomen and groin. Stroke from side to side keeping abdomen covered between washing and
rinsing. Rinse and dry well.  
Then, apply a clean gown or pajama top. If an extremity is injured or immobilized, dress the
affected side first. This maintains patient warmth and comfort. Dressing affected side first
allows manipulation of gown over body with reduce range of motion
Then, wash the lower extremities. Cover chest and abdomen with top of the bath blanket.
Cover legs with bottom of blanket. Expose the near leg by folding the blanket toward midline,
ensuring the other leg and perineum are draped. This prevents unnecessary exposure.
Then, place a bath towel under leg, supporting leg and knee and ankle. Place the patient's foot
in the bath basin to soak while washing and rinsing if applicable. If a patient is unable to support
leg, cleaning can be done by washing feet thoroughly with washcloth.
Wash legs using long, firm strokes from ankle to knee to thigh. Do not rub or massage the back
of the calf. Rinse and dry well. Clean and clip nails as needed and remove and discard the
towel.
Then, raise the side rail, move to the opposite side of the bed, lower the side rail and repeat
steps for the other leg and foot. If the skin is dry, apply moisturizer. Cover the patient with a
bath blanket when finished.
Then, cover the patient with a bath blanket, raising the side rail for safety, remove soiled gloves
and perform hand hygiene. Change the bath water. Clean water reduces microorganism
transmission to perineal structures.
Next, wash the back. Perform hand hygiene and apply a clean pair of gloves as indicated.
Lower side rail. Assist the patient into a prone or side-lying position as needed. Place the towel
lengthwise along the patient's side and keep him or her covered with a bath blanket.
Keep the patient draped by a sliding bath blanket over shoulders and thighs during bathing.
Wash, rinse and dry back from neck to buttocks using long, firm strokes. Move from back to
buttocks to anus, paying special attention to folds of buttocks and anus.
If fecal material is present, enclose in a fold of under pad or toilet tissue and remove with
disposable wipes. Clean the buttocks and anus, washing from front to back. Clean, rinse and
dry the area thoroughly. Place a clean absorbent pad under buttocks if needed.
Remove contaminated gloves. Raise the side rail and perform hand hygiene. Return to bed and
lower the side rail, giving a back rub. This promotes relaxation for the patient.
Apply additional body lotion or oil to patient skin as needed. Moisturizing lotion prevents dry,
chapped skin.
Remove soiled linen and place in a dirty-linen bag. Clean and replace bathing equipment then
wash hands. This reduces transmission of pathogens.
Assist patients in dressing. Comb patient’s hair. Women may want to apply makeup. Help as
needed. This promotes the patient's body image.
Then, make the patient's bed. This provides a clean, comfortable environment.
Check function and position of external devices like indwelling urinary catheters, nasogastric
tubes or IV lines. This ensures that systems remain functional after the bathing procedure.
Place the bed in the lowest position. This maintains patient safety by decreasing the height of
the bed frame from the floor.
Replace call light and personal possessions. Leave the room as clean and comfortable as
possible. This prevents transmission of infection. Clean environment promotes patient comfort.
Then, perform hand hygiene. This reduces infection transmission of pathogens.
And lastly, for evaluation phase, observe skin, paying attention to areas soiled previously,
reddened, dry or showing signs of breakdown. If a patient shows areas of redness, use Braden
scale to measure risk for pressure ulcer.
Then, observe the range of motion during the bath. This measures joint mobility.
Lastly, ask the patient to rate the level of comfort and the level of fatigue. This determines the
patient's tolerance of bathing activities.
And that wraps up my return demonstration of bathing the client in bed. Thank you and have a
nice day!

RETDEM SCRIPT: BED MAKING

The second part of my return demonstration is the making of the client’s bed. Nurses need to be
able to prepare hospital beds in different ways for specific purposes. It promotes client’s comfort,
provides a clean and neat environment for the patient and provides a smooth, wrinkle-free bed
foundation, minimizing sources of skin irritation.
Bed making starts with assessment, then the nursing diagnosis, followed by the planning then
implementation and the evaluation.
For the assessment phase, assess skin condition and need for a special mattress. This ensures
proper adjustments and skin problems will be properly protected.
Next, assess the client's ability to reposition itself. This determines if additional assistance is
needed.
Then, assess potential for patient incontinence or excess drainage on bed linen. This determines if
protective equipment is likely needed for the procedure.
Then, check the chart for orders or specific precautions concerning movement and positioning. This
ensures patient safety and prevents injury.
For the nursing diagnosis, absence of bed making results in the client's risk for impaired skin
integrity and impaired bed mobility. Bed making then promotes patient comfort and a clean, neat
environment minimizing sources of skin irritation.
For the planning phase, review orders for specific precautions concerning the patient's movement
or positioning. This prevents injury to patients during turning.
Identify the patient using two identifiers according to agency policy. This ensures that the patient is
correct.
Then, explain the procedure to the patient, including that he or she will be asked to turn on side and
roll over linen. This minimizes patient’s anxiety and promotes cooperation and participation.
Next, prepare equipment and supplies. This includes, linen bag, mattress pad, bottom sheet, draw
sheet, top sheet, blanket, bedspread, waterproof pads or bath blankets, pillowcases, bedside chair
or table, clean gloves, towel and disinfectant. This avoids interruption of the procedure or leaving
the patient unattended.
For the implementation phase, it has 9 steps. First, introduce yourself, verify your client with agency
protocol and explain the procedure. This helps to alleviate my client’s anxiety and promote client
participation and cooperation during the procedure.
Then, perform hand hygiene and wear PPE.  This reduces the risk of infection transmission and to
protect healthcare.
Next, provide patient’s privacy. This begins by drawing the curtains.
Then, remove the top bedding. The top bedding is composed of the blanket and the top sheet.
Remove the top bedding and any other things attached to the bed such as the call light.
Then, loosen the top linen that is attached to the foot part.
Then, cover the patient with a blanket. This provides privacy and maintains the warmth of the
patient.
Instruct the patient to hold the top edge of the blanket. If the patient is unconscious, tuck it under
the shoulder or the patient instead. Its purpose is to keep the patient covered while removing the
top linen. Grasp the top edge of the linen and pull it towards the foot part.
Next, change the bottom sheet and the waterproof pad. Instruct the patient to come to your side so
that adequate space is provided when we roll our patient to this side. Move the patient per segment
– the upper, middle and the lower segment.
Then, log roll the patient as one unit. Cross over the foot of the patient and do the same thing with
the patient's arms. Raise the bed to a comfortable level. Roll the patient, keeping his body covered
with the blanket. Adjust the pillows as needed.
Then, loosen the bottom and draw a sheet and roll it towards the center of bed under the patient.
Now that we touched the soiled linen, change the gloves to avoid contamination. Tuck the bottom
sheet on the head part first, then to the side and tuck the remaining sheet to the side.
Apply the draw sheet, unfold to the center ensuring that the low back and the upper thigh of the
patient are covered.
Then, reposition the client back to the center, raise the side rail and move to the other side of the
bed and lower the side rail and repeat the process.
Remove the soiled linen of the other side. Remove the gloves and apply a new one to avoid
contamination. Tuck the bottom sheet as well and pull the draw sheet afterwards.
Next, reposition the patient again and apply the top sheet and the blanket. Apply the new top sheet
and the blanket, raise the side rail.
Then, remove the bath blanket. Instruct the patient to hold the top sheet and the new blanket to
remove the bath blanket from the under.
Tuck the top sheet and blanket at the top of the foot part by gently lifting the mattress  
Then, remove the pillow and change the pillowcase. Remove the gloves and put the new
pillowcase even without the gloves.
Lastly, ensure the continuity of patient safety and comfort. Ensure that the side rails are up and
place the bed in a low position. Give the call light back to the patient so that the patient can ask for
any assistance if needed and ensure that everything is near the patient such as the bedside table
so that he can personally reach things from it, providing a little sense of independence for the
patients.
For the evaluation phase, ask the patient if he/she is comfortable. This ensures that the bed linen is
positioned correctly and the patient is positioned comfortably.
Next, inspect areas of skin for irritation. Because fold or creases cause pressure to the skin.
Lastly, assess the patient for any signs and symptoms of fatigue, dyspnea, pain or discomfort. This
provides you data for patient’s activity tolerance and ability to participate in other procedures. And
that wraps up my return demonstration of bed making. Thank you and have a nice day!