HYGIENE CARE Bed Bathing Shampooing Oral Care Back Massage Perineal Care

Manual of Healthcare Procedures | SKSU | 2024
HYGIENE CARE: BED BATHING

Definition:
• Bed bath means bathing a patient who is confined to bed and cannot have the physical
and mental capability of self-bathing. This procedure is often used for bedridden or
immobile patients.
• Bathing is the act of cleaning the body. Baths are given for therapeutic purposes.
Bed bath procedure is an essential component of nursing care.
Purposes
• To disinfect the skin's surface and cleanse body of dirt, debris and perspiration
• To refresh and re-energize the client
• To stimulate blood circulation
• To provide comfort and relaxation
• To enhance self-concept and strengthen the client's self-esteem
• To provide tactile stimulation while improve their overall muscle tone and joint mobility
• To facilitate head to be assessment
• To regulate body temperature
• To help in resting and induce sleep
• To prevent pressure sores/ bed sores
• To keep bacteria from spreading on the skin and remove toxic substances from body
surface
• To maintain an effective nurse-patient relationship
• To give health instruction to patient
• To remove unpleasant odors due to perspiration
• To relieve fatigue
• To prevent contractures by giving exercises
• To minimize the skin irritation
• To give patients and their families the opportunity to learn about good personal hygiene.
Types of Patients Needing Bed Bath

✓ Unconscious or semiconscious patients
✓ Postoperative patients
✓ Patients with strict bed rest
✓ Paraplegic patients
✓ Orthopedic patients in plaster – cast and traction
✓ Seriously ill patients
NOTE:
❖ Individuals' bathing habits may vary depending on their cultural practices, the nature of
their illness, the condition of their skin (dry skin requires less frequent bathing), and the
type of weather, among other factors.
❖ Too much bathing can interrupt the sebum's intended lubricating effect, resulting in skin
drying.
Scientific Principles of Bed Bathing:

• Heat is conveyed to the body by convection. The tolerance of heat is different in different
persons. Keep the patient warm and private by covering them. Unnecessary exposure or
chilling must be avoided.
• The skin is sometimes irritated by the chemical composition of certain soaps. Soap should
not be used on ruptured skin.
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• Moving the joints through their full range of movement helps prevent loss of muscle tone
and improves circulation. Body mechanics principles should be followed. Maintain safety
and avoid falls.
• If the client is obese or unable to move on the bed, the healthcare worker may shift from
one side of the bed to the other to ensure proper body mechanics.
• Before bathing, assess the patient's overall condition. If patient is unstable, avoid giving
a bath.
• Long smooth strokes on the arms and legs that are directed from the distal end to
proximal increases the rate of venous flow.
• Healthy, unbroken skin is a defense against harmful agents and assures resistance to
injuries to a certain extent. The frequency of bathing is determined by the condition of the
skin.
• Hygiene practices vary in society according to the socioeconomic standard and culture of
the individual. Hand washing is required both before and after the procedure.
• Sensory receptors in the skin are sensitive to heat, pains, touch and pressure.
• A bath should not be provided immediately following a meal. Bed bath should be given one
hour before meals or one hour after meals.
• Early signs of bed sore are detected by inspecting the skin and back. Crease and folds, as
well as bony prominences, must be given special attention because these areas are prone
to bed sores.
• Be reminded to clean the parts of the body from the cleanest to the least clean, and
always expose one part of the body at a time to be washed, rinsed, and dried.
• To prevent dryness on the back, creams or oils can be applied. Never apply alcohol spirit
directly to the skin.
• Throughout the procedure, provide health education.
Factors Affecting the Skin

❖ Impaired self-care
❖ Immobilization
❖ Exposure to pressure and moisture
❖ Vascular insufficiency
❖ Reduced sensation
❖ Nutritional alternation
❖ Constrictive external devices
TYPES OF BED BATH:

1. Cleansing Bed Bath: are administered as usual routine care.
The types of cleaning baths are:
• Shower bath or tub bath: this bath is allowed to the patient only if he has enough
confidence for self-help and to withstand procedure
• Sponge bath or complete bath
• Partial bath: it is the act of cleaning particular areas in the body part. They are face,
axilla, and genitalia, upper and lower-limbs.
• Self-administered bath: this is same as in bed bath except the patient is assisting in
taking bath
2. Therapeutic Bed Bath: This necessarily requires a doctor's order specifying the type of
bath, water temperature, body surfaces to be allowed to treat, and prescribed medication
solution to be applied.
• A therapeutic bath is typically taken in a tub.
• Further categorized as:
a) Cool or tepid water bath
b) Soak bath
c) Sitz bath
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SHOWER BATH OR TUB BATH
Ambulatory patients may be given permission to take a bath inside the bathroom with
the assistance of any healthcare worker. Necessary articles for the bed bath procedure:
▪ Warm tap water
▪ Soap
▪ Towel
▪ Clean clothes
Steps of Procedures:
1. Inform the patient and his family about the procedure.
2. Gather all the articles.
3. Check that the bathroom floor is not slippery and that it is warm.
4. Help the patient up to the shower room (if necessary) to keep him or her from falling.
5. Close the bathroom door for privacy.
6. Always keep the bathroom door unlocked so that a nurse or other medical staff can
enter if necessary.
7. As needed, assist the patient in bathing.
8. As needed, assist patient in going to bed.
9. Maintain a comfortable position for the patient.
10. Replace all articles, and documents and report the procedure.
COMPLETE BED BATHING
Bed bathing or sponge bathing is the term used to describe bathing a patient in bed.
Complete bed bathing involves cleansing skin areas where secretions gather or dirt
accumulates, such as the face, hand, axilla, groyne, perineal area, feet, and other body parts.
Indications of complete bed bath

❖ Patients who are unconscious or semi-conscious.
❖ Patients who are bedridden.
❖ Patients who are paralyzed.
❖ Orthopedic patient with traction and a plaster cast
❖ Patients who are critically ill.
KEY POINTS IN BED BATH PROCEDURE
Here are key points to keep in mind when conducting a bed bath:
1) Patient Dignity and Privacy: Always prioritize the patient’s dignity and privacy. Use
curtains or doors to create a private space and communicate with the patient throughout the
process.
2) Hand Hygiene: Wash your hands thoroughly before starting the bed bath and wear
disposable gloves throughout the procedure to prevent the spread of infection.
3) Gather Supplies: Collect all necessary supplies before beginning the bed bath, including
soap, washcloths, towels, gloves, moisturizer, and any specialized cleansing products.
4) Maintain a Comfortable Environment: Ensure the room is warm and comfortable to
prevent the patient from getting chilled during the bed bath.
5) Explain the Procedure: Communicate with the patient, explaining each step of the bed
bath to ensure their understanding and cooperation. Obtain verbal consent before
proceeding.
6) Adapt to Patient’s Abilities: If the patient is able, encourage them to participate in the bed
bath as much as possible. Adapt the procedure based on the patient’s level of mobility and
comfort.
7) Use Warm Water: Use warm water for the bed bath to enhance the patient’s comfort.
Check the water temperature to prevent burns.
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8) Address Specific Areas: Cleanse the patient’s face, upper body, lower body, and perineal
area systematically. Pay attention to skin folds, underarms, and areas prone to moisture.
9) Be Gentle and Thorough: Be gentle when washing the patient’s skin, especially if they
have fragile or sensitive skin. Thoroughly clean and dry all areas to prevent skin issues.
10) Perineal Care: If performing perineal care, use a separate washcloth and follow proper
hygiene practices. Always maintain the patient’s dignity during this part of the bed bath.
11) Moisturize Dry Skin: Apply a mild lotion or moisturizer to dry skin, especially in areas
prone to dryness. Be mindful of the patient’s preferences and any existing skin conditions.
12) Document Observations: Document any observations, changes in skin condition, or
concerns during the bed bath in the patient’s medical chart.
13) Adapt to Cultural Sensitivities: Respect and consider the patient’s cultural background
and personal preferences during the bed bath. Adapt the procedure as needed to
accommodate individual beliefs and practices.
14) Ensure Safety: Be aware of the patient’s safety throughout the procedure. Use bed rails or
assistive devices as necessary to prevent falls or injuries.
15) Maintain Professionalism: Approach the bed bath with professionalism, empathy, and a
caring attitude. Respond to the patient’s needs and concerns with compassion.
PROCEDURE ON CLEANSING BED BATH
Equipment Needed:
1. Bath blanket or Large Towel
2. Bath towels (3)
3. Towellete/ Hand towel (1)
4. Washcloths (3)
5. Patient’s clothing
6. Extra linens (as needed)
7. Pail used for water
8. Bedpan or Urinal
9. Laundry bag
10. Working gloves
11. Tray containing the following:
▪ Wash basin half filled with water
▪ Liquid Wash/ Soap in a soap dish
▪ Patient’s comb/ hair brush
▪ Body powder/ Lotion/ Oil
▪ Nail cutter (if necessary)
▪ Two pitchers (one with cold and other with hot water)
▪ Newspaper for lining
▪ Bath Thermometer
▪ Lotion/ Oil for massage
Action Rationale
1. Review the patient’s chart. Check for precautions concerning patient’s
movement and positioning. To prevent
injury to the patient during bathing activities
and determines level of assistance.
2. Identify and discuss the procedure with To assess the patient’s ability to assist in
the patient. bathing and their personal hygiene
preferences. Encourages patient
participation and allows for individualized
nursing care.
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3. Wash hands and prepare the This deters the spread of microorganisms.
necessary equipment and bring it to
bedside.
4. Close doors and windows to ensure no Provide privacy at all times.
drafts in the room. Turn off the electric
fan or air conditioning unit inside the
patient’s room.
5. Don working gloves. This prevents the spread of microorganisms.
6. Offer the bedpan or urinal. Allow the Voiding or defecating before a bath lessens
patient to defecate or urinate. Dispose likelihood that the bath will be interrupted
contents properly. since warm bath water may stimulate the
urge to void.
7. Change working gloves. Raise the bed Having bed in a more convenient height
to a working height. position prevents strain on the healthcare
worker’s back.
8. Lower the side rails near you and Having patient positioned near the healthcare
assists the patient to the side of the worker helps prevent unnecessary
bed on supine position. stretching and twisting of muscles.
9. Loosen top covers and place the bath Patient should not be exposed unnecessarily
blanket over the patient and roll the top so that warmth may be maintained.
sheet.
10. Removes patient’s gown keeping the Covering with a bath blanket maintains the
bath blanket in place. warmth of the patient.
11. Raise the side rails and prepare the Side rails maintain patient’s safety.
water for bathing. Fill the basin with Warm water is comfortable and relaxing for
sufficient warm water (at 43-46° the patient. It also stimulates circulation and
Celsius) or checks the water provides for more effective cleansing.
temperature using the back of the
hand/ elbow. Have patient place
fingers into the basin to check water
temperature.
12. Place a towel across the patient’s Prevents chilling and keeps the blanket dry.
chest and on top of the bath blanket.
13. Wet and fold the washcloth into a Having loose ends of a washcloth drag across
MITT. the patient’s skin is uncomfortable.
14. Wipe the farther eye from inner to Rinsing or turning the cloth prevents spread
outer part. Turns the mitt and washes of organisms from one eye to the other.
the outer eye.
15. Rinse the washcloth and cleanse the
patient’s face starting at the forehead,
down to the cheeks, nose, chin, and
neck ending at the ears. Then pat dry
with towel across the chest.
16. Ask the patient’s preference whether Soap can be drying and maybe avoided as a
to use soap or facial wash on the face. matter of personal preference.
17. Expose the patient’s far arm and Washing the far side first eliminates
places the towel lengthwise under it. contaminating a clean area once it is
Using firm long strokes, soap, rinse washed. Gentle friction stimulates
and dry the patient’s arm and axilla. circulation and helps remove dirt, oil and
Strokes should be from distal to organisms.
proximal areas. Firm strokes from distal to proximal areas
increase venous blood return.
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18. Place a folded towel on the bed next to Allows thorough washing of the hand and
the patient’s hand and put the hand in between the fingers, as well as facilitating
the basin. Soap, rinse and dries the removal of debris from under the nails.
hand.
19. Change the water as often as
necessary. Do the same steps to the
nearer arm.
20. Spread the towel across the patient’s Avoid unnecessary exposure and chilling.
chest while lowering the blanket to the
umbilical area.
21. Soap, rinse and dry the patient’s Dirt usually accumulates in between skin
chest. Keep chest covered with towel folds.
between the washing and rinsing. Pay
special attention to the skin folds under
the female patient’s breast.
22. Lower the bath blanket to cover the Skin fold areas may be sources of odor ans
perineal area. Soap, rinse and dry the skin breakdown if not cleaned and dried
patient’s abdomen carefully inspect properly.
and cleanse the umbilical area and
any abdominal folds or creases.
23. Return bath blanket to original Towel protects the linen and prevents the
position. Expose the patient’s far leg patient from feeling uncomfortable from a
and places the towel lengthwise under damp or wet bed.
it.
24. Use long firm strokes, soap, rinse and Dirt usually accumulates in these areas.
dry the leg starting from the ankle to
the knee, and knee to thigh to the
groin. Pay particular attention to back
of the knee and the groin.
25. Do the same step to the leg near you.
26. Position the patient into DORSAL Supporting the foot and legs help reduce
RECUMBENT with a pillow placed strain and discomfort for the patient.
under the client’s knee.
27. Lay the waterproof underpad and line
it with towel across the foot part and
put the basin in between feet.
28. Soak each foot in warm water for Foot places in the basin of water is
approximately 3-5 minutes. comfortable and relaxing which allows
thorough cleaning of the foot, particularly in
area in between the toes and under the
toenails.
29. Soap, rinse and dry the feet one at a
time. Brush toenails if necessary.
30. Change wash cloth and refill the basin Changing to clean supplies decreases the
with clean water. spread of organisms to the next area of
cleaning.
31. Wash gloved hands. Lay a towel under To deter the spread of microorganisms.
the buttocks.
32. Clean the perineal area. If patient Providing perineal self-care may decrease
prefers to do it by himself, make a mitt embarrassment of the patient. Effective
in his hand. Remove the towel under perineal care reduces odor and decreases
the buttocks with contaminated side the chance of infection through
inside. Discard washcloth and wash contamination.
gloved hands.
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33. Assist the patient to a prone/ lateral Fecal matter near the anus can be a source
position and reposition also the bath of microorganism. Prolonged pressure on
blanket. Lowers the bath blanket the sacral area or other bony prominences
exposing the buttocks. Lay towel along may compromise circulation and lead to the
the side of the patient. Soap, rinse and development of decubitus ulcer.
dry the patient’s back and buttocks.
Pay particular attention to cleansing
between the gluteal folds and observe
for redness or other indications of skin
breakdown in the sacral area.
34. Remove gloves and dispose
properly. If not contraindicated, give
the patient a back rub.
GIVING BACK RUB/ MASSAGE Back rub improves circulation to the tissues
35. Expose patient’s back by drawing the and aids in relaxation.
bath blanket up to the hip area.
36. Warm the lubricant or lotion in the Cold lotion causes muscle tension.
palm of your hands or place the
container in warm water.
37. Apply lotion with light and soothing Effleurage relaxes the patient and lessens
strokes (effleurage) starting from the tension.
sacral area towards the back and
shoulders.
38. Perform the four different strokes Continuous hand contact is soothing and
(including petrissage, friction and stimulates circulation and muscle
tapotment) 3-5 minutes while relaxation.
administering strokes over bony
prominences.
39. Remove excess lotion with towel/ bath Removing excess lotion provide additional
blanket. Assist patient to lie on his comfort for the patient.
back comfortably or back to supine
position and cover with bath blanket.
40. Help the patient wear clean gown Clean gown promotes the warmth and
before attending to his/her grooming. comfort of the patient.
41. Changes bed linens and does Providing clean linens promotes medical
aftercare of the equipment. asepsis and the comfort of the patient.
42. Washes hands and dispose all used Handwashing deters the spread of
items. microorganisms.
43. Record any significant observations. A careful record is important for planning and
Document care provided and the individualizing the patient’s care.
patient’s ability to participate in the
procedure. Report to the C.I. or charge
nurse for any unusualities noted.
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Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat
College of Health Sciences
PERFORMANCE CHECKLIST ON COMFORT MEASURES:

CLEANSING BED BATH
Name: ____________________________________ Score: ________________

Course/Year/Section: _______________ Date: _________________
Direction: In using the checklist, please use the following rating scale in determining the
performance of the student.
5 – Excellent 4 – Very Satisfactory 3 – Satisfactory 2 – Fair 1 – Poor
Equipment Needed:
1. Bath blanket or Large Towel
2. Bath towels (3)
3. Towellete/ Hand towel (1)
4. Washcloths (3)
5. Patient’s clothing
6. Extra linens (as needed)
7. Pail used for water
8. Bedpan or Urinal
9. Laundry bag
10. Working gloves
11. Tray containing the following:
▪ Wash basin half filled with water
▪ Liquid Wash/ Soap in a soap dish
▪ Patient’s comb/ hair brush
▪ Body powder/ Lotion/ Oil
▪ Nail cutter (if necessary)
▪ Two pitchers (one with cold and other with hot water)
▪ Newspaper for lining
▪ Bath Thermometer
STEPS OF THE PROCEDURES RATING

CLEANSING BED BATH E VS S F P
1. Review the patient’s chart. 5 4 3 2 1
2. Identify and discuss the procedure with the patient. 5 4 3 2 1
3. Wash hands and prepare the necessary equipment and bring it to 5 4 3 2 1
bedside.
4. Close doors and windows to ensure no drafts in the room. Turn off 5 4 3 2 1
the electric fan or air conditioning unit inside the patient’s room.
5. Don working gloves. 5 4 3 2 1
6. Offers the bedpan or urinal. Allow the patient to defecate or urinate. 5 4 3 2 1
Dispose contents properly.
7. Change working gloves. Raise the bed to a working height. 5 4 3 2 1
8. Lower the side rails near you and assists the patient to the side of 5 4 3 2 1
the bed on supine position.
9. Loosen top covers and place the bath blanket over the patient and 5 4 3 2 1
roll the top sheet.
10. Remove patient’s gown keeping the bath blanket in place. 5 4 3 2 1
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11. Raise the side rails and prepare the water for bathing. Fill the basin 5 4 3 2 1
with sufficient warm water (at 43-46° Celsius) or checks the water
temperature using the back of the hand/ elbow. Have patient place
fingers into the basin to check water temperature.
12. Place a towel across the patient’s chest and on top of the bath 5 4 3 2 1
blanket.
13. Wet and fold the washcloth into a MITT. 5 4 3 2 1
14. Wipe the farther eye from inner to outer part. Turns the mitt and 5 4 3 2 1
washes the outer eye.
15. Rinse the wash cloth and cleanse the patient’s face starting at the 5 4 3 2 1
forehead, down to the cheeks, nose, chin, and neck ending at the
ears. Then pat dry with towel across the chest.
16. Ask the patient’s preference whether to use soap or facial wash on 5 4 3 2 1
the face.
17. Expose the patient’s far arm and places the towel lengthwise under 5 4 3 2 1
it. Using firm long strokes, soap, rinse and dry the patient’s arm
and axilla. Strokes should be from distal to proximal areas.
18. Place a folded towel on the bed next to the patient’s hand and put 5 4 3 2 1
the hand in the basin. Soap, rinse and dries the hand.
19. Changes the water as often as necessary. Do the same steps to the 5 4 3 2 1
nearer arm.
20. Spreads the towel across the patient’s chest while lowering the 5 4 3 2 1
blanket to the umbilical area.
21. Soap, rinse and dry the patient’s chest. Keep chest covered with 5 4 3 2 1
towel between the washing and rinsing. Pay special attention to the
skin folds under the female patient’s breast.
22. Lower the bath blanket to cover the perineal area. Soap, rinse and 5 4 3 2 1
dry the patient’s abdomen carefully inspect and cleanse the
umbilical area and any abdominal folds or creases.
23. Return bath blanket to original position. Exposes the patient’s far leg 5 4 3 2 1
and places the towel lengthwise under it.
24. Use long firm strokes, soap, rinse and dry the leg starting from the 5 4 3 2 1
ankle to the knee, and knee to thigh to the groin. Pay particular
attention to back of the knee and the groin.
25. Do the same step to the leg near you. 5 4 3 2 1
26. Position the patient into DORSAL RECUMBENT with a pillow 5 4 3 2 1
placed under the client’s knee.
27. Lay the waterproof underpad and line it with towel across the foot 5 4 3 2 1
part and put the basin in between feet.
28. Soak each foot in warm water for approximately 3-5 minutes. 5 4 3 2 1
29. Soap, rinse and dries the feet one at a time. Brush toenails if 5 4 3 2 1
necessary.
30. Change wash cloth and refill the basin with clean water. 5 4 3 2 1
31. Wash gloved hands. Lay a towel under the buttocks. 5 4 3 2 1
32. Clean the perineal area. If patient prefers to do it by himself, make 5 4 3 2 1
a mitt in his hand. Remove the towel under the buttocks with
contaminated side inside. Discard washcloth and wash gloved
hands.
33. Assist the patient to a prone/ lateral position and reposition also 5 4 3 2 1
the bath blanket. Lowers the bath blanket exposing the buttocks.
Lay towel along the side of the patient. Soap, rinse and dry the
patient’s back and buttocks. Pay particular attention to cleansing
between the gluteal folds and observe for redness or other
indications of skin breakdown in the sacral area.
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34. Remove gloves and dispose properly. If not contraindicated,

5 4 3 2 1
give the patient a back rub.
GIVING BACK RUB/ MASSAGE 5 4 3 2 1
35. Expose patient’s back by drawing the bath blanket up to the hip
area.
36. Warm the lubricant or lotion in the palm of your hands or place the 5 4 3 2 1
container in warm water.
37. Apply lotion with light and soothing strokes (effleurage) starting from 5 4 3 2 1
the sacral area towards the back and shoulders.
38. Perform the four different strokes (including petrissage, friction and 5 4 3 2 1
tapotment) 3-5 minutes while administering strokes over bony
prominences.
39. Remove excess lotion with towel/ bath blanket. Assist patient to lie 5 4 3 2 1
on his back comfortably or back to supine position and cover with
bath blanket.
40. Help the patient wear clean gown before attending to his/her 5 4 3 2 1
grooming.
41. Change bed linens and does aftercare of the equipment. 5 4 3 2 1
42. Wash hands and dispose all used items. 5 4 3 2 1
43. Record any significant observations. Document care provided and 5 4 3 2 1
the patient’s ability to participate in the procedure. Report to the C.I.
or charge nurse for any unusualities noted.
44. Maintains body mechanics throughout the performance of the 5 4 3 2 1
procedure.
45. Manifest neatness and properly performed the procedure. 5 4 3 2 1
46. Receptive to criticisms and observes courtesy. 5 4 3 2 1
47. Shows calmness and confidence. 5 4 3 2 1
48. Uses correct English while manifesting mastery of the 5 4 3 2 1
procedure.
Comments: ____________________________________ Total Score: _________

____________________________________ Average: _________
_____________________________________ FINAL RD GRADE: ________
Performed by: Verified by:
____________________________ ________________________________
Student’s signature over printed name Instructor’s signature over printed name
Page | 84
SHAMPOOING A PATIENT’S HAIR IN BED
Hair accumulates the same dirt and oil as the skin. It should be washed as often as
necessary to keep it clean. A weekly shampoo may be sufficient for some persons whereas others
may prefer to perform this aspect of personal hygiene daily. The healthcare worker may need to
shampoo the hair of those patients who cannot get out of bed for bathing and showering or who
lack the strength or ability to independently care for their hair. Healthy hair is dependent on
maintaining healthy scalp.
Definition: Washing of the hair with the use of shampoo or bath soap as often as necessary to
keep it clean.
Purposes:
❖ Promote circulation.
❖ Remove dead cell, dirt, and debris.
❖ Distribute hair oils.
❖ Prevent skin irritation.
❖ Relaxes and refreshes client.
❖ Improve appearance and self-esteem.
❖ Remove substances such as blood or body secretions, or electrode jelly (used when an
ECG or other such study is done).
❖ Treat conditions of the scalp with topical applications of medications.
Expected Outcome:
• Client will have healthy hair and scalp free from infestation, infection, irritation or
alterations in hydration and oils.
• The client will experience improved circulation to the scalp.
Equipment Needed:
1. Bedside chair/Table
2. Bath towels (3)
3. Bath blanket
5. Shampoo trough/ Kelly Pad
6. Paper for lining
7. Rubber sheet/ bed protector
8. Linen saver or plastic trash bag
9. Clean gloves
10. Tray containing:
• Washcloth
• Hair shampoo and conditioner
• Dry cotton balls (2)
• Comb/brush
• Pitchers with hot water and tap water
• Safety pins
11. Pails (2)
• Pail containing clean water
• Empty pail
Action Rationale
1. Review chart for any limitations in physical To assess need for shampoo and for
activity. contraindications in performing hair wash.
Prevent injury to patient.
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2. Identify the patient. Ensures the correct patient and to gain

cooperation to allow for individualized
nursing care.
3. Explain the procedure to the patient. Explanation facilitates understanding and
cooperation.
4. Close curtains around bed and close the Provide privacy at all times and prevent
door to the room, if possible. patient from chilling.
5. Perform hand hygiene. Put on PPE, as This prevents the spread of microorganisms.
indicated.
6. Assemble the necessary supplies and Organization facilitates accurate skill
arrange conveniently on the bedside performance for proper time management,
stand or over bed table. planning and improve efficiency.
7. Position the patient with head and A supine position facilitates drainage away
shoulder near the edge of the bed from from the face, eyes, and head.
which you will work.
8. Protect the floor with newspaper and place To prevent spillage and facilitate cleanliness.
pail over it.
9. Replace top sheet with bath blanket. It also avoids saturating the bed linen.
Remove the pillow from under the
patient’s head and place pillow with
waterproof cover lined with towel under
the patient’s shoulder so that the head is
bent backward.
10. Place a folded bath towel around the Layered material absorbs water and prevents
patient’s shoulders. the patient from feeling wet and chilled.
11. Position the shampoo trough under the Using a trough provides a method for
patient’s head with the drainage spout collecting and draining the water away from
extending over the edge of the bed and the patient and the bed.
directed into the pail.
12. Cover eyes with folded washcloth at the Cotton balls prevents entrance of water inside
forehead and plug ears with cotton balls. the ears.
13. Brush or comb patient’s hair and Removing tangles before washing will prevent
massage the scalp. breaking strands of hair.
14. Obtain warm water (43 to 46° C). Using a
pitcher, wet the hair thoroughly with water.
15. Instruct patient to close their eyes. Wet Wet hair dilutes the shampoo and helps to
the hair thoroughly with warm water. form suds.
Apply shampoo on hair and scalp
according to patient’s preference.
16. Work the shampoo into a lather. Massage Lathering helps distribute the shampoo
scalp using fingertips of both hands. Use throughout the entire hair for uniform
firm strokes but do not dig the scalp with cleansing.
fingernails. Start at the front and working
toward the back of the head.
17. Rinse the hair completely. Repeat Rinsing prevents leaving shampoo in the hair,
shampooing and rinsing if necessary. which gives hair a dull appearance; if left on
Apply conditioner if requested and rinse the scalp, shampoo could cause irritation for
again. some people.
18. Squeeze as much water as possible out Remove excess water to reduce soaking the
of the hair with your hands. towels or wetting the linens.
19. Remove the earplugs. Dry the forehead Discarding the water and the equipment will
and ears with face towel. prevent accidental spilling.
20. Wrap the patient’s head with bath towel Towel absorbs water.
around the patient’s shoulder.
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21. Remove the shampoo trough and adjust Discarding the water and the equipment will
the pillow with waterproof covering lined prevent accidental spilling.
with towel under the patient’s head.
22. Dry the patient’s hair and scalp. Use Drying properly prevents chilling to patient.
another towel if first becomes saturated.
23. Gently brush hair and dry with dryer if Brushing helps stimulate the capillaries in the
desired or leave a towel under patient’s patient’s scalp and increase circulation in
head until hair is completely dry. the area.
24. Remove bath blanket and adjust top To keep patient warm and covered.
sheet. Change patient’s gown if damp.
25. Raise side rail and lower bed before Precautionary measures prevent falls and
assisting patient to comfortable position. injury to the patient.
26. Remove your gloves. Perform hand Handwashing deters the spread of
hygiene. microorganisms.
27. Remove equipment. Clean and return the Discarding the water and the equipment will
equipment to proper place for storage. prevent accidental spilling.
28. Document care provided, the patient’s Careful recording is important for planning and
ability to participate and his/her response. individualizing the patient’s care.
Page | 87


SHAMPOO IN BED
Name: ____________________________________ Score: ________________

Equipment Needed:
1. Bedside chair/Table
2. Bath towels (3)
3. Bath blanket
5. Shampoo trough/ Kelly Pad
6. Paper for lining
7. Rubber sheet/ bed protector
8. Linen saver or plastic trash bag
9. Clean gloves
10. Tray containing:
• Washcloth
• Hair shampoo and conditioner
• Dry cotton balls (2)
• Comb/brush
• Pitchers with hot water and tap water
• Safety pins
11. Pails (2)
• Pail containing clean water
• Empty pail
RATING
STEPS OF THE PROCEDURES
E VS S F P
1. Review chart for any limitations in physical activity. 5 4 3 2 1
2. Identify the patient. 5 4 3 2 1
3. Explain the procedure to the patient. 5 4 3 2 1
4. Close curtains around bed and close the door to the room, if possible. 5 4 3 2 1
5. Perform hand hygiene. Put on PPE, as indicated. 5 4 3 2 1
6. Assemble the necessary supplies and arrange conveniently on the 5 4 3 2 1
bedside stand or over bed table.
7. Position the patient with head and shoulder near the edge of the bed 5 4 3 2 1
from which you will work.
8. Protect the floor with newspaper and place pail over it. 5 4 3 2 1
9. Replace top sheet with bath blanket. Remove the pillow from under 5 4 3 2 1
the patient’s head and place pillow with waterproof cover lined with
towel under the patient’s shoulder so that the head is bent backward.
Page | 88
10. Place a folded bath towel around the patient’s shoulders. 5 4 3 2 1

11. Position the shampoo trough under the patient’s head with the 5 4 3 2 1
drainage spout extending over the edge of the bed and directed into
the pail.
12. Cover eyes with folded washcloth at the forehead and plug ears with 5 4 3 2 1
cotton balls.
13. Brush or comb patient’s hair and massage the scalp. 5 4 3 2 1
14. Obtain warm water (43 to 46° C). Using a pitcher, wet the hair 5 4 3 2 1
thoroughly with water.
15. Instruct patient to close their eyes. Wet the hair thoroughly with 5 4 3 2 1
warm water. Apply shampoo on hair and scalp according to patient’s
preference.
Work the shampoo into a lather. Massage scalp using fingertips of both 5 4 3 2 1
hands. Use firm strokes but do not dig the scalp with fingernails. Start
at the front and working toward the back of the head.
17. Rinse the hair completely. Repeat shampooing and rinsing if 5 4 3 2 1
necessary. Apply conditioner if requested and rinse again.
18. Squeeze as much water as possible out of the hair with your hands. 5 4 3 2 1
19. Remove the earplugs. Dry the forehead and ears with face towel. 5 4 3 2 1
20. Wrap the patient’s head with bath towel around the patient’s 5 4 3 2 1
shoulder.
21. Remove the shampoo trough and adjust the pillow with waterproof 5 4 3 2 1
covering lined with towel under the patient’s head.
22. Dry the patient’s hair and scalp. Use another towel if first becomes 5 4 3 2 1
saturated.
23. Gently brush hair and dry with dryer if desired or leave a towel under 5 4 3 2 1
patient’s head until hair is completely dry.
24. Remove bath blanket and adjust top sheet. Change patient’s gown 5 4 3 2 1
if damp.
25. Raise side rail and lower bed before assisting patient to comfortable 5 4 3 2 1
position.
26. Remove your gloves. Perform hand hygiene. 5 4 3 2 1
27. Remove equipment. Clean and return the equipment to proper place 5 4 3 2 1
for storage.
28. Document care provided, the patient’s ability to participate and 5 4 3 2 1
his/her response.
29. Maintains body mechanics throughout the performance of the 5 4 3 2 1
procedure.
procedure.
____________________________________ Average: _________
_____________________________________ FINAL RD GRADE: ________
____________________________ ________________________________
Page | 89
ASSISTING THE PATIENT WITH ORAL CARE
Definition: It is brushing and flossing of the teeth including the inspection of the mouth for dental
carries, gum problems, soft plaque deposits, etc. Poor oral hygiene and loss of teeth
may affect a client’s social interaction and body image as well.
Purpose:
❖ Cleanse the teeth of food residue and microorganisms.
❖ Maintain moisture and integrity of the tissues.
❖ To refresh the mouth.
❖ Improve the pleasure of eating.
❖ Prevent oral infection and dental caries.
❖ Relieve discomfort from inflamed lesions.
❖ Maintain integrity of the mucus membranes, gums, and lips.
❖ Preserve oral cavity and teeth.
❖ Maintain or improve self-concept.
Expected Outcome:
a. Client’s mouth, teeth, gums, and lips will be clean and free from food particles.
b. Any inflammation, bleeding, infection, or ulceration present will be noted and treated.
c. The oral mucosa will be clean, intact, and well hydrated.
Equipment Needed:
1. Bath Towel
2. Toothbrush
3. Toothpaste with fluoride
4. Emesis basin/ Kidney basin
5. Glass of water
6. Working gloves
7. Mirror
8. Dental floss
9. Lip moisturizer/ Petroleum jelly (optional)
10. Mouthwash (optional)
Action Rationale
1. Review chart for any limitations in physical To assess the patient’s ability to assist in oral
activity. care and their personal hygiene preferences.
2. Identify and discuss the procedure with the Encourages patient participation and allows
patient. for individualized nursing care.
3. Close curtains around bed and close the To provide privacy for the patient, if patient
door to the room, if possible. may be embarrassed of cleansing and
removal of dentures.
4. Gather the necessary supplies and bring to Facilitates self-care.
the bedside stand or over bed table.
5. Perform hand hygiene. Put on PPE, as Handwashing deters spread of
indicated. microorganisms.
6. Lower side rail and assist patient to sitting A sitting or side-lying position prevents
position, if permitted, or turn patient onto aspiration of fluids into the lungs.
side.
7. Place bath towel across patient’s chest. The towel protects the patient from
Raise bed to a comfortable working dampness. Raising the bed promotes
position. efficient body mechanics.
Page | 90
8. Encourage patient to brush own teeth, or The healthcare worker should encourage the
assist, if necessary. patient to exercise as mush independence as
possible.
9. Moisten toothbrush and apply toothpaste to Water softens the bristles.
bristles.
10. Place brush at a 45-degree angle to gum Angling the brush permits cleansing of all
line and brush from gum line to crown of surfaces of the teeth.
each tooth.
11. Brush outer and inner surfaces. Brush Brushing facilitates the removal of plaque and
back and forth across biting surface of tartar.
each tooth.
12. Brush tongue gently with toothbrush. Removes any coating that may be on the
tongue. Gentle motion does not stimulate the
gag reflex.
13. Have patient rinse vigorously with water Vigorous swishing helps remove loosened
and spit into emesis basin. Repeat until debris.
clear.
14. If with dentures, assist the patient with the Artificial dental devices can be more
removal and cleansing of dentures if thoroughly cleaned when removed from the
necessary. mouth.
15. Rinse dentures thoroughly with water and Water aids the removal of debris and the
return them to the patient. cleansing agent.
16. Assist patient to floss teeth, if appropriate: Helps remove food particles and plaque
Remove approximately 6 inches of dental between teeth and along the gum line where
floss from container or use a plastic floss your toothbrush can't quite reach.
holder.
17. Wrap the floss around the index fingers, Better removal of bad breath-causing
keeping about 1 to 1.5 inches of floss taut bacteria than brushing alone.
between the fingers.
18. Insert floss gently between teeth, moving Removal of plaque from below the gumline,
it back and forth downward to the gums. which can erode tooth enamel and develop
into tartar (can cause teeth discoloration).
19. Move the floss up and down, first on one
side of a tooth and then on the side of the
other tooth, until the surfaces are clean.
20. Repeat in the spaces between all teeth.
21. Instruct patient to rinse mouth well with Rinsing after flossing ensures that everything
water after flossing. removed by floss is washed away.
22. Offer mouthwash if patient prefers. Mouthwash leaves a pleasant after taste.
23. Offer lip balm or petroleum jelly. Prevents cracking and drying of the lips.
24. Assist patient to a safe and comfortable
position. Raise side rail and lower bed.
25. Do after care of the equipment.
26. Remove gloves and perform hand This deters the spread of microorganisms.
hygiene.
27. Record the procedure done and patient’s Charting provides accurate documentation of
response. patient’s care.
Page | 91
PROVIDING ORAL CARE FOR UNCONSCOIUS PATIENT
Equipment Needed:
1. Soft toothbrush/ Toothette
2. Toothpaste
3. Tongue blade/ depressor
4. Kidney basin
5. Glass of water
6. Drinking straw
7. Gauze pad
8. Cotton tip applicators
9. Towels
10. Plastic asepto-syringe
11. Prescribed solution/mouthwash (no alcohol)
12. Suction apparatus with catheter (optional)
Action Rationale
1. Review chart for any limitations in physical To assess the patient’s ability to assist in
activity. oral care and their personal hygiene
preferences.
2. Identify and discuss the procedure with the Encourages patient participation and allows
patient. for individualized nursing care.
3. Close curtains around bed and close the door To provide privacy for the patient, if patient
to the room, if possible. may be embarrassed of cleansing and
removal of dentures.
4. Gather the necessary supplies and bring to Facilitates efficient self-care and
the bedside stand or over bed table. organization.
5. Perform hand hygiene. Put on PPE, as Handwashing and wearing gloves deters
indicated. spread of microorganisms.
6. Lower one side rail and position patient on hisSide lying position with the head turned
side, with head turned toward the healthcare downward prevents aspiration of fluid into
worker and tilted toward the mattress. the lungs.
7. Place bath towel across patient’s chest. A towel and kidney basin protect the patient
Place an emesis/ kidney basin in position from dampness.
under chin.
8. Gently open the patient’s mouth and gently A padded tongue depressor keeps the
insert a padded tongue depressor between mouth open for easier cleaning and
the back molars. prevents the patient from biting the
healthcare worker’s fingers.
9. Brush teeth carefully with moistened soft A soft toothbrush and padded depressor
brush. provide friction necessary to clean areas
where plaque and tartar accumulate.
10. Remove dentures, if present. Brush the
teeth and gums carefully with toothbrush and
paste. Lightly brush the tongue.
11. Use padded tongue depressor/ toothette This prevents aspiration of fluids into the
dipped in water to rinse the oral cavity. lungs.
• If desired, insert the rubber tip of the
irrigating syringe into patient’s mouth
and rinse gently with a small amount of
water.
Page | 92
• Position patient’s head to allow for return

of water or use suction apparatus to
remove the water from oral cavity.
12. Clean the dentures before returning to the
patient’s mouth.
13. Apply lubricant/ petroleum jelly to patient’s Prevents cracking and drying of the lips.
lips.
14. Leave the client in lateral position with Precautionary measures prevent falls and
head turned toward side for 30-60 minutes injury to the patient.
after oral hygiene care.
❖ Suction 1 more time (as necessary)
❖ Remove towel from under the client’s
mouth and face.
15. Remove equipment and return patient to a
position of comfort.
16. Remove your gloves and perform hand Handwashing deters the spread of
hygiene. microorganisms.
17. Raise side rail and lower bed and does after Lessens risk of falls and provide patient
care. safety.
18. Document findings in patient chart. Careful recording is important for planning
and individualizing the patient’s care.
Page | 93


ASSISTING THE PATIENT WITH ORAL CARE
Name: ____________________________________ Score: ________________

Equipment Needed:
1. Bath Towel
2. Toothbrush
3. Toothpaste with fluoride
4. Emesis basin/ Kidney basin
5. Glass of water
6. Working gloves
7. Mirror
8. Dental floss
10. Mouthwash (optional)
RATING
STEPS OF PROCEDURES
E VS S F P
3. Close curtains around bed and close the door to the room, if 5 4 3 2 1
possible.
4. Gather the necessary supplies and bring to the bedside stand 5 4 3 2 1
or over bed table.
6. Lower side rail and assist patient to sitting position, if permitted, 5 4 3 2 1
or turn patient onto side.
7. Place bath towel across patient’s chest. Raise bed to a 5 4 3 2 1
comfortable working position.
8. Encourage patient to brush own teeth, or assist, if necessary. 5 4 3 2 1
9. Moisten toothbrush and apply toothpaste to bristles. 5 4 3 2 1
10. Place brush at a 45-degree angle to gum line and brush from 5 4 3 2 1
gum line to crown of each tooth.
11. Brush outer and inner surfaces. Brush back and forth across 5 4 3 2 1
biting surface of each tooth.
12. Brush tongue gently with toothbrush. 5 4 3 2 1
13. Have patient rinse vigorously with water and spit into emesis 5 4 3 2 1
basin. Repeat until clear.
14. If with dentures, assist the patient with the removal and 5 4 3 2 1
cleansing of dentures if necessary.
Page | 94
15. Rinse dentures thoroughly with water and return them to the 5 4 3 2 1
patient.
16. Assist patient to floss teeth, if appropriate: Remove 5 4 3 2 1
approximately 6 inches of dental floss from container or use a
plastic floss holder.
17. Wrap the floss around the index fingers, keeping about 1 to 5 4 3 2 1
1.5 inches of floss taut between the fingers.
18. Insert floss gently between teeth, moving it back and forth 5 4 3 2 1
downward to the gums.
19. Move the floss up and down, first on one side of a tooth and 5 4 3 2 1
then on the side of the other tooth, until the surfaces are
clean.
20. Repeat in the spaces between all teeth. 5 4 3 2 1
21. Instruct patient to rinse mouth well with water after flossing. 5 4 3 2 1
22. Offer mouthwash if patient prefers. 5 4 3 2 1
23. Offer lip balm or petroleum jelly. 5 4 3 2 1
24. Assist patient to a safe and comfortable position. Raise side 5 4 3 2 1
rail and lower bed.
25. Do after care of the equipment. 5 4 3 2 1
26. Remove gloves and perform hand hygiene. 5 4 3 2 1
27. Record the procedure done and patient’s response. 5 4 3 2 1
28. Maintains body mechanics throughout the performance 5 4 3 2 1
of the procedure.
procedure.

____________________________________ Average: _________
_____________________________________ FINAL RD GRADE: ________
____________________________ ________________________________
Page | 95


PROVIDING ORAL CARE FOR UNCONSCOIUS PATIENT
Name: ____________________________________ Score: ________________

Equipment Needed:
1. Soft toothbrush/ Toothette
2. Toothpaste
3. Tongue blade/ depressor
4. Kidney basin
5. Glass of water
6. Drinking straw
7. Gauze pad
8. Cotton tip applicators
9. Towels
10. Plastic asepto-syringe
11. Prescribed solution/mouthwash (no alcohol)
12. Suction apparatus with catheter (optional)
RATING
STEPS OF PROCEDURES
E VS S F P
3. Close curtains around bed and close the door to the room, if 5 4 3 2 1
possible.
4. Gather the necessary supplies and bring to the bedside stand 5 4 3 2 1
or over bed table.
6. Lower one side rail and position patient on his side, with head 5 4 3 2 1
turned toward the healthcare worker and tilted toward the
mattress.
7. Place bath towel across patient’s chest. Place an emesis/ 5 4 3 2 1
kidney basin in position under chin.
8. Gently open the patient’s mouth and gently insert a padded 5 4 3 2 1
tongue depressor between the back molars.
9. Brush teeth carefully with moistened soft brush. 5 4 3 2 1
10. Remove dentures, if present. Brush the teeth and gums 5 4 3 2 1
carefully with toothbrush and paste. Lightly brush the tongue.
11. Use padded tongue depressor/ toothette dipped in water to 5 4 3 2 1
rinse the oral cavity.
Page | 96
• If desired, insert the rubber tip of the irrigating syringe into

patient’s mouth and rinse gently with a small amount of
water.
• Position patient’s head to allow for return of water or use
suction apparatus to remove the water from oral cavity.
12. Clean the dentures before returning to the patient’s mouth. 5 4 3 2 1
13. Apply lubricant/ petroleum jelly to patient’s lips. 5 4 3 2 1
14. Leave the client in lateral position with head turned toward 5 4 3 2 1
side for 30-60 minutes after oral hygiene care.
❖ Suction 1 more time (as necessary)
❖ Remove towel from under the client’s mouth and face.
15. Remove equipment and return patient to a position of comfort. 5 4 3 2 1
16. Remove your gloves and perform hand hygiene. 5 4 3 2 1
17. Raise side rail and lower bed and does after care. 5 4 3 2 1
18. Document findings in patient chart. 5 4 3 2 1
19. Maintains body mechanics throughout the performance 5 4 3 2 1
of the procedure.
procedure.

____________________________________ Average: _________
_____________________________________ FINAL RD GRADE: ________
____________________________ ________________________________
Page | 97
BACK RUB/ MASSAGE

Back rubs/ massage can conveniently be given after baths, before bedtime, or after
repositioning. Back rubs help boost relaxation, stimulate circulation, and promote sleep. Back
rubs do not need to be long, and typically take about five minutes of your time. Always ensure it
is okay to provide a back rub. Healthcare providers must check with their supervisor and in the
care plan. Again, giving a back rub gives the healthcare provider has the opportunity to observe
skin condition for rashes, bruises, red, white, or open areas, and other signs of skin breakdown.
Always report and record observations of any changes in skin condition.
Purpose for Giving a Back Rub/ Massage

▪ To give comfort
▪ To stimulate blood circulation
▪ To promote rest and sleep
▪ To prevent pressure sores
▪ To assess the skin condition
▪ To relax and relieve tension in tissues and muscles
▪ To refresh the client and relieve fatigue
General Instructions for Giving a Back Rub/ Massage

• Back care is given as a part of morning care and evening care.
• When giving a back rub, use more pressure (gentle) on the upward strokes towards the
head and less pressure on the downward strokes.
• Back rubs may be contraindicated in patients susceptible to clotting disorders — check
with the supervisor.
• Do not take your hands off of the patient’s back until the end of the procedure.
• Stop the back rub if, at any time, the client reports discomfort or no longer wishes you to
continue.
Types of Back Massage Strokes

1. Effleurage (Stroking): is a long sweeping movement with palm of hand conforming to
the contour of the surface treated, over small surface (on the neck) the thumb and
fingers are used. Strokes should be slow, rhythmical and gentle with pressure constant
and in the direction of venous stream.
2. Petrissage (Kneading): performed with the ulnar side palm resting on the surface and
the fingers, and thumb grasping the skin and subcutaneous tissues which move with the
hand of the operator.
3. Friction: is performed with the whole palmar surface of the hand or fingers and thumbs
over limited areas. This movement is a circular form of kneading with pressure against
the underlying part of tissue which cannot be grasped.
4. Tapotement (Percussion): This is used at the end of the other kind of strokes of
massage. Light, stimulating, and repetitive massages are produced via wrist, fists,
fingers, sides of the hands.
Different types of tapotement techniques are:
a. Perform Hacking: Stretched the elbow, keep the palms face to face in little right
angle and do very quick and sharp striking.
b. Perform Cupping: Stretched the elbow and make a cup shape with hand,
create vacuums and try to produce cupping sound striking against the surface of
the back. May produce redness.
c. Perform pounding: Providing very fast striking with loosing closed fists.
d. Perform beating: Gently striking the area with lightly clenched fists according to
the gravity. Can produce immediate redness.
Page | 98
Agents used for back massage:

• Massage Oil: commonly used to lubricate the skin and decrease friction.
• Lotions or emollients: reduce friction and lubricate the skin. They are appropriate for
most patients, especially those with a tendency toward dry skin; that is, elderly patients.
• Rubbing alcohol: Alcohol evaporates quickly, so it has a cooling but very drying effect.
A certain amount of alcohol is absorbed by the skin so it should not be used on infants,
elderly patients, or patients with liver disease.
• Powder: reduces friction but also has a drying effect on the skin. It may be appropriate
for those patients who perspire freely and/or are confined to bed.
PROCEDURE ON BACK RUB/ MASSAGE
Action Rationale
To elicit cooperation and better view of
1. Explain the procedure and position to the patient.
the client’s back.
Prevents the spread of microorganisms.
2. Perform hand hygiene and gather all supplies. Good organization promotes time
efficiency.
3. Adjust bed to a comfortable height. Prevent back strain and injury.
4. Provide privacy, and adjust the light, Promotes client comfort and area
temperature, and sound within the room. visibility.
5. Lower the side rails and help the patient assume Prevents falls and promotes client safety.
a prone or side lying position (sim’s position).
6. Expose the patient’s back, shoulders, upper Promotes client privacy and expose only
arms, and buttocks, and cover the remainder of areas that will be touched.
the body.
7. Use lotion that has been warmed in a basin of Do not heat lotion in the microwave.
warm water, or by running the bottle under warm Rationale: It may explode or be too hot
water for a few minutes. and burn the skin.
8. Place a small amount of lotion in your hand and This lubricates your hands during the
rub your palms together to warm the lotion and back rub and helps warm the lotion, so
lubricate your hands. Caution: the client that the the client does not feel too cold.
lotion may still feel cool.
9. Apply both hands to the sacral area (the lower Use gloves only if you or the client have
back), applying gentle pressure moving upward any open cuts, wounds, or sores to
along each side of the spine. prevent infection.
10. Massage in a circular motion, strokes moving
upwards from buttocks to shoulders, and then
back down the outer part of the back. Continue
this massage pattern for about 2–3 minutes.
Figure 29. Back Rub Motions (Image

courtesy of T. Christianson/TRU) CC BY
2.0
Page | 99
11. You may change the pattern to small circular

motions, either making a circular movement
moving upward along the spine and outward
from the spine, and laterally alongside the back,
down to the iliac crest (hip) or downward and
inward toward the spine. Continue this massage
pattern for about 2–3 minutes.
Figure 30. Back Rub Motions (Image

courtesy of T. Christianson/TRU) CC BY
2.0
12. When you are almost done with the back rub, let
the client know so they are prepared for the
ending of their back rub.
13. Wipe away any excess lotion. Assist the client Provides client comfort and relaxation.
with dressing. Position the client for comfort.
14. Lower the bed to its lowest setting. Ensure the Provides patient safety.
side rails are up.
15. Put away equipment and supplies. Dispose of Proper disposal
any dirty linens.
16. Wash and dry your hands. Prevents the spread of microorganisms.
17. Document the client’s response and record any Promote proper documentation and client
changes in condition or behavior. monitoring.
PERINEAL CARE
The perineum is the tiny patch of sensitive skin between your genitals (vaginal opening or
scrotum) and anus, and it’s also the bottom region of your pelvic cavity. The perineum may refer
to just the part of your body you can see (the skin in between your genitals and your anus). Some
might refer the perineum as the perineal area, genital area, or the triangle area between the legs.
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 client care. It is important to
maintain a professional, matter-of-fact attitude. As with all good caregiving efforts, remember to
allow the client to do as much as they can on their own.
The healthcare workers can start by providing a wet washcloth, soap, and a towel. Instruct
the client to wash the perineal area. You may need say it more simple terms so they understand,
such as “I’ll give you a washcloth so you can wash between your legs or your private area.”
Remind the uncircumcised male client to retract the foreskin to cleanse the penis.
Cleanliness of the genital area is an important part of everyone’s care, particularly if the
client is having difficulty controlling bowel and bladder functioning. This procedure is part of
personal hygiene care and must be done whenever the client is soiled or wet.
Page | 100
PROCEDURE ON FEMALE PERINEAL CARE
Action Rationale
1. With the client lying on their back, uncover Provides privacy and warmth.
the perineal area only.
2. Put on gloves. Medical Asepsis to avoid contact with mucous
membranes.
3. Separate the labia and use a clean part of
the washcloth for each stroke. Wash from
urinary meatus down to perineum (from
front to back) as many times as needed.
Use a clean part of the washcloth for each
stroke.
Figure 31. Female Perineal Care (Image

Courtesy of HCA Program/ TRU) CC BY 2.0
4. Wash down the labia minora and majora. Asepsis: “Top to bottom, clean to dirty” prevents
Far then near, top to bottom. Rinse all cross-contamination.
areas well, using a clean part of the cloth
for each stroke.
5. Wash across supra-pubic area (far to near).
Wash groin, starting on the farthest side,
including the upper and inner thigh (top to
bottom). Rinse and dry all areas well.
6. Turn the client on their side facing away
from you.
7. Wash and rinse buttocks.
8. Wash anus using a “J stroke” action. Then Asepsis. Do not rinse washcloth in the basin
rinse using a corner of the towel or a fresh after washing the anal area.
washcloth.
9. Dry buttocks then dry anus.
10. Remove gloves and dispose properly in Proper disposal of personal protective
designated trash bin. equipment.
11. Perform hand hygiene: Wash hands/ hand Prevents the spread of microorganisms.
rub using hand sanitizer.
PROCEDURE ON MALE PERINEAL CARE

Action Rationale
1. With the client lying on his back, uncover Provides privacy and warmth
the perineal area only.
2. Put on gloves. Medical Asepsis to avoid contact with mucous
membranes.
Page | 101
3. Draw back foreskin, if uncircumcised. Asepsis: clean-to-dirty, prevents cross-

Wash the head of the penis from the contamination.
urinary meatus outward in a circular
motion, using a clean part of the cloth for
each stroke. Rinse well using the same
method. Return the foreskin.
Figure 32. Male Perineal Care (Image Courtesy

of HCA Program/ TRU) CC BY 2.0
4. Wash shaft of penis from head of penis Prevents cross-contamination.
toward the body, using a clean part of the
cloth for each stroke.
5. Wash down the upper surface of the
scrotum.
6. Wash across supra-pubic area. Asepsis: near-to-far, top-to-bottom
7. Wash groin starting on farthest side,
including upper and inner thigh.
8. Rinse and dry all areas well.
9. Turn the client on their side facing away
from you.
10. Wash and rinse the buttocks.
11. Wash the anus using a “J stroke” action. Asepsis. Do not rinse/place washcloth in basin
12. Then rinse using a corner of the towel or a after washing the anal area.
fresh washcloth.
13. Dry buttocks, then dry the anus.
14. Remove gloves and dispose properly in Proper disposal of personal protective
designated trash bin. equipment.
15. Perform hand hygiene: Wash hands/ hand Prevents the spread of microorganisms.
rub using hand sanitizer.
Note: If the client is very difficult to turn or finds it painful to turn, healthcare worker can
use an adaptation to personal hygiene care/perineal care.
After washing the face, axilla and hands, you may then wash the perineal area. You then
remove your gloves, change the wash water, obtain a new washcloth and towel. Then position
the client on their side (sim’s position), wash their back, and then put on new gloves and wash
the anal area.
By doing hygiene care in this sequence, the healthcare worker will reduce the number of
times turning the client, but still following all rules of medical asepsis.
If the client wears an incontinent brief, healthcare worker can then put that on while the
client is on their side. Fanfold one side of the brief and tuck it under the client. Check for correct
placement of the brief. It should cover their buttocks and groin area. The top part of the brief will
be about 1–3 inches above their buttocks. Roll the client to the other side. Let them know they
will feel a “bump” from the brief as they roll over it. Ensure the bed rails are up. Move to the other
side of the bed. Pull the other half of the brief from under the client. Assist the client back to the
supine position (client is lying on their back). Pull the brief up between their legs. Peel tape from
tabs and fold each side inward toward the front. Secure tape to the front of the brief.
Page | 102
HEAT AND COLD APPLICATION

Heat and cold applications promote offer comfort by reducing tissue swelling and promote
healing and are ordered to relieve pain, fight local infection, swelling, or inflammation, control
bleeding, and reduce body temperature (Acello & Hegner, 2021). Regulated healthcare
professionals (nurses, physiotherapists, physicians) use heat and cold applications to reduce
tissue swelling and promote healing and comfort for injuries and post-operations. Even though
heat and cold are effective interventions, there are risks associated with these. Therefore, hot,
and cold applications should only be used if part of the client’s care plan and only for a specific
length of time. Some facilities allow only professional personnel to apply heat and cold, so be
sure to follow the agency policies.
Hot and Cold Effects
Think back to a time when you were really hot and you started sweating and your fingers
were swollen. Now think about a time when you were really cold and you started to shiver and
maybe your lips turned a little blue. What you experienced are the effects of heat and cold. Heat
and cold have opposite effects on body functions. Heat increases blood flow by vasodilating blood
vessels. When heat is applied to an area, the blood vessels in that area will dilate to increase
blood flow. However, when cold blood flow is slowed by vasoconstricting blood vessels to
conserve body heat. Applying a cold pack to an area will constrict blood flow in that area to reduce
swelling.
HEAT APPLICATIONS
Heat relieves pain, relaxes muscles, promotes healing, reduces tissue swelling, and
decreases joint stiffness. When heat is applied to the skin blood vessels in the area dilate. Blood
flow increases bringing more oxygen and nutrients to the surrounding tissue for healing. The
vasodilation allows for excess fluid to be removed from the area faster. On observation, the skin
will be red and warm to the touch (Acello & Hegner, 2021; Sorrentino, et al., 2019). Heat
applications are also comforting. And the sensation of heat may decrease the transmission of
pain signals to the brain which can relieve pain and discomfort. In addition, heat applications relax
muscles and joints which can decrease stiffness. Heat applications are used for chronic, or
ongoing, conditions. These include back pain and arthritis. Heat applications may also be used
only after the first two to three days following an acute, or sudden, injury (Acello & Hegner, 2021).
There are two types of heat applications:

A. Dry heat application is dry against the skin and no water touches the skin. Dry heat
applications include hot packs, hot water bags, heating pads, and hot aquathermia pads.
A dry application stays at the desired temperature longer.
B. Moist heat application is moist against the skin where the moisture or water touches the
skin. Moist heat applications include hot compresses, hot soaks, and sitz baths. Moist
heat applications Moist heat has greater and faster effects and are more penetrating than
dry heat applications (Acello & Hegner, 2021; Sorrentino, et al., 2019).
Complications of Heat/ Hot Applications

High temperature can cause burns. When heat is applied too long, blood vessels will start
to constrict. Persons at risk for complications include older adults, fair-skinned persons, those
with decreased sensation to heat and pain. Persons with dementia and those who have metal
implants are also at risk for injury. Others at risk for complications include:
▪ Loss of consciousness
▪ Scarring of the skin
▪ Use of some medications
▪ Spinal cord injuries
Page | 103
▪ Stroke
▪ Diabetes
▪ Aging
▪ Clients with dementia or cognitive impairment
▪ Clients with metal implants (pacemaker, joint replacement)
COLD APPLICATIONS
Cold applications are used for acute or sudden injuries such as treat sprains, fractures,
or fevers and are therefore useful right after an injury. Cold applications have numbing effect so
relieves or reduces pain. When the blood vessels vasoconstrict blood flow to the area and as a
result, less blood is able to come to the area. This in turn, decreases bleeding and reduces
swelling. Cold is applied during the first two to three days following an injury.
There are two types of cold applications:

A. Dry Cold Applications: dry against the skin and no water touches the skin. Dry cold
applications include cold packs, ice bags, and cold aquathermia pads.
B. Moist Cold Applications: include cold compresses and cold soaks. Moist cold
applications are more penetrating than dry cold applications (Acello & Hegner, 2021;
Sorrentino, et al., 2019).
Complications of Cold Applications
Cold temperature can cause burns, pain, blisters, and poor circulation. When cold is
applied for a long time, blood vessels dilate; this occurs as the body tries to warm the body
temperature. Persons at risk for complications include older adults, fair-skinned persons, those
with decreased sensation to heat and pain.
Persons with dementia and those who have metal implants are also at risk for injury.
Others at risk for complications include:
▪ Loss of consciousness
▪ Scarring of the skin
▪ Use of some medications
▪ Spinal cord injuries
▪ Stroke
▪ Diabetes
▪ Aging, which can cause decreased sensations due to changes in body function
▪ Clients with dementia or confusion
▪ Clients with metal implants (pacemaker, joint replacement)
Types of Applications Sample Images

1. Aquathermia Pad (Aqua K-Pad)
➢ An aquathermia pad is a pad with tubes
inside. The pad is attached to a
cooling/heating unit with two hoses. The
cooling/heating unit is filled with distilled
water to bring to desired temperature.
➢ The water flows through one of the
hoses and into the tubes in the pad.
Then the water flows through the other
hose and back into the cooling/heating
unit to maintain the desired water Figure 33. Aquathermia pad
temperature before flowing back into the
pad.
Page | 104
2. Cold Pack
➢ A cold pack is a type of dry cold
application. It is a pack filled with cold
fluid. Cold packs may be cooled by
keeping them in the freezer, by striking
or squeezing them to activate
chemicals, or placing ice into bag or
glove.
➢ The aquathermia pad can also be used
as a cold pack. Cold packs are applied
to the area of the body being treated.
They may be reusable or disposable
(Acello & Hegner, 2021; Sorrentino, et
al., 2019). Figure 34. Sample Hot/ Cold Pack
(Google images, 2024)
3. Cold Compresses
➢ A cold compress is a cloth or pad that is
soaked in cold water. It is then applied
to the area of the body being treated. A
cold compress warms quickly so it must
be resoaked and reapplied.
➢ Compresses such as 4 X 4 gauze or
Telfa pads, are used to apply moist cold
to a small area. These compresses are
easily made of washcloths or towels.
➢ Compresses and cold packs are usually
not sterile. However, if there is a break
in the client’s skin, sterile dressings may
be used (Acello & Hegner, 2021;
Sorrentino, et al., 2019). Figure 35. Samples of Cold Compress
(Google images, 2024)
4. Hot Pack
➢ Hot packs can be hot water bags,
heating pads, and hot aquamatic pads.
Some hot packs are filled with hot fluid.
Hot packs may be heated by heating
them in the microwave or in hot water or
by striking or squeezing them to
activate chemicals. Hot packs are
applied to the area of the body being
treated. They may be reusable or
disposable.
➢ The water temperature of a hot pack Figure 36. Sample Hot water bag and Instant
should not exceed 110°F, or 43°C. A Hot packs (Google images, 2024)
hot pack such as an electric heating
pad or an aquathermia pad, which
produces dry heat, is used to treat
muscle sprains and mild inflammations
and for pain relief.
➢ K-pads use Temperature-controlled,
distilled water that flows through the
waterproof pad. The water temperature
of a hot aquamatic pad is typically 95°
to 105°F, or 35° to 41°C
Page | 105

al., 2019).
5. Warm Compresses
➢ Description automatically generated
Compresses such as 4 X 4 gauze or
Telfa pads, are used to apply moist heat
to a small area.
➢ Large warm, moist packs of cotton or
terry cloth are used to apply heat over a
larger area. Commercially prepared
warm packs are also available and may
be used to apply either dry or moist
heat. Covering any hot pack with heavy,
dry material helps it retain heat longer.
➢ Application of an Aqua-K pad over a
pack enables the pack to remain heated
almost indefinitely.
➢ The water temperature of a hot
compress is typically 100° to 105°F, or
38° to 41°C. Compresses and hot packs
are usually not sterile. However, if there Figure 37. Warm compress -Electrothermal
is a break in the client’s skin, sterile water pack, rechargeable (Google images,
dressings may be 2024)
used (Acello & Hegner, 2021;
Sorrentino, et al., 2019).
6. Hot Soak
➢ A hot soak is a type of moist heat
application that consists of immersing
the client’s affected body part in warm
water or medicated solution for a
prescribed time. The area of the body
being treated is placed in a basin filled
with hot water.
➢ The water temperature of a hot soak is
typically 105° to 120°F, or 41° to 49°C
al., 2019).
Figure 38. Immersion of body part in water
with medicated solution (Google images, 2024)
7. Sitz Bath
➢ A sitz bath is a type of moist heat
application. The pelvic, perineal, and
rectal areas of the body are placed in
hot water. The water temperature of a
sitz bath is typically 105°F, or 41°C.
➢ Disposable sitz basins are often used or
a regular bathtub with enough water to
cover the client’s hips and perineum
al., 2019).
Figure 39. Sitz bath kit (Google images, 2024)
Page | 106
TEPID SPONGE BATH
Definition: Tepid sponging or cold sponging is a general application of moist cold liquid to
cool skin, by evaporation and by the absorption of body heat in the cold water.
Purposes
▪ To reduce body temperature
▪ To aid in elimination thru skin
▪ To relieve restlessness
▪ To provide comfort and relaxation to patient
General Considerations
• Avoid chilling the patient.
• Sponge face, neck, leg, back and buttocks.
• Avoid circular or friction, sponge slowly and gently.
• Cool cloth in axilla and groin
• Reassess 15 minutes and after completion of sponge bath.
PROCEDURE ON TEPID SPONGE BATH
Action Rationale
1. Explains procedure, purpose of treatment To elicit cooperation and client’s data will
while assessing the condition of the client. serve as basis in evaluation their
response to treatment.
2. Performs hand hygiene: wash hands or does Prevents the spread of microorganisms
alcohol hand rub. Put on working gloves. and prevents transmission of
contaminants.
3. Assembles equipment: Good organization promotes time
• Wash basin efficiency.
• Pitchers of water (18-32°C/ 65-93°F)
• Washcloths (4 pcs)
• Bath blanket
• Bath towel
• Ice cap
• Hot water bag
• Thermometer.
4. Closes windows and turns off fan or aircon to Provides client privacy and prevents
prevent drafts or chills. hypothermia.
5. Loosens top sheet. Replaces with bath To protect bed linens.
blanket.
6. Assists client to the side of bed. Takes Provides healthcare worker with a
client’s temperature. baseline temperature.
7. Removes client’s clothing from underneath To ensure privacy and reduce exposure of
the top sheet or blanket. body parts.
8. Fills basin with water. Soaks washcloths. Make sure to check the water temperature
that should be neither too hot nor too
cold. Appropriate temperature is 27 to
37°C.
9. Places ice cap/ compress over client’s head.
10. Spreads bath towel across the client’s chest. The axilla and groin areas contain large
Places saturated washcloths in axilla and blood vessels that are close to the
inguinal area and let stay. Replaces with new skin’s surface, which aide the transfer
of heat.
Page | 107
one as needed to maintain temperature of

saturated washcloths.
11. With another washcloth adequately
saturated, sponges face and neck 2-3 times
using different washcloth each time. Pats
dry.
12. Changes water as necessary to maintain
desired temperature.
13. Renders sponge bath for 25-30 minutes. Cool sponges given rapidly or for a short
period of time tend to increase the
body’s health production.
14. Removes washcloths from axilla and inguinal
area.
15. Assists the client to new gown. Changes Avoid letting client wear heavy clothing or
beddings as needed. excessive sheet covering as it only
elevates their temperature.
16. Leaves ice cap/ cold compress in place for
30 minutes more.
17. Cleans and returns used equipment. Keeps Good organization promotes time
room in order. efficiency.
18. Takes the client’s temperature 30 minutes To evaluate the effectiveness of the
after the procedure. Places client into sponge bath.
comfortable position.
19. Washes hands. Prevents the spread of microorganisms.
20. Documents the time and duration of Promote proper documentation and client
treatment, client’s temperature before and monitoring.
after tepid sponge bath, including client’s
response to treatment, and any anti-pyretic
medications ordered and given.
Page | 108

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Manual of Healthcare Procedures | SKSU | 2024

HYGIENE CARE: BED BATHING

Types of Patients Needing Bed Bath

Scientific Principles of Bed Bathing:

Factors Affecting the Skin

TYPES OF BED BATH:

SHOWER BATH OR TUB BATH

COMPLETE BED BATHING

Indications of complete bed bath

KEY POINTS IN BED BATH PROCEDURE

PROCEDURE ON CLEANSING BED BATH

Republic of the Philippines

PERFORMANCE CHECKLIST ON COMFORT MEASURES:

Name: ____________________________________ Score: ________________

STEPS OF THE PROCEDURES RATING

34. Remove gloves and dispose properly. If not contraindicated,

Comments: ____________________________________ Total Score: _________

Performed by: Verified by:

SHAMPOOING A PATIENT’S HAIR IN BED

2. Identify the patient. Ensures the correct patient and to gain

Republic of the Philippines

PERFORMANCE CHECKLIST ON COMFORT MEASURES:

Name: ____________________________________ Score: ________________

10. Place a folded bath towel around the patient’s shoulders. 5 4 3 2 1

ASSISTING THE PATIENT WITH ORAL CARE

PROVIDING ORAL CARE FOR UNCONSCOIUS PATIENT

• Position patient’s head to allow for return

Republic of the Philippines

PERFORMANCE CHECKLIST ON COMFORT MEASURES:

Name: ____________________________________ Score: ________________

Comments: ____________________________________ Total Score: _________

Performed by: Verified by:

Republic of the Philippines

PERFORMANCE CHECKLIST ON COMFORT MEASURES:

Name: ____________________________________ Score: ________________

• If desired, insert the rubber tip of the irrigating syringe into

Comments: ____________________________________ Total Score: _________

Performed by: Verified by:

BACK RUB/ MASSAGE

Purpose for Giving a Back Rub/ Massage

General Instructions for Giving a Back Rub/ Massage

Types of Back Massage Strokes

Agents used for back massage:

PROCEDURE ON BACK RUB/ MASSAGE

Figure 29. Back Rub Motions (Image

11. You may change the pattern to small circular

Figure 30. Back Rub Motions (Image

PROCEDURE ON FEMALE PERINEAL CARE

Figure 31. Female Perineal Care (Image

PROCEDURE ON MALE PERINEAL CARE

3. Draw back foreskin, if uncircumcised. Asepsis: clean-to-dirty, prevents cross-

Figure 32. Male Perineal Care (Image Courtesy

HEAT AND COLD APPLICATION

Hot and Cold Effects

There are two types of heat applications:

Complications of Heat/ Hot Applications

There are two types of cold applications:

Complications of Cold Applications

Types of Applications Sample Images

Name: ____________________ Score:

Comments: ____________________________ Total Score: _

Name: ____________________ Score:

Name: ____________________ Score:

Comments: ____________________________ Total Score: _

Name: ____________________ Score:

Comments: ____________________________ Total Score: _