BATHS AND BATHING
Bathing is necessary in sickness no less than in health. It stimulates
and equalizes the circulation, is soothing in feverish conditions, is
refreshing to most people, and by affording a certain amount of exercise
it lessens the fatigue of lying in bed. Moreover, without frequent
bathing it is impossible to keep the skin in good condition, since
scales of dead skin, oily matter, and solid substances left by
perspiration collect on the surface of the body when a person is lying
still in bed as well as when he is leading an active life. The common
belief that sick people are likely to catch cold from bathing is quite
unfounded; every patient, unless his condition is such that the doctor
orders otherwise, should have one complete cleansing bath each day. In
addition to the regular cleansing bath other kinds are often prescribed
as medical treatment.
CLEANSING BATHS
A _tub bath_ if allowed by a patient's condition, is the most
satisfactory kind, but special precautions must be taken to guard her
from fatigue and chill. The bath room and everything to be used should
be made ready before she leaves her bed. Necessary clothing and toilet
articles should be collected and arranged conveniently, a chair covered
with a blanket and also a bath mat should be placed beside the tub, and
the temperature of the bath room should be regulated so that it is about
70° F., or a little lower if the room is likely to become overheated as
the bath proceeds. The bath water should be drawn last. Its temperature,
tested by a thermometer, should be between 96° and 100° at the
beginning, and may be increased if desirable.
If the patient is weak, wash and dry her face, neck, and ears, and if
necessary cut the finger and toe nails before she leaves the bed, in any
case before she enters the tub. As soon as the patient has left the bed,
strip it and leave it to air; then assist her into the bath room and
help her carefully into the tub. Do not allow her to stay in the water
more than ten minutes at most, and stop the bath at once if she shows
the slightest sign of faintness, dizziness, exhaustion, difficult
breathing, marked change of color, or other unusual symptom. Indeed, if
the patient is weak or her reaction to the bath uncertain, as when she
takes her first tub bath after an illness, someone should always be
within call to help the attendant in case of need. A faint, heavy
patient in a bath tub is an impossible load for one person to handle.
While the patient is in the tub, soap her well, brush her finger and toe
nails, rinse, and rub her to stimulate the circulation. Then help her
from the tub, seat her in the chair, draw the blanket closely about her
from neck to feet, dry her with warm towels, exposing the body as little
as possible, and, if she is to return to bed, put on a fresh night gown,
and wrapper and slippers. Next place the lower sheet, the draw sheet,
and one pillow on the bed as quickly as possible, help the patient into
bed, keeping her well covered with a blanket, and finish making the bed.
If she seems chilly, give a hot water bag and hot drink and leave the
blanket next her in place. After the patient has been made comfortable,
clean the tub and put the bath room in order.
Even patients supposedly able to take tub baths without assistance
should not lock the bath room door nor be left alone a long time.
BED BATH.--Practice is essential in order to give a bed bath skillfully.
The aim is to make the patient thoroughly clean and thoroughly dry,
without chilling, fatiguing, or exposing her, without making the bed
damp, and without unnecessary haste or delay. One method of giving a
bed bath follows, but any method that accomplishes these aims is likely
to be satisfactory.
First see that the room is about 70° F. and likely to remain so, and
exclude draughts. Collect everything to be used, including a blanket to
cover the patient, an old blanket or large bath towel to protect the
bed, at least two other towels, one a bath towel and the other a face
towel, two wash cloths, soap, nail brush, powder, alcohol, comb and
brush, nail file, scissors, etc.; fresh bed and personal linen; a large
basin containing water at 105°, a jug of hotter water, and a slop jar.
Remove the upper bed clothes except one blanket, which should cover the
patient constantly during the bath, and spread them where they will air;
remove all the pillows but one, and place the bath blanket under the
patient as the under sheet is placed in bed making. If a bath blanket is
not used, keep the bath towel under the part that is being bathed by
moving the towel from place to place.
Next remove the night gown in the following way: Let the patient lie on
her back, with her knees flexed; draw the gown up as far as possible,
then raise or get her to raise her hips so that the gown may be drawn up
above the waist. Next raise her head and shoulders with one arm and draw
the night gown up to the neck with the other; remove one sleeve, draw
the gown over the head and then off the other arm.
[Illustration: FIG. 16.--WASHING A PATIENT WITHOUT EXPOSURE. (_Sanders
"Modern Methods in Nursing."_)]
The patient is now ready for the bath. Wet the wash cloth thoroughly,
but hold it gathered in the hand so that it will not drip. Wash the
face, neck, and ears first, dry them thoroughly, and next, using the
second wash cloth, wash the arms and hands, chest and abdomen, giving
particular attention to the armpits and navel. Raise the blanket
slightly with one hand to keep it from becoming damp, but expose the
patient as little as possible; the arms and legs need not remain covered
while being washed. Dry each part thoroughly before washing the next.
Next turn the patient on her side and wash the back, the buttocks, and
upper part of the thighs; give special attention to the fold between the
buttocks. Then turn the patient on her back, and wash the thighs, legs,
and feet. If it is important to move the patient as little as possible,
leave the back until last so that the under sheet may be changed without
turning her again. Cut the toe nails if necessary before washing, and
clean them carefully afterward. Unless there is a reason to the
contrary, wash the hands and the feet in the basin, first protecting the
bed with a towel, newspaper, or clean wrapping paper. Be sure to clean
well between the toes, and to dry the feet thoroughly; they may need
some friction. Throughout the bath empty and refill the basin as
necessary.
Wash the genital region last. Let the patient lie upon her back with
knees flexed and separated, or upon one side with the knees flexed and
one slightly raised. Patients who are able may take this part of the
bath themselves with whatever assistance may be necessary. The
attendant, however, must either do it herself or make sure that the
patient does it thoroughly. To neglect a helpless patient is always
unkind, and no less unkind when the motive is a mistaken sense of
modesty. If discharge from the genitals is present use absorbent cotton,
or clean, soft old cloth to wash the parts, and burn it afterward. It is
sometimes desirable to place the patient on a bedpan and rinse the parts
by a gentle stream of warm water poured from a jug. After the attendant
has completed this part of the bath she should wash her own hands
thoroughly.
After the bath rub the patient with alcohol. If a complete alcohol rub
is impossible, at least rub the points where pressure comes, especially
the back. After the rub apply a little toilet powder if the patient
desires it. When the toilet is complete remove the bath blanket, remake
the bed and put the room in order.
CARE OF THE MOUTH AND TEETH.--In sickness the mouth and teeth require
more than ordinary attention; indeed, the condition of a patient's mouth
is a fair index to the quality of the care she is receiving. If the
patient can brush her own teeth she should do so in the morning, at
night, and after meals. At those times the attendant, without waiting to
be asked, should bring her a towel, tooth-brush, cup of tepid water,
tooth paste or powder, and a small basin or dish to receive the used
water. The process is generally more thorough when the patient does it
herself, and even a patient unable to sit up can brush her teeth
successfully if the nurse holds the powder and cup of water, and
provides a basin shallow enough for the patient to use by turning her
head to one side.
[Illustration: FIG. 17.--THE NURSE ASSISTING THE PATIENT IN BRUSHING THE
TEETH. (_From "Elementary Nursing Procedures," California State Board of
Health._)]
The attendant must cleanse the mouth of a patient who is unable to do it
herself. If this cleansing is neglected, a dark tenacious substance
collects upon the teeth and gums, composed chiefly of food particles,
bacteria, mouth secretions, and worn out cells of the mucous membrane.
Once formed it is difficult to remove, hence the mouths of all patients
and especially those who have fever, must receive proper care from the
very beginning of illness. Cotton swabs are convenient for cleansing the
mouth; they are made by winding a small piece of absorbent cotton upon a
match or wooden tooth-pick.
To cleanse the mouth of a helpless patient, take to the bedside the
mouth wash prescribed by the doctor, a towel to protect the bedclothes,
several swabs, and a receptacle for used swabs; the latter should be a
strong paper bag or several thicknesses of newspaper. Clean the tongue,
gums, teeth, and spaces between the teeth gently but thoroughly, using
especial care if the gums are tender. Dip only clean swabs in the
solution, discard each one after using it once, and burn it afterward.
Let the patient rinse her mouth after cleansing it if she is strong
enough. If the mouth is very dry, encourage her to drink more water.
Notify the doctor if the gums and tongue crack or bleed since he may
wish to order a special mouth wash. Cold cream or boracic ointment may
be used if the lips are dry and cracked.
False teeth should be thoroughly brushed and cleansed, and kept in cold
water if taken out during the night.
CARE OF THE HAIR.--Long hair, if neglected, becomes tangled and matted
in a surprisingly short time. Unless the patient is actually in a dying
condition she is not too sick to have it properly attended to at least
once a day. Before combing the hair protect the pillow with a towel;
then part the hair in the middle from the forehead to the nape of the
neck, and draw it to either side. Begin to comb at the ends, holding the
strand of hair firmly in one hand placed between the head and the comb;
in this way tangles can be removed without hurting. After combing and
brushing the hair, braid it in two braids, beginning near the ears; draw
it as tightly or loosely near the head as the patient prefers, but
remember that tight braids mean fewer tangles. If the hair is heavy or
badly tangled the patient may be too much fatigued to have it all combed
at one time; in this case braid the part that has been finished and
complete the work later.
TO WASH THE HAIR OF A BED PATIENT.--The hair of a patient can be
successfully washed in bed if sufficient care is taken not to chill or
tire the patient, or to wet the bed. The following articles are needed:
one small jug of strong soap suds made by dissolving a pure soap in hot
water, one large jug of hot water at about 112° F., one jug of cold
water, a slop jar or foot tub, one long rubber sheet or piece of enamel
cloth, and several towels including at least one bath towel. Let the
patient lie as near the edge of the bed as possible. Roll one small
towel lengthwise, place it below the hair at the back of the neck, bring
it up above the ears to the forehead and pin tightly, in order to catch
water that might wet the face and neck. Next make a kind of trough of
the large rubber by rolling its long edges inward for a few inches.
Place this across the bed under the patient's head so that her neck
rests on the lower roll. Raise by means of pillows the end of the rubber
trough that lies toward the middle of the bed, in order to prevent water
from running into the bed or collecting under the patient's head. Let
the other end of the rubber extend over the edge of the bed down into
the slop jar or foot tub, which may be placed on a chair or stool. Then
wash the hair and scalp with the soap solution, and rinse them
thoroughly with water from the large jug. Squeeze as much water as
possible from the hair, remove the rubber and substitute a heavy bath
towel, and rub and fan the hair until dry. A shampoo in bed is tiring.
Do not attempt it unless the patient is strong enough to stand not only
the shampoo itself, but also a complete change of bed clothing, which
will almost certainly be necessary if the attendant has been careless or
clumsy in the slightest degree.
HOT FOOT BATHS properly speaking are medical treatment, but they are
taken by many persons to relieve colds, headache, or insomnia. Let the
patient sit, well wrapped, with her feet in water at about 105°, and
then increase the temperature gradually by adding hotter water. Take
care to add hot water slowly and not to pour it directly upon the
patient's feet or ankles; otherwise she may be scalded. Mustard may be
added to the bath water in the proportion of one tablespoonful of
mustard to each gallon of water. If mustard is to be used make it into a
smooth paste with cold water, thin the paste with warm water, and when
thin enough to pour easily add it to the bath water and stir well. The
bath may continue for 10 to 20 minutes, and the feet should be dried
afterward without friction. The patient should go to bed at once; she
should not wander about, clearing away her foot bath, doing forgotten
things, getting herself chilled, and losing all the good effects.
A foot bath may be given easily to a patient in bed. Bring to the
bedside a blanket, a towel, the tub filled with water, and something
with which to protect the bed; this may be a rubber sheet, bath towel,
old blanket folded, or several thick clean newspapers. Loosen the upper
covers at the foot of the bed, fold them back above the patient's knees,
and cover her legs and feet with the extra blanket making it overlap the
bed clothing so that it will not slip. Flex the patient's knees, put the
bed protector under her feet, place the tub on the side of the bed,
raise the legs and feet with one hand and arm, and slide the tub into
place with the other, raising the elbow in such a way that it keeps the
blanket out of the water. Lower the feet slowly into the water, fold the
towel, and place it over the edge of the tub in order to protect the
patient's knees from the cold rim; then tuck the blanket closely about
the tub and legs and proceed as before. After the bath use the towel,
unless it is wet, to receive the feet when they are withdrawn from the
tub. Remove the tub, dry the feet thoroughly, cover them warmly, and
remake the bed.
COOL SPONGE BATH.--For feverish patients doctors often order cool sponge
baths. In order to give a cool sponge bath, first protect the bed
thoroughly, but leave the patient uncovered except for a towel laid over
the hips. Use cool water, or cool water and alcohol, and have the wash
cloth as wet as it can be without dripping. Bathe the body without
friction, using long, light strokes, and leave each part wet until the
bath has been completed. Do not use soap. Sponge in this way the arms,
legs, chest, and back, but not the abdomen, for ten to twenty minutes,
giving special attention to the neck and inner side of the arms and
legs, because in those places large blood vessels lie nearer the surface
of the body. After finishing the bath dry the body by patting it gently
with towels.
Take the patient's pulse occasionally during the bath, and stop the bath
at once if the patient's pulse grows weaker, if she shivers violently,
or if her face, fingers, or toes turn a bluish color. Babies react
rapidly to cool sponging; for a baby use tepid water, sponge for five
minutes only, and watch the child closely during the bath.
EXERCISES
1. What may a bath be expected to accomplish in addition to cleansing?
2. In giving a tub bath, what precautions should be taken to avoid
chilling the patient? to avoid tiring the patient?
3. What symptoms would lead you to think that a tub bath was not
agreeing with a patient? What should you do in such a case?
4. Name six essentials of a skillfully given bed bath.
5. What preparations should be made and what articles assembled before
beginning a bed bath?
6. Describe the method of bathing a patient in bed.
7. What care should the mouth and teeth of every sick person receive?
How should such care be given to a patient who is helpless?
8. Describe the daily care of a patient's hair, and tell how a shampoo
may be given to a patient in bed.
9. How should you give a mustard foot bath to a patient in bed?
10. When and how should you give a cool sponge bath?
FOR FURTHER READING
The Human Mechanism--Hough and Sedgwick, Chapter XI.