Chapter 22

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.

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.

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.