American Medical Association Family Medical Guide - American Medical Association [139]
Remove soiled underwear (including disposable briefs) promptly. Be sure to keep sheets pulled tight to prevent wrinkles, and keep them clean, dry, and free of crumbs.
Provide a healthy diet (see page 183) and plenty of fluids to help keep the person’s skin healthy. Eating high-protein foods (such as lean meat, fish, dried peas and beans, and whole grains) and taking nutritional supplements also can help prevent and treat pressure sores.
Bathing
Unless a person is extremely ill, he or she usually can bathe independently with minimal help. Place a large towel under the person to protect the bedding before bringing him or her a basin of warm water, mild soap, and a washcloth. Be sure that the room is warm, and provide another large towel to drape over the person for warmth and privacy. The person should give himself or herself a sponge bath once a day.
If the person you are caring for is unable to bathe without help, you can give him or her a bath in bed. Although giving a bed bath presents its own challenges, it is not a difficult task to perform once you have mastered the routine. Make sure that the room is warm before undressing the person, taking care to provide as much privacy as possible. Cover him or her with a large towel and place another towel underneath to protect the bedding. Before you begin, check the water to make sure it is at a comfortable temperature. When you use soap, make sure it is a mild soap that will not dry out or irritate the person’s skin.
As you bathe the person, look carefully for sores, rashes, or other skin problems. If the person is recovering from surgery, be sure to examine the incision carefully to make sure it is healing properly. Some indications of possible infection include fever; redness, pain, and swelling around the incision; and pus. It is important to report any of these signs to the doctor or nurse immediately.
When giving a bed bath, wash and dry one area of the person’s body at a time, uncovering only the part of the body you are washing. This helps keep the person warm and maintains a sense of privacy.
Follow these steps:
1. Use plain water to bathe the person, starting at the head. Use soap only in sweaty areas (such as the armpits, groin, and buttocks); wash between skin folds. Be thorough but gentle. Change the water as needed.
2. Gently pat the person dry with a fresh, soft towel; don’t rub.
3. Roll the person onto one side to wash and dry his or her back.
4. Let the person dip his or her hands into a basin of fresh water. This is more refreshing than having the hands wiped with a washcloth.
5. Before helping the person dress, make sure that every area of his or her body is thoroughly dry. Provide or apply deodorant, lotion, or body powder as needed.
Helping With Toileting Needs
Bladder and bowel movements can be difficult for people who cannot use the toilet. A person who is confined to bed will need to use a bedpan or commode; a man may be able to use a handheld urinal. If a person cannot use these devices, he or she may need to wear absorbent disposable briefs. Always give the person complete privacy.
If the person cannot wipe after urinating or having a bowel movement, you will need to do it for him or her. Keeping the genital and anal areas clean helps prevent the skin from breaking down. Always wipe a woman or girl gently from front to back (from the vagina to the anus) to ensure that bacteria do not enter the vagina or urinary tract and cause infection.
Some caregivers need to give an enema (by injecting a liquid into the rectum) to relieve constipation (see page 769) or an accumulation of hardened feces in the rectum (fecal impaction). If the person has an indwelling catheter (a plastic tube inserted directly into the bladder)