Fundamentals - Practice & Skills, part 5: Bed Baths, Bed Making, Oral/Denture Care, and Seizure Precautions
by Meris Shuwarger BSN, RN, CEN, TCRN July 22, 2021 Updated: December 07, 2022 7 min read
This article focuses on basic care and comfort, including bed baths and bed making, oral care and denture care. It also covers the important topic of seizures and what to do with a patient who is on seizure precautions.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
A bed bath simply means washing someone who is confined to a bed. Bed baths help keep the skin clean, which can prevent infections. A gentle bed bath can also be soothing for your patient.
Giving patients bed baths is a typical nursing duty, so it is important to know how to properly give a patient a bed bath.
How to give a bed bath
To start, fill a basin with warm water. You can also use disposable bath wipes.
It is important to ensure patient privacy when you give a bed bath. As you wash your patient, cover those areas you are not in the process of washing with a bath sheet. This is both for privacy and to keep the patient from getting cold.
When you give a bed bath, start with the eyes. Wipe the eyes with a damp cloth, without soap. This helps decontaminate the skin area around the eyes. Bacteria should be kept away from the eyes because it could cause an infection.
Next, wash the face, chest, arms, abdomen, legs, feet, and back.
When washing a patient's skin, first wet the skin, then gently apply a small amount of soap. Make sure all the soap is rinsed off and pat the area dry before covering it and moving on to the next area.
The last area to wash is the perineum — the patient's genitals and rectum. Before washing the perineum, change the water. Again, this is to prevent infection.
If your patient has a vulva, remember to wipe from front to back as you wash them. This avoids bringing fecal bacteria toward the urethra, which could lead to a urinary tract infection.
Bed making procedure
Bed making is another standard nursing duty, one you will perform often. Because of the potential for muscle fatigue or injury when you perform daily tasks, such as bed making or giving a patient a bed bath, it is important that you protect your back as you work, and that means making sure to raise the bed to waist height before you start.
Note that we do not shake out the linens when changing a bed in a hospital. This is to keep from dispersing any skin cells or other pathogens that might have accumulated on the linens.
When you replace old or soiled linens, immediately place them in a bin or soiled linen bag; do not pile them on the floor. This is another preventative measure to stop the dispersal of pathogens.
Patient oral care
Oral care is another fundamental nursing activity. Oral hygiene — the practice of keeping the oral cavity healthy through the cleaning of the gums, teeth, tongue, lips and, if necessary, dentures — can have a positive effect on the patient’s well-being and general health.
For patients who are alert and oriented, place an emesis basin (a shallow basin with a kidney-shaped base and sloping walls—contrary to its name, not usually used for vomiting!) underneath their chin, and provide a cup of water to help them with rinsing and spitting when you perform oral care.
If the patient is unconscious or cannot protect their airway as you perform oral hygiene, angle their head 45 degrees and turn them to the side to prevent aspiration (when something enters the airway or lungs by accident).
Keep suction readily available in case you need it to remove excess spittle or water from inside or around the patient's mouth.
Never place your fingers in a patient's mouth, regardless of whether they are alert, oriented, or unconscious. This will prevent the possibility of your being bitten, as well as keeping potential pathogens out of the patient's mouth.
Patient denture care
When it comes to patient denture care, remember that dentures can be very expensive, and it is important to handle them carefully.
Place some towels in the sink base when you clean dentures. If you accidentally drop them, their fall will be cushioned, which can keep them from breaking.
Cleaning dentures is a relatively easier task compared to brushing a patient's teeth. With dentures, you can brush them with a toothbrush and toothpaste, or you can use a dedicated denture cleanser.
Use cool water to rinse dentures, then store them in a labeled denture cup filled with denture solution or water. This will keep them from drying out. Make sure the cup is labeled with your patient's name and date of birth.
A seizure is a burst of uncontrolled electrical activity between brain cells (also called neurons or nerve cells) that causes temporary abnormalities in muscle tone or movements (stiffness, twitching, or limpness), behaviors, sensations, or states of awareness.
Not all seizures are alike. Some are single events due to an acute cause, such as medication. Other seizures may be recurring seizures, also known as epilepsy.
While seizure prevention is a key long-term goal, preventing immediate physical danger to a patient who is at risk for seizures is the first priority. That means it is vital to establish and maintain seizure precautions, which are procedures designed to protect the patient from injury and include creating a safe environment around the patient and ensuring the proper equipment is available in the patient's room.
If you are treating a patient on seizure precautions, you must follow a number of protocols.
Pad the bed rails
First, make sure to pad the side rails of the patient's bed. This is to prevent a seizing patient from injuring their head if they hit it on the hard metal rails.
Usually the hospital will supply pads for a patient on seizure precautions, but you can also tape blankets and towels around the rails if necessary.
Access to oxygen
Make sure the room is equipped with oxygen and a delivery device. When a patient seizes, it could be due to a lack of oxygen. In addition, during a seizure, blood oxygenation levels could drop, which will require you to administer oxygen.
Make sure that suction equipment is set up and ready to be used in the patient's room in the event you need to suction the airways of a seizing patient.
Vital signs equipment
A seizure can change a patient’s pulse rate, often causing an increase in their heart rate. Occasionally, a seizure causes a patient's heart to slow, or even stop. So be sure the room has equipment that can track the patient's vital signs.
Nursing care during a seizure
Seeing someone have a seizure can be a frightening experience. As a nurse, you should be prepared to deal with this situation. Knowing how to care for a patient during a seizure is key to helping you keep your cool and be an effective nurse.
Lower to the floor
First, if the patient is standing or upright, lower them gently to the floor in as controlled a manner as possible. If you are alone, use your leg as a slide to help lower them to the floor.
Once the patient is on the floor (or if they are already lying in their bed), turn them onto their left side. This will keep them from choking on any secretions and decrease the risk of aspiration.
Loosen restrictive clothing
A seizure can happen anytime, anywhere. For example, if the patient is wearing a suit and tie, loosen the tie and unbutton the suit and shirt so they are not straining against something that's putting pressure on their airway.
This is to ensure the airway is “patent,” which means there is an open pathway between a patient's lungs and the outside world so they can breathe.
Protect the patient from harm
The number one priority when a patient is seizing is to protect them from harm. That means if there is anything in proximity that could hurt them — furniture, for example — it is moved out of the way. Furniture, like the side rails of a bed, is a potential hazard because the patient could bang their head on it.
Keep the mouth clear
Previous practice suggested that when a patient was having a seizure it was important to restrain them or put something in their mouth. This is no longer the case. Never restrain a patient or put anything in their mouth when they are seizing.
As noted above, if you restrain a patient, they can hurt themselves by pushing against the restriction. That is why we loosen clothing.
Similarly, putting something in a seizing patient’s mouth places you at risk of being bitten and your patient at risk of choking. So never put a belt, wallet, tongue blade, or your hand in a seizing patient's mouth.
These changes are due to what we call evidence-based practice. After years of following one set of practices, the evidence gained over time has proven that there is a better way to help a seizing patient, and that is why we no longer restrain them or put anything in their mouths.
Note the seizure’s start and stop times
As part of your nursing documentation, make sure that you note when the seizure started and when it stopped. This will help to discern which kind of seizure your patient has just experienced.
Nursing care post-seizure
After a seizure, your patient is going to be in the postictal phase — meaning their condition is somewhere between the end of the seizure and a return to their normal condition. During this phase, they may be highly disoriented, confused, upset, even combative.
It is important that you reorient your patient as much as possible. Try to keep them calm and reassure them they are safe.
At this time, you should record their vital signs and perform a brief neurological exam. This exam will help you discern how well the patient's brain and the rest of their nervous system are functioning and consists of assessing mental status, reflexes, pupillary responses, and motor and sensory functions. Need to remember these steps? Check out our Health Assessment Flashcards for Nursing Students.
Remember, in the postictal phase, your patients may be really out of it. They may be acting in a way that is not their normal self. Be kind and calm and compassionate, because they are most likely scared and confused.
Hi, I'm Meris, and in this video, we are going to be talking about bedmaking, bed baths, oral and denture care, and most importantly, what to do with a patient who is on seizure precautions. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website, levelupRN.com. If you already have a set for yourself and you're following along, I am on card number 55. So let's get started.
So first up, we're going to be talking about bed baths and bed making.
You will see here on this card we do have step-by-step for how to give a bed bath.
I'm not going to go into everything in detail here, but one of the things I wanted to make sure to point out is that we start by washing the eyes first without soap.
That way, we can make sure to decontaminate that skin area without bringing bacteria in towards the eyes and ending up with an infection that way.
And then we're going to wash the face, chest, arms, abdomen, legs, feet, and back. The last thing we should wash is the perineum. So that's going to be the patient's genitals and rectum. We're going to make sure that we change the water before we wash the perineum.
And remember that if you have a patient with a vulva, you need to be wiping from front to back to avoid bringing any kind of fecal bacterial up towards the urethra because if you have a shorter urethra, you are more likely to get a urinary tract infection. So very important to remember that.
Now when it comes to bed making, just a few key points. You want to make sure that you raise the bed to waist height for yourself so that you don't injure yourself.
We don't shake the linen. So I know that at home, you might shake out your fitted sheet or your comforter.
We don't do that in the hospital because we don't want to disperse any skin cells or any pathogens.
And then we want to make sure that the soiled linens go immediately in the soiled linen bag, not on the floor. So that is it for that card.
Let's move right along to card number 56. This is going to be talking about basic care and comfort as it relates to oral care and denture care.
If my patient is alert and oriented, I'm going to make sure that I have a basin underneath their mouth, and I'm going to give them a cup to rinse and spit with.
Now obviously, if I have a patient who is unconscious or who cannot protect their airway if I'm messing with it, then I need to make sure that I angle their head 45 degrees and turn them to the side to prevent aspiration.
I should also make sure that I have suction readily available in case I should need it.
We don't ever place our fingers in the patient's mouth, alert, oriented, or unconscious. It's just asking for trouble. Don't do it.
Now when it comes to denture care, dentures are very expensive. So you want to make sure that you are being very careful when caring for them, and in fact, you want to place some towels in the sink basin, so that if you accidentally drop those dentures, they don't break. It'll cushion the fall and, hopefully, keep them intact.
The nice thing is, you can just brush the dentures with a toothbrush and toothpaste, or you can use dedicated denture cleanser.
When storing the dentures, though, you want to make sure that they are stored in a labeled denture cup, meaning that it has your patient's name and date of birth, and you want to have denture solution or water in the cup.
You don't want it to dry out.
Okay. Now, moving on to a very, very, very, very important card. This is going to be card number 57 on seizure precautions.
So a patient who's on seizure precautions has a few things that you need to take care of. One is that we've got to pad the side rails of the bed.
So if I'm on seizure precautions and I start to seize, I don't want to hit my head against the hard side rail in my bed, so you're going to pad it.
Usually, you might have specific pads, or you can even just use lots of blankets and tape it around the side rail.
Also want to make sure that we have oxygen in the room with a delivery device, that we have suction equipment set up and ready to go, along with vital signs equipment.
All of that should be in the room and ready to go if you have a patient on seizure precautions.
Now, let's talk about what we do during a seizure. And this is it's just so important, not only for your nursing exams and the NCLEX, but just so that you are prepared for what to do if this ever happens because it can be really scary if you've never seen somebody have a seizure before.
So if we are standing-- if the patient is standing, my job is to lower them to the floor as controlled as possible, perhaps using my leg like a slide to lower them to the floor.
No matter what, once they're on the floor or in bed, I want to turn them to their left side. That's going to be very important. Make sure that any secretions are coming out of their mouth and not-- that they're not choking on their secretions.
I also want to loosen restrictive clothing. Maybe they're wearing a suit and tie. I want to loosen that tie, unbutton those buttons so that as they seize, they're not straining against something that's putting pressure on their airway.
When your patient is seizing, you want to protect them from harm. That's the number one priority there, is to protect them from harm.
So what does this mean? It means that if there is something in the way, I'm going to move the thing out of the way.
If my patient is seizing on the floor, and they're right next to a chair, I'm going to move the chair so that they don't hit their heads.
The other thing that is really, really, really important to understand about seizures is that previously, you might have heard of some guidance to restrain a patient or put something in their mouths.
This is why we talk about evidence-based practice. That used to be what we did, but it is not anymore because the evidence says you should never restrain a patient who is having a seizure because they hurt themselves by pushing against the restriction.
And also, you don't want to put anything in their mouths. You could injure them. You could get bitten. They could choke. So we don't put anything in the patient's mouth.
Not their belt, not their wallet, not a tongue blade, nothing, and especially not your hands, please.
You also want to make sure that you note when the seizure started and stopped. All of that is very important to know because that's going to factor into what kind of seizure it is.
After a seizure, your patient is going to be in something called the postictal phase, and during this phase, they may be really disoriented. They might be confused, upset, combative, even.
So you're just going to try and reorient your patient as much as you can, keep them calm and reassure them, and then you're also going to want to record their vital signs and perform a brief neurological exam.
So all of those things are just so desperately important for a Fundamentals student to understand, "What's my role as the nurse when I care for a patient?" If you stay to the at the end of this video, I'm going to tell you a little bit about the time that I had a seizure.
Okay, so that is it for bed baths, bed making, oral and denture care, and seizure precautions.
I hope this review was helpful. If it was, please like this video, and if you have anything to add or a great way to remember something, I want to hear it, so please comment below.
And the next video I bring to you is going to be talking about pains, different types of pain, and how we treat it. So be sure you subscribe because you don't want to miss that. You'll be the first to know. Thanks so much, and happy studying.
Okay, so the first time I had a seizure, I had just gotten to my friend's house. I was going to watch a movie with her and her mom. I picked up McDonald's.
I went to her house, and we started watching the movie. And the next thing I know, I'm waking up on the couch looking up, and my best friend and her mom are staring down at me, and I'm covered in french fries because I was holding the french fries when I started to seize, and so I shook them all over the place.
And my best friend and her mom said, "Hey, Meris, you just had a seizure. Are you okay? Can you hear me? We've called 911. They're on their way."
And I, being postictal and coming out of it very confused and disorientated, and I said, "I didn't have a seizure. I just fell asleep during the movie."
And they were like, "No, you had a seizure." And I called my mom and started crying and said, "They're making me go to the hospital by ambulance. I'm sorry. I don't know how we're going to pay for it."
And my mom said, "Honey, don't worry about it. We'll figure it out. Please go to the hospital."
But the point being, in that postictal phase, your patients may be really out of it and maybe acting in a way that is not their normal self. So just be kind and calm and compassionate because they are very scared and confused. I promise you.
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