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INTRODUCTION

Perineal care involves thorough cleansing of the client’s external genitalia and surrounding
skin. A client routinely receives perineal care during a bath. Clients most in need of perineal care
are at greatest risk for acquiring infection, such as clients with indwelling Foley catheters, clients
who are incontinent, and clients recovering from rectal or genital surgery or childbirth.

“Pericare” is important in promoting the client’s comfort and cleanliness. Special attention is
given to cleansing the skin around the genitals, because secretions can accumulate and cause
skin breakdown and infection of the skin and urinary or reproductive systems. The nurse retains
responsibility for doing this procedure if the client is unable to do so and determines the client’s
understanding of the importance of basic perineal hygiene.

Gloves must be worn during the procedure because of the risk of contacting microorganisms,
such as human immunodeficiency virus (HIV) or herpesvirus, from perineal drainage. Certain
clients require perineal care at times other than during a bath (e.g. because of fecal incontinence
or as part of Foley catheter care). /in addition, pericare promotes healing after perineal surgey or
vaginal deliveries.

Perineal care as part of the bed bath is embarrassing for many clients. Nurses also may find it
embarrassing initially, particularly with clients of the opposite sex. To minimize embarrassment for
both the nurse and the client, it helps for the nurse to be of the same sex as the client.
Embarrassment should not cause the nurse to overlook the client’s hygiene needs.

Furthermore, most clients, who require a bed bath from the nurse, are able to clean their own
genital areas with minimal assistance. The nurse may need to hand a moistened washcloth and
soap to the client, rinse the washcloth, and provide a towel.

Because some clients are unfamiliar with terminology for the genitals and perineum, it may be
difficult for nurses to explain what is expected. Most clients, however, understand what is meant if
the nurse simply says, “I’ll give you a washcloth to finish your bath.” Older clients may be familiar
with the term private parts. Whatever expressions the nurse uses, it needs to be one that the
client understands and one that is comfortable for the nurse to use.

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OBJECTIVES

For the given task the group would aims:


• To be able to perform the skills in perineal care
• To be able to understand the rationale of providing perineal care
• To apply the procedure efficiently and in a matter-of-fact manner

In providing perineal care, the nurse aims:


• To remove normal perineal secretions and odors
• To prevent infection
• To promote client comfort
• To get pertinent data on the assessment of perineum

DISCUSSION PROPER

 Equipments/materials needed for perineal care:

Perineal-genital care provided in conjunction with the bed bath


 Bath towel
 Bath blanket
 Disposable gloves
 Bath basin two-thirds filled with water at 43-46°C (110-115°F)
 Soap
 Washcloth
 Toilet tissue or diaper wipes
 Protective ointment as required
Special perineal-genital care
 Bath towel
 Bath blanket
 Disposable gloves
 Cotton balls or swabs
 Solution bottle, pitcher, or container filled with warm water or a prescribed solution
 Bedpan to receive rinse water
 Moisture-resistant bag or receptacle for used cotton swabs
 Perineal pad

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Perineal Care for Male Clients

Preparation:
1. Assess for the presence of irritation, excoriation, inflammation, swelling, excessive discharge,
odor, pain, or discomfort, urinary or fecal incontinence, recent rectal or perineal surgery and
indwelling catheter.

2. Determine whether the client is experiencing any discomfort in the perineal-genital area.

3. Obtain and prepare the necessary equipment and supplies.

Performance:
1. Explain to the client what you are going to do, why it is necessary, and how he can cooperate,
being particularly sensitive to any embarrassment felt by the client.

2. Wash hands and observe other appropriate infection control procedures (e.g. clean gloves)

3. Provide for client privacy by drawing the curtains around the bed or closing the door to the
room.

4. Prepare the client.


• Fold the top bed linen to the foot of the bed and fold the gown up to expose the genital
area
• Place a bath towel under the client’s hips. The bath towel prevents the bed from becoming
soiled

5. Position and drape the client and clean the upper inner thighs.
• Position the male client in a supine position with knees slightly flexed and hips slightly
externally rotated.
• Put on gloves, wash, and dry the upper inner thighs.

6. Inspect the perineal area.


• Note particular area of inflammation, excoriation, or swelling, especially between the
scrotal folds.
• Also note excessive discharge or secretions from the orifices and the presence of odors.

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7. Wash and dry the perineal-genital area.
• Wash and dry the penis, using firm strokes. Handling the penis firmly may prevent an
erection.
• If the client is uncircumcised, retract the prepuce (foreskin) to expose the glans penis (the
tip of the penis) for cleaning. Replace the foreskin after cleaning the glans penis.
(Retracting the foreskin is necessary to remove the smegma that collects under the
foreskin and facilitates bacterial growth. Replacing the foreskin prevents constriction of the
penis, which may cause edema)
• Wash and dry the scrotum. The posterior folds of the scrotum may need to be cleaned
when the buttocks are cleaned. (The scrotum tends to be more soiled than the penis
because of its proximity to the rectum, thus it is usually cleaned after the penis).

8. Inspect perineal orifices for intactness.


• Inspect particularly around the urethra in clients with indwelling catheters

9. Clean between the buttocks.


• Assist the client to turn onto the side facing away from you.
• Pay particular attention to the anal area and posterior folds of the scrotum in males. Clean
the anus with toilet tissue before washing it, if necessary.
• Dry the area well.

10. Document any unusual findings such as redness, excoriation, skin breakdown, discharge or
drainage and any localized areas of tenderness.

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 Perineal Care for Female Clients

Preparation:
1. Assess for the presence of irritation, excoriation, inflammation, swelling, excessive discharge,
odor, pain, or discomfort, urinary or fecal incontinence, recent rectal or perineal surgery and
indwelling catheter.

2. Determine whether the client is experiencing any discomfort in the perineal-genital area.

3. Obtain and prepare the necessary equipment and supplies.

Performance:
1. Explain to the client what you are going to do, why it is necessary, and how he can cooperate,
being particularly sensitive to any embarrassment felt by the client.

2. Wash hands and observe other appropriate infection control procedures (e.g. clean gloves)

3. Provide for client privacy by drawing the curtains around the bed or closing the door to the
room.

4. Prepare the client.


• Fold the top bed linen to the foot of the bed and fold the gown up to expose the genital
area
• Place a bath towel under the client’s hips. The bath towel prevents the bed from becoming
soiled

5. Position and drape the client and clean the upper inner thighs.
• Position the female in a back-lying position, with the knees flexed and spread well
apart (abducted).
• Cover her body and legs with the bath blanket. Drape the legs by tucking the
bottom corners of the bath blanket under the inner sides of the legs. Minimum exposure
lessens embarrassment and helps to provide warmth. Bring the middle portion of the base
of the blanket up over the pubic area.
• Don gloves, and wash and dry the upper inner thighs.

6. Inspect the perineal area.

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• Note particular area of inflammation, excoriation, or swelling, especially between the
scrotal folds.
• Also note excessive discharge or secretions from the orifices and the presence of odors.

7. Wash and dry the perineal-genital area.


• The perineum is sometimes more comfortably and effectively cleansed by pouring warm
water or a prescribed solution over the perineum while patient is positioned on the bedpan.
• Tell the patient what sensations she will feel as you perform the procedure.
• Put on the gloves if desired. Separate the labia with one hand to expose the urethral and
vaginal openings.
• With your other hand, wipe from front to back in a downward motion, using warm water or
soap and water and a washcloth or cotton balls. Be sure to use a different corner of the
washcloth or a different cotton ball for each downward stroke to prevent cross-
contamination or spread of rectal flora to vagina.
• Carefully examine gluteal folds for debris. Gently visualize vulva for debris as fecal
materials causes irritation and skin breakdown when left in contract with skin.

8. Inspect perineal orifices for intactness.


• Inspect particularly around the urethra in clients with indwelling catheters.

9. Clean between the buttocks.


• Assist the client to turn onto the side facing away from you.
• Clean the anus with toilet tissue before washing it, if necessary.
• Thoroughly pat dry with second towel since residual moisture provides an ideal
environment for the growth of microorganisms.
• If indicated, apply barrier lotion or ointment. Barrier ointments may be used if client is
incontinent or skin folds tend to harbor moisture.

10. Document any unusual findings such as redness, excoriation, skin breakdown, discharge or
drainage and any localized areas of tenderness.
• Record perineal care and any special treatment in your notes. Document the need for
continued treatment if necessary, in your care plan. Describe perineal skin condition and
any odor or discharge.

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After providing perineal care…

• Reposition the patient and make her comfortable. Remove the bath blanket and then
replace the bed linens.

• Clean and return the basin and dispose of soiled articles including gloves.

• Dispose of linens and garbage according to hospital policy.

• Wash your hands.

• Deodorize room if appropriate. .

Special considerations:

• Give perineal care to a patient of the opposite sex in a matter-of–fact way to minimize
embarrassment.

• If client has incontinence, first remove excess feces with toilet tissues. Then provide a
bedpan, and add a small amount of antiseptic soap to a peri bottle to eliminate odor.
Irrigate the perineal area to remove any remaining fecal matter.

• After cleaning the perineum, apply ointment or cream (petroleum jelly, zinc oxide cream, or
vitamin A and D ointment) to prevent skin breakdown by providing a barrier between the
skin and excretions.

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CONCLUSION

Perineal care is always a part of the basic hygienic measures given to patient in order to
promote comfort, reduce the risk of infection and it may also be a source of assessment data. In
doing this procedure, it is a priority to provide the privacy the client needs. Nurses should know the
proper positioning and draping of the patient in order to provide utmost comfort and the privacy the
client needs. Also, as much as possible, visitors should be asked to leave the room during the
procedure. The nurse should either close the door or have curtains around the client’s bed. During
the procedure, and in all other procedures, nurses should always maintain the safety of the client,
maintain warmth, promote independence of the clients and should anticipate the needs of the
client.

Clients most at risk for infection of the perineum should be taught of the signs and symptoms
of early infection, as well as principles and techniques for cleansing the perineum correctly.
However, clients who are physically unable to perform hygiene and who rely on family members
for care must have family instructed on hygiene techniques. This secures the continuity of care of
the patient even after discharge. Nurses must also emphasize the importance of following the
techniques to the significant others to prevent contamination and lessen the risk for infections.

In addition, nurses should perform the procedure efficiently and in a matter-of-fact manner so
as to minimize the embarrassment from both the client and the nurse. Embarrassment should not
cause the nurse to overlook the client’s hygiene needs.

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REFERENCES

Kozier, et.al. Fundamentals of Nursing: Concepts, Process, And Practice Fifth edition. Pearson
Education Asia PTE LTD, Singapore. 2002. pp. 742-744.

Potter, P. & Perry, A. Clinical Nursing Skills and Techniques 5th Edition. Elsevier PTE LTD,
Singapore. 2004. pp 128-131.

Potter, P. & Perry, A. Fundamentals of Nursing 6th Edition Volume 2. Elsevier PTE LTD,
Singapore. 2005. pp 1031-1035.