This document provides guidance on perineal care for nursing students. It outlines 8 learning outcomes for students, which include assessing patients' needs, choosing appropriate techniques and equipment, demonstrating proper techniques, and documenting the procedure. It then discusses principles of perineal care, indications for care, supplies needed, and step-by-step procedures for female and male patients. The goal is to thoroughly clean the genital area while maintaining privacy, comfort and infection prevention.
Proper perineal care allows for inspection of the skin. It keeps the perineal area clean and less likely to break down. It also decreases the risk for urinary tract infections.
Perineal care involves washing the external genitalia and surrounding with soap and water or with water alone or in combination with any commercially prepared peri-wash.
Proper perineal care allows for inspection of the skin. It keeps the perineal area clean and less likely to break down. It also decreases the risk for urinary tract infections.
Perineal care involves washing the external genitalia and surrounding with soap and water or with water alone or in combination with any commercially prepared peri-wash.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
Florence nightingale’s environment theoryShrooti Shah
The foundation of Nightingale’s theory is the environment- all the external conditions and forces that influence the life and development of an organism.
According to her, external influences and conditions can prevent, suppress, or contribute to disease or death.
Her goal was to help the patient retain his own vitality by meeting his basic needs through control of the environment.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
Florence nightingale’s environment theoryShrooti Shah
The foundation of Nightingale’s theory is the environment- all the external conditions and forces that influence the life and development of an organism.
According to her, external influences and conditions can prevent, suppress, or contribute to disease or death.
Her goal was to help the patient retain his own vitality by meeting his basic needs through control of the environment.
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
When a patient uses a bedpan, promote comfort and normalcy and respect the patient’s privacy as much as possible. Be sure to maintain a professional manner. In addition, provide skin care and perineal hygiene after bedpan use
Regular bedpans have a rounded, smooth upper end and a tapered, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the open end toward the foot of the bed
. A special bedpan called a fracture bedpan is frequently used for patients with fractures of the femur or lower spine
Fracture bedpan - used for patients with fractures of the femur or lower spine. The fracture pan has a shallow, narrow upper end with a flat wide rim, and a deeper, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the deeper, open lower end toward the foot of the bed.
Ordinary Bedpan
EQUIPMENTS
Bedpan (regular or fracture)
Toilet tissue
Disposable clean gloves
Additional PPE, as indicated
Cover for bedpan or urinal (disposable waterproof pad or cover)
ASSESSMENT
Assess the patient’s normal elimination habits.
Determine why the patient needs to use a bedpan (e.g., a medical order for strict bed rest or immobilization).
Assess the patient’s degree of limitation and ability to help with activity.
Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient.
Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged.
Assess the characteristics of the urine and the patient’s skin
Assisting With Use of a Bedpan When the Patient Has Limited Movement
Patients who are unable to lift themselves onto the bedpan or who have activity limitations that prohibit the required actions can be assisted onto the bedpan in an alternate manner using these actions
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. Learning Outcomes:
At the end of lecture-discussion and
demonstration, the students will be able
to:
1. Assess the patient effectively to determine
the need for assistance with perineal
care.
2. Analyze data to determine special needs,
concerns, and self-care abilities in
completing perineal care.
3. Learning Outcomes:
At the end of lecture-discussion and
demonstration, the students will be able
to:
3. Determine appropriate patient outcomes
of the perineal care procedures, and
recognize the potential for adverse
outcomes.
4. Choose the appropriate procedure and
equipment for the specific perineal care
needed.
4. Learning Outcomes:
At the end of lecture-discussion and
demonstration, the students will be able
to:
5. Determine the assistance needed to
complete the procedure.
6. Demonstrate the proper techniques for
assisting with perineal care.
7. Evaluate the effectiveness of the perineal
care techniques for specific patient.
5. Learning Outcomes:
At the end of lecture-discussion and
demonstration, the students will be able
to:
8. Document the procedure in the patient’s
plan of care as well as specific
observations of any abnormal findings
and the patient’s comfort level.
6. PERINEAL CARE
involves thorough cleansing of the client’s
external genitalia, anal area and
surrounding skin.
“peri-care” or “perineal-genital” care
Involves washing the external genitalia
with soap & water or with water alone or in
combination with any commercially
prepared periwash.
Can be delegated to nursing assistive
personnel.
7. PERINEAL CARE
Carried out as part of the pt’s bath or
as a separate procedure.
Perineal area is conductive to the
growth of pathogenic organism
because it is warm, moist, and is not
well ventilated.
Cleanliness is essential to prevent
bad odor & promote comfort.
8. To prevent or eliminate infection,
odor and promote healing
Purpose:
Remove secretions, and provide
comfort
9. To clean the perineum from the
cleanest to the less clean area.
Principle:
1
Follow Standard Precautions.2
Maintain patient’s privacy.3
Proximal level of functioning.4
10. Patients who need frequent perineal
care:
Who are unable to do self care
Patients with genito-urinary tract infections
With fecal & urinary incontinence
An Indwelling foley catheter
Who are recovering from rectal or genital
surgery or childbirth
Patients with excessive vaginal drainage
Patients with injury and ulcers
Uncircumcised males
Morbid obesity
11. Delegation Considerations:
A
• Importance of not massaging reddened
skin areas during bathing.
B
• Recognizing early signs of impaired skin
integrity.
C
• Proper ways to position male and female clients with
musculoskeletal limitations or who have an indwelling
foley catheter or other equipment (e.g. intravenous
tubing)
D
• When to report changes in the skin or
perineal area to the nurse.
12. Nursing Diagnosis
Self-Care Deficit (Hygiene) related to
Decreased or lack of motivation
Weakness or tiredness
Pain or discomfort
Perceptual or cognitive impairment
Inability to perceive body part or spatial
relationship
Neuromuscular or musculoskeletal impairment
Medically imposed restriction
Therapeutic procedure restraining mobility (e.g.,
intravenous infusion, cast)
Severe anxiety
Environmental barriers
13. Assess presence of:
Irritation, excoriation, inflammation, swelling
Excessive discharge
Odor; pain or discomfort
Urinary or fecal incontinence
Recent rectal or perineal surgery
Indwelling catheter
Determine
Perineal-genital hygiene practices
Self-care abilities
14. Equipment
Washclot
h (6) and
bath
towels (2)
Bath
blanke
t Soap
and
soap
dish
Toiletry
items
Toilet
tissue
or
diaper
wipes
Water
proof
pad or
bed pan
Disposabl
e gloves
Laundr
y bag
Solution
bottle or
prescribe
d rinsing
solution
cotton
balls
or
swabs
Perinea
l pad
Bath basin
with warm
water at 4 3
°C to 46°C (
1 1 0 ° F to
115°F)
15. Bedpans
- are made of metal or plastic and come in
two sizes (pedia, adult)
- standard bed pan and fracture pan
Equipment:
16. Urinals
- made of plastic or metal with a
bottle-like configuration.
Equipment:
17. Procedures:
ASSESSMENT
1. Introduce self and identify patient
using two identifiers (eg. Name
and birthday; name and medical
record number, according to
agency policy).
Explain to the client what
you are going to do, why it is
necessary, and how he or she
can cooperate, being particularly
sensitive to any embarrassment
felt by the client.
Ensure correct
patient.
Complies with
the Joint
Commission
Standards and
improve
patient safety.
(TJC, 2016)
18. 2. Assess client’s tolerance for
perineal care: activity
tolerance, comfort level
during movement, cognitive
ability, musculoskeletal
function, presence of
shortness of breath.
Determines client’s
ability to perform
perineal care.
3. Assess client’s visual
status, ability to sit without
support, hand grasp, ROM
of extremities
Determines degree of
assistance patient
needs for bathing, ROM
may be delegated to
assistive personnel.
Procedures:
19. 4. Assess for presence of
equipment (eg. Foley
Catheter, Condom Catheter)
Affects how you plan bathing
activities and positioning.
Helps determine how to set up
supplies.
5. Assess for allergy or
sensitivity to Chlorhexidine
gluconate (CHG).
When allergy or sensitivity is
present, select another
cleansing solution.
6. Ask if patient has noticed
any problems related to
condition of genitalia,
excess moisture,
inflammation, drainage or
excretions from lesions or
Provides you with information
to direct physical assessment
of genitalia. Also influences
selection of skin care products.
Procedures:
20. 7. Assess patient’s
knowledge of
perineal hygiene in
terms of its
importance,
preventive
measures to take,
and common
problems.
Determine patient’s
learning needs.
Procedures:
21. 8. If patient is able
to maneuver and
handle
washcloth, allow
them to clean
perineum on their
own.
Maintain patient’s
dignity and self-
care ability
Procedures:
22. PLANNING
1. Review orders for specific
precautions concerning
patient’s movement or
positioning.
Prevents injury to patient
during bathing activities.
Determine level of
assistance required by the
patient.
2. Explain procedure and ask
patient for suggestions on
how to prepare supplies. If
using CHG, explain benefit
of reducing infection and
that solution leaves a
sticky feeling
Promotes cooperation and
participation. Patients who
prefer using own perineal
hygiene solutions may need
to discuss benefits of CHG.
Procedures:
23. 3. Prepare
equipment and
supplies. If it is
necessary to
leave room, be
sure that call light
is within patient’s
reach.
Avoids interrupting
procedure or
leaving patient
unattended to
retrieve missing
equipment.
Procedures:
24. IMPLEMENTATION
FEMALE CLIENT
A. Assess
environment for
safety (eg. Check
room for spills,
make sure that
equipment is
working properly
and that the bed is
Identifies safety
hazards that could
cause or potentially
lead to harm.
Procedures:
25. B. Closed room, door, and
windows, draw room
divider curtain. Offer
patient bedpan or urinal.
Provide toilet tissue
Provides for patient privacy.
Helps patient feel more
comfortable after voiding.
Prevents interruption of
bath.
C. Perform hand hygiene. If
patient has non-intact skin
or skin is soiled with
drainage, excretions, or
body secretions, apply
clean gloves. Ensure that
patient is not allergic to
Reduces transmission of
microorganisms.
Prevents allergic reaction if
latex gloves are used.
Procedures:
26. D. Lower side rail. Help patient
into dorsal recumbent position.
Note restrictions or limitations
in patient’s positioning. Place
waterproof pad under patient’s
buttocks. Drape patient with
bath blanket placed in shape of
a diamond. Lift lower edge of
bath blanket to expose
perineum.
Provides full exposure of female
genitalia. If patient is totally
dependent, provide assistance to
support her in side-lying position
and raise leg as perineum is
bathed. If position causes patient
discomfort, reduce degree of
abduction in her hips.
E. Fold lower corner of bath
blanket up between patient’s
legs onto abdomen. Wash and
dry patient’s upper thighs.
Keeping patient draped until
procedure begins minimizes
anxiety. Build up of perineal
secretions soils surrounding skin
surfaces.
Procedures:
30. F. Wash labia majora.
Use nondominant hand
to gently retract labia
from thigh, with
dominant hand wash
carefully in skin folds.
Wipe in direction from
perineum to rectum.
Repeat on opposite side
with separate section of
washcloth. Rinse and
Perineal care involves
thorough cleaning of
patient’s external genitalia
and surrounding skin. Skin
folds may contain body
secretions that harbor
microorganisms. Wiping
from front to back reduces
chance of transmitting
fecal organisms to urinary
meatus.
Procedures:
31. G. Gently separate labia with non
dominant hand to expose urethral
meatus and vaginal orifice. With
dominant hand, wash downward
from pubic area toward rectum in
one smooth stroke. Wash middle
and both sides of perineum. Use
separate section of cloth for each
stroke. Clean thoroughly around
labia minora, clitoris, and vaginal
orifice. Avoid placing tension on
indwelling catheter if present and
clean area around it thoroughly.
cleansing method
reduces transfer
of
microorganisms
to urinary meatus
(for menstruating
women or
patients with
indwelling
catheters, clean
with cotton balls.)
Procedures:
32. H. Provide catheter care
as needed.
Cleaning along catheter
from exit site reduces
incidence of health care-
associated urinary
infection.
I. Rinse thoroughly. May
use bedpan and pour
warm water over
perineal area. Dry
thoroughly from front
to back.
Rinsing removes soap
and microorganisms
more effectively than
wiping. Retained
moisture harbors
microorganisms.
Procedures:
33. J. Fold lower corner
of bath blanket back
between patient’s
legs and over
perineum. Ask
patient to lower legs
and assume
comfortable
position.
Procedures:
34. IMPLEMENTATION
MALE
A.Apply pair of clean
gloves. Lower side rail.
Help patient to supine
position. Note any
restriction in mobility.
Provides full exposure of
male genitalia. Position
patients who are unable
to lie supine on their
side.
B. Fold lower half of bath
blanket up to expose
upper thighs. Wash
and dry thighs.
Buildup of perineal
secretions soils
surrounding skin
surfaces.
Procedures:
37. C. Cover thighs with bath
towels. Raise bath
blanket up to expose
genitalia. Gently raise
penis and place bath
towel underneath.
Gently grasp shaft of
penis. If patient is
uncircumcised, retract
foreskin. If patient has
an erection, defer
Draping minimizes
patient anxiety. Towel
prevents moisture from
collecting in inguinal
area. Gentle but firm
handling of penis
reduces chances of an
erection. Secretions
capable of harboring
microorganisms collect
underneath foreskin.
Procedures:
38. D. Wash tip of penis at
urethral meatus first.
Using circular motion,
clean from meatus
outward. Discard
washcloth and repeat
with clean cloth until
penis is clean. Rinse
and dry gently.
Direction of cleaning
moves from area of least
contamination to area of
most contamination,
preventing
microorganisms from
entering urethra.
Procedures:
39. E. Return foreskin to its
natural position. This is
extremely important in
patients with decreased
sensation in their lower
extremities.
Tightening of foreskin
around shaft of penis
causes local edema and
discomfort. Patients with
reduced sensation do not
feel tightening of foreskin.
F. Gently clean shaft of
penis and scrotum by
having patient abduct legs.
Pay special attention to
underlying surface of penis.
Lift scrotum carefully and
wash underlying skinfolds.
Rinse and dry thoroughly.
Vigorous massage of penis
may cause an erection.
Underlying surface of penis
is an area where secretions
accumulate. Abduction of
legs provides easier access
to scrotal tissues.
Secretions collect easily
between skinfolds
Procedures:
40. G. Avoid placing
tension on indwelling
catheter if present and
clean area around it
thoroughly. Provide
catheter care.
Clean along
catheter from exit
site reduces
incidence of
nosocomial urinary
infection.
Assist the client to turn
on the side. Separate
the client’s buttocks and
use toilet paper if
necessary, to remove
Removing fecal
material provides
for easier cleaning
Procedures:
41. Cleanse the anal area, rinse
thoroughly, and dry with a towel.
Change sponge towel as
necessary.
Keep the anal area
clean to minimize the
risk of skin irritation and
breakdown.
For postpartum or menstruating
females, apply a perineal pad
as needed from front to back.
This prevents
contamination
of the vagina and
urethra from the anal
area.
Apply skin care products to the
area according to need of
doctor’s order.
Creams or ointments
may be prescribed to
treat skin irritation.
H. Folded bath blanket over
Procedures:
42. Observe perineal area for
any irritation, redness, or
drainage that persisted
after hygiene.
Remove soiled gloves
and discard in trash; raise
side rail before leaving
bedside to dispose of
water and obtain fresh
water. Perform Hand
hygiene.
Prevents
transmission of
infection. Protects
patient from
injury.
Procedures:
43. Document the
procedure, describing
the client’s skin condition
(redness, excoriation,
skin breakdown,
discharge or drainage,
and any localized areas
of tenderness.) and
tolerance to the care.
Sign the chart.
To provide
continuity of care.
Giving signature
maintains
professional
accountability.
Procedures: