Perineal- Genital CARE PDF

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Warning: TT: undefined function: 32 Warning: TT: undefined function: 32NCM 104 – SLPerineal - Genital CareOVERVIEW OF THE SKILLThe perineum is the external structure of the pelvic floor. It is composed of the skin and muscle surroundi ng thegenitalia; it is the area between the scrotum and anus in t...

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NCM 104 – SL Perineal - Genital Care

OVERVIEW OF THE SKILL The perineum is the external structure of the pelvic floor. It is composed of the skin and muscle surrounding the genitalia; it is the area between the scrotum and anus in the male and between the vulva and anus in the female. Care of the perineum and genitalia is directed toward maintaining a hygienic perineal environment. Perineal and genital care is usually self-care; however, alterations in the client’s ability to perform self -care or alterations in the perineum and genitalia are reasons for nurses or other care providers to perform this skill. Perineal and genital care is an emotionally and culturally difficult subject. Many cultures have specific beliefs and taboos regarding the perineal/genital area. Many people are embarrassed by the idea of anyone else seeing or touching their genitals, particularly a stranger. The nurse must be aware of these possibilities when approaching genital/perineal care. In general, a professional, nonjudgmental approach will put the client more at ease with the procedure. Ask the client or the client’s caregiver if possible about any preferences the client may have in this area. During labor, amniotic fluid, urine, and feces may be expelled. While the client is ambulatory, encourage frequent peri-care with urination. If the client is anesthetized, perform frequent peri-care to prevent infection and before any invasive procedure such as vaginal examination, internal monitoring, or rupture of membranes. Obstetrics presents special perineal care needs. In the postpartum period for vaginal birth: If the client is ambulatory, perform peri-care at the toilet. Use a peri-bottle with water at a temperature comfortable to the mother. Teach her to use the entire contents of the bottle and spray from the front to the back, across the perineum (not into the vagina) to remove urine and fecal material. If there is an episiotomy or laceration, she will want to blot with tissue or a washcloth until the perineum is no longer sore. Also, if perineal medications are to be used (witch hazel, topical anesthetics, and so on), teach the client to do this with each urination and to use a clean sanitary pad. Ice should be considered to help alleviate pain and edema. In the postpartum period for Cesarean birth: Until the mother is ambulatory, peri-care must be performed in the bed. Assist the mother to a bedpan, which has been padded underneath with waterproof pads. Use the water bottle to spray vaginal secretions from the perineum from the front to the back, across the perineum (not into the vagina). If an episiotomy is present, apply perineal medications as required and consider ice compresses for the first 12 hours to alleviate pain and edema. Once the mother is ambulatory, this care may be performed at the toilet and the client instructed in the technique.

ASSESSMENT 1. Evaluate client status: level of consciousness, ability to ambulate, ability to perform self-care, frequency of urination and defecation, skin condition. This allows the nurse to decide who, where, how, and when to perform perineal care. 2. Identify cultural preferences for perineal care. Perineal care is strongly associated with cultural practices, who may touch the perineal area and how as well as the proper way to “wipe.” To the extent possible, these preferences should be identified and incorporated into the client’s care. 3. Assess the client’s perineal health. Ask the client if he has any perineal/genital itching or discomfort. Ask the client if she has any urethral, vaginal, or anal discharge. Determines the presence of signs and symptoms that may need additional assessment and intervention.

4. Determine if the client is incontinent of urine or stool. Affects how the procedure will be done and what additional procedures may be necessary. 5. Assess whether the client has recently had perineal/ genital surgery. Affects how the procedure will be done and what additional procedures may be necessary.

PLANNING/Expected Outcomes: 1. Perineum and genitalia will be dry, clean, and free of secretions and unpleasant odors. 2. The client will report feeling comfortable and clean in the perineal area. 3. The client will not experience discomfort or undue embarrassment during the procedure. 4. The perineum will be free of skin breakdown or irritation. Equipment Needed: • Personal protective equipment (gloves, gown) • Toilet paper/washcloths • Waterproof pads EVALUATION 1. The perineum and genitalia are dry, clean, and free of secretions and unpleasant odors. 2. The client reports feeling comfortable and clean in the perineal area. 3. The client did not experience discomfort or undue embarrassment during the procedure. DOCUMENTATION Nurses’ Notes • Document the time and type of perineal care provided. • Document any unusual findings such as skin breakdown, infection, or unusual drainage. • If the client has special preferences or cultural considerations be sure to document that these were respected. Kardex • Note any special preferences or cultural considerations. VARIATIONS Geriatric Variations: • Incontinence in the elderly is a major influence in decisions to seek long-term care. • Loss of ability to perform perineal self-care may be a source of embarrassment and a serious threat to ego integrity. Be sensitive to the emotional and self-image needs of the elderly client in need of perineal care. • Some elderly clients, whether due to disease or as a way to compensate for poor self-image, may behave inappropriately during perineal care. Gently but firmly discourage the client from inappropriate touching or comments. If the behavior continues, a same sex caregiver might be appropriate. Pediatric Variations: • Encourage parents to change the child’s diapers frequently to minimize skin contact with urine and feces. • Be sensitive to cultural concerns, particularly in regard to genital care for female children. Some societies have strict cultural taboos. Some societies have deep concerns regarding inappropriate touching. A same sex caregiver is more

appropriate in this situation. If there are concerns regarding touch, it may be appropriate to have two caregivers provide peri-care or perhaps have a same sex family member present during care. • Be aware that the child might revert to bedwetting because of the stress of hospitalization. • Teach children to wipe from front to back when cleaning themselves. Home Care Variations: • Consideration should be given to using supplies that do not increase the caregiver burden. For example, linens should be minimized and soft disposable cloths may be a solution. Also, there are some products that can modify the toilet and provide a bidet-type cleansing alternative. Long-Term Care Variations: • Incontinence may be a major factor in long-term care settings. Institutional practices must provide for sanitary and timely attention to perineal care needs. NURSING TIPS • When performing perineal care on a client in bed, make sure the bed height is adjusted to permit proper body mechanics. • Perineal care and bed linen changes may be performed at the same time. Begin by performing pericare, then wrap soiled linens under the client and place clean linens to the edge of soiled linens. Roll the client to the other side and proceed with the linen change. • Always wash your hands after performing perineal care. Gloves do not provide a flawless barrier. • When performing peri-care for an adult or child, it is important to be sensitive to developmental considerations. Peri-care is usually learned early and inability or difficulty performing this basic task for oneself can evoke feelings of embarrassment, worthlessness, and incompetence. It is critical that the nurse convey respect in an ageappropriate and culturally sensitive manner. • Perineal care should be performed as often as necessary. Some procedures will necessitate a schedule. If pericare is necessary after elimination, do not delay. Even short delays can result in unnecessary suffering. • Ask the client about soap/iodine allergies. Often, clients will not disclose this on admission. Some perineal procedures will require use of iodine preparations. • In uncircumcised males, gently retract the foreskin to clean smegma and other debris from the area around the glans. This procedure is not universal, however, and it is appropriate to ask the client whether this is acceptable. Care should be taken to replace the foreskin as soon as possible to prevent edema of the glans. • Many cultures prescribe cleansing from the “front to the back” of the female perineum to prevent rectal debris and germs from coming in contact with the vulva. Be aware that this is also a cultural preference and if necessary may be followed for medical reasons (for example, interruptions in vaginal or perineal integrity).

CHECKLIST ON PERINEAL – GENITAL CARE Procedure

Assessment 1. Assess the client’s perineal area and extent of soiling. 2. Determine the client’s capabilities. Planning 3. Wash hands. 4. Assemble the equipment. Implementation 5. Identify the client and explain the procedure. 6. Provide privacy. 7. Place the client in dorsal recumbent position. 8. Place a rubber sheet under the client’s buttocks and place client in a bedpan. 9. Expose perineal and drape (diamond drape for female) 10. Wash hands and put on clean gloves. 11. Perform the procedure as follows: For Female Patient a. Flush the perineal area with warm water. b. Place cotton balls in a receptacle or basin with soap suds c. Cleanse the vulva from the anterior portion towards the anus then discard cotton balls. d. Gently separate the labia with gloved fingers and clean between the labia majora and labia minora. e. With labia separated, clean the clitoris, urethral meatus and vaginal orifice. f. Clean the thigh using a stroke away from perineum. g. Rinse and pat dry. For Male Patient a. Place bath blanket down to the mid-thigh. b. Move the cotton balls from the tip of the penis down its length toward the pubic area. c. Hold the shaft of penis and if uncircumcised retract the foreskin then pull back after. d. Use a circular motion to clean the meatus and glans penis in an outward direction. e. Rinse and pat dry. f. Clean and rinse scrotum. 12. Turn the patient on his or her side, wash and rinse the anal area. 13. Replace bath blanket with top sheet or linen. 14. Clean all the equipment and put them in proper place. 15. Remove and discard gloves. 16. Wash hands. Evaluation 17. Evaluate clients for feeling of comfort. 18. Evaluate for any unusual observations on the perineal-genital area. Documentation 19. Record the procedure and pertinent observation like redness, swelling on the area.

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