Perineal Care

PERINEAL CARE

Perineal care is cleaning the external genitalia and surrounding area. Perineal care is also referred to as "peri-care" or " perineal-genital "care.

      Purpose

·         To keep cleanliness and prevent from infection in perineal area.

·         To promote normal perineal secretions and odors

·         To make him/her com comfortable

      Who requires Perineal Care??

Patients who are

·         Unable to do self- care

·         With genito urinary tract infections/ surgery/ ulcer.

·         With incontinence of urine and stool

·         With excessive vaginal discharge

·         With indwelling catheters

·         Post - partum patients

Preliminary Assessment

·         Assess the condition of the perineal skin- any itching, irritations, ulcers, and edema  Assess excessive discharge, Urinary or fecal incontinence, Recent rectal or perineal surgery, Indwelling catheter

·         Assess the patient's ability for self- care

·        Assess the patient's mental state to follow instructions

Points to be kept in mind:

·         Always wear gloves

·         Offer the client a bedpan/urinal or assist him to the bathroom before starting.

·         Be very gentle when washing the area.

·         The perineal area is more sensitive to temperature than the rest of the body. The water may be more comfortable if it is slightly cooler than the temperature of bath water.

·         Position the client in the "back-lying" and/or "side-lying" position when giving peri - care.

·         A towel or bedpan may be placed under the hips to assist in peri care.

·         Always wash from front to back to prevent spreading fecal matter from anal area to vagina or urethra (opening to bladder).

·         Peri care for the male client is started at the tip of the penis.

·        Make sure to wipe thoroughly and dry.

Articles

·         Sterile Pack containing bowl with gauze piece or cotton balls/swabs, thumb and artery forceps

·         Clean gloves.

·         Povidone iodine,  Kidney tray.

·         Towels (Bath towel, Bath blanket)

·         Warm Water ( 110 - 115 deg F) and basin (optional).

·         Drape.

·         Bedpan (optional)

Procedure:

Steps	Rationale
Introduce self and verify the client's identity.	Reduces anxiety and promotes co-operation;
Provide privacy.	Maintains clients self esteem
Place the mackintosh with towel under the perineal area	prevents soiling of linen
Perform hand hygiene and wear gloves.	Reduces transmission of micro organisms
Prepare client Fold the top linen to the foot of the bed and fold the gown to expose the genital area.
Position and drape the client Female ·         Position on back lying position with knees flexed and spread apart. ·         Drape the patient using diamond technique.   Males   Position on the back knees slightly flexed and      hips slights externally rotated.
Wash and dry the upper inner thighs (optional)
Inspect the perineal area
Females ·         Expose peri area ·         Clean perineal area in the downward direction (from pubic area to rectum). ·         Clean labia majora on the both sides, Labia minora on both and the clitoris to urinary meatus, and last to rectum. Male ·         Expose perineal area ·         If uncircumcised, retract the foreskin expose the glans penis for cleaning. Tip of the penis is cleaned in a circular manner from urethral meatus down to base of glans. Replace the foreskin after cleaning the glans penis. ·         Shaft of the penis is cleaned in a longitudinal manner from down to top (straight strokes) ·         Wash and dry the scrotum.	Using separate awab prevents the transmission of microorganisms from one area to the other. Ensures cleaning from more clean area to less clean area Retracting the foreskin in necessary to remove the smegma (thick, cheesy secretion) that collects under the foreskin and facilitates bacterial growth.
Clean between the buttocks
Dry the area well
Replace the articles
Document any unusual findings such as redness, excoriation, skin breakdown, or any tenderness.