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Perineal- Genital CARE
Nursing Skills
Course
Nursing (NCM 107)
328 Documents
Students shared 328 documents in this course
University
Bicol University
Academic year: 2020/2021
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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 surroundi ng 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
CHECKLIST ON PERINEAL – GENITAL CARE
Procedure Able to Perform
Able to Perform with Assistance
Unable to Perform
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.
- Turn the patient on his or her side, wash and rinse the anal area.
- Replace bath blanket with top sheet or linen.
- Clean all the equipment and put them in proper place.
- Remove and discard gloves.
- Wash hands. Evaluation
- Evaluate clients for feeling of comfort.
- Evaluate for any unusual observations on the perineal-genital area. Documentation
- Record the procedure and pertinent observation like redness, swelling on the area.
Remarks:__________________________________________________________________________________
Grade: ________________
Clinical Instructor’s Signature Student’s Signature
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Perineal- Genital CARE
Course: Nursing (NCM 107)
328 Documents
Students shared 328 documents in this course
University: Bicol University
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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.
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