fundamentals of nursing skills

1. PERINEAL CARE
Katherine C. Villaran, RN, MAN

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:

27. Draping the patient for
perineal-genital care

28. Female Genitalia

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:

36. Male Genitalia

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: