Wednesday, 24 March 2010

PERINEAL CARE

Perineal care, which includes care of the external genitalia and the anal area, should be performed during the daily bath and, if necessary, at bedtime and after urination and bowel movements. The procedure promotes cleanliness and prevents infection. It also removes irritating and odorous secretions, such as smegma, a cheeselike substance that collects under the foreskin of the penis and on the inner surface of the labia. For the patient with perineal skin breakdown, frequent bathing followed by application of an ointment or cream aids healing.
Standard precautions must be followed when providing perineal care, with due consideration given to the patient's privacy.
Equipment
Gloves, washcloths, clean basin, mild soap, bath towel, bath blanket, toilet tissue, linen-saver pad, trash bag , optional: bedpan, peri bottle, antiseptic soap, petroleum jelly, zinc oxide cream, vitamin A and D ointment, and an ABD pad.
Following genital or rectal surgery, you may need to use sterile supplies, including sterile gloves, gauze, and cotton balls.
Preparation of equipment
Obtain ointment or cream as needed. Fill the basin two-thirds full with warm water. Also fill the peri bottle with warm water if needed.
Implementation
  • Assemble equipment at the patient's bedside and provide privacy.
  • Wash your hands thoroughly, put on gloves, and explain to the patient what you're about to do.
  • Adjust the bed to a comfortable working height to prevent back strain, and lower the head of the bed, if allowed.
  • Provide privacy and help the patient to a supine position. Place a linen-saver pad under the patient's buttocks to protect the bed from stains and moisture.
Perineal care for the female patient
  • To minimize the patient's exposure and embarrassment, place the bath blanket over her with corners head to foot and side to side. Wrap each leg with a side corner, tucking it under her hip. Then fold back the corner between her legs to expose the perineum.
  • Ask the patient to bend her knees slightly and to spread her legs. Separate her labia with one hand and wash with the other, using gentle downward strokes from the front to the back of the perineum to prevent intestinal organisms from contaminating the urethra or vagina. Avoid the area around the anus, and use a clean section of washcloth for each stroke by folding each used section inward. This prevents the spread of contaminated secretions or discharge.
  • Using a clean washcloth, rinse thoroughly from front to back because soap residue can cause skin irritation. Pat the area dry with a bath towel because moisture can also cause skin irritation and discomfort.
  • Apply ordered ointments or creams.
  • Turn the patient on her side to Sims' position, if possible, to expose the anal area.
  • Clean, rinse, and dry the anal area, starting at the posterior vaginal opening and wiping from front to back.
Perineal care for the male patient
  • Drape the patient's legs to minimize exposure and embarrassment and expose the genital area.
  • Hold the shaft of the penis with one hand and wash with the other, beginning at the tip and working in a circular motion from the center to the periphery to avoid introducing microorganisms into the urethra. Use a clean section of washcloth for each stroke to prevent the spread of contaminated secretions or discharge.
  • Rinse thoroughly, using the same circular motion.
  • For the uncircumcised patient, gently retract the foreskin and clean beneath it. Rinse well but don't dry because moisture provides lubrication and prevents friction when replacing the foreskin. Replace the foreskin to avoid constriction of the penis, which causes edema and tissue damage.
  • Wash the rest of the penis, using downward strokes toward the scrotum. Rinse well and pat dry with a towel.
  • Clean the top and sides of the scrotum; rinse thoroughly and pat dry. Handle the scrotum gently to avoid causing discomfort.
  • Turn the patient on his side. Clean the bottom of the scrotum and the anal area. Rinse well and pat dry.
After providing perineal care
  • Reposition the patient and make him comfortable. Remove the bath blanket and linen-saver pad, and then replace the bed linens.
  • Clean and return the basin and dispose of soiled articles including gloves.
Special considerations
  • Give perineal care to a patient of the opposite sex in a matter-of-fact way to minimize embarrassment.
  • If the patient is incontinent, first remove excess feces with toilet tissue. Then position him on a bedpan, and add a small amount of antiseptic soap to a peri bottle to eliminate odor. Irrigate the perineal area to remove any remaining fecal matter.
  • After cleaning the perineum, apply ointment or cream (petroleum jelly, zinc oxide cream, or vitamin A and D ointment) to prevent skin breakdown by providing a barrier between the skin and excretions.
  • To reduce the number of linen changes, tuck an ABD pad between the patient's buttocks to absorb oozing feces.
Documentation
Record perineal care and any special treatment in your notes. Document the need for continued treatment, if necessary, in your care plan. Describe perineal skin condition and any odor or discharge.