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Friday, February 1, 2013
Perineal
care is often referred to as "pericare;" it consists of external
irrigation of the vulva and perineum following voiding or defecation and is
part of the routine A. M. and P. M. care. It involves thorough cleansing of the client’s
external genitalia and surrounding skin.
A client routinely receives perineal care
during a bath. Clients most in need of perineal care are at greatest risk for
acquiring infection, such as clients with indwelling Foley catheters, clients
who are incontinent, and clients recovering from rectal or genital surgery or
childbirth. Special attention is given to
cleansing the skin around the genitals, because secretions can accumulate and
cause skin breakdown and infection of the skin and urinary or
reproductive systems.
Gloves must be worn during the procedure because of the risk of
contacting microorganisms, such as human
immunodeficiency virus (HIV) or herpes virus, from perineal drainage. Certain clients
require perineal care at times other than during a bath (e.g. because of fecal
incontinence or as part of Foley catheter care). /in addition, pericare
promotes healing after perineal surgey or vaginal deliveries.
Purpose:
1. Prevent or eliminate infection or odor
2. Promote healing
3. Remove secretion
4. Provide comfort
Principle:
1. Clean the perenium from the cleanest to the less clean
area.
2. Ensure patient privacy.
3. Wipe from front to back (vagina toward rectum) on female
patients to avoid contaminating the vagina or urethral meatus.
4. Do not use the same washcloth for any other portion of
the patient's bath.
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.
Procedure:
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.
Rationale:
1. Reduce the transmission of
microorganism.
2. Provide privacy.
3. If client is ambulatory,
perineal care may be done either with
client on or standing at the toilet. If perineal care is to be performed in the
bed, place the client on her side or over a deep bedpan.
4. Protects bed linen.
5. May require several attempts.
If performing at the bedside, may collect paper in disposable pad or linens
until end of procedure.
6. Several perineal solutions are
available which may or may not require rinsing. Carefully evaluate this
requirement. Solutions that require rinsing may cause skin breakdown if left on
the skin.
7. Maximizes cleaning; prevents
spread of rectal flora to the vagina.
8. Fecal material causes
irritation and skin breakdown when left in contact with skin.
9. Rinses soap, which can irritate
the skin, from the area.
10. Residual moisture provides an
ideal environment for the growth of microorganism.
11. Barrier ointment may be used
if client is incontinent or skin fold tends to harbor moisture.
12. Promotes client’s comfort.
13. Prevents spread of disease or
bacteria.
Labels: Personal
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