Assessment:
Assess for the presence of irritation, excoriation, inflammation or swelling, excessive discharge, odor, pain or discomfort, urinary or fecal incontinence, recent rectal or perineal surgery and indwelling catheter. Determine perineal-genital hygiene practices and self-care abilities.
Planning:
Delegation, perineal-genital care can be delegated to UAP. If the client has recently had perineal, rectal, or genital surgery, the nurse needs to assess if it is appropriate for the UAP to perform perineal-genital care. Prepare equipment to be used.
Equipment:
Perineal-genital care provided in conjunction with the bed bath: bath towel, bath blanket, clean gloves, bath basin with water at 43 to 46ºC (110 to 115ºF), soap and wash cloth.
Special perineal-genital care: bath towel, bath blanket, clean gloves, cotton balls or swabs, cotton balls or swabs, solution bottle, pitcher, or container filled with warm water or a prescribed solution, bedpan to receive rinse water, moisture-resistant bag or receptacle for use and perineal pad.
Implementation:
Determine whether the client is experiencing any discomfort in the perineal-genital area. Obtain and prepare the necessary equipment and supplies. 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. Wash hands and observe other appropriate infection control procedures (e.g., clean gloves). Provide for client privacy by drawing the curtains around the bed or closing the door to the room. Some agencies provide signs indicating the need for privacy. Prepare the client: fold the top linen to the foot of the bed and fold the gown up to expose the genital area. Place a bath towel under the client’s hips. Position and drape the client and clean the upper inner thighs.
Position the female in back-lying position with the knees flexed and spread well apart. Cover her body and legs with the bath blanket. Drape the legs by tucking the bottom corners of the bath blanket under the inner sides of the legs. Bring the middle portion of the blanket up over the public area. Put on gloves, wash and dry the upper inner thighs. Inspect the perineal area. Note any particular areas of inflammation, excoriation, or swelling, especially between the labia in females and the scrotal folds in males. Also note excesswive discharge or secretions from the orifices and the presence of odor. Clean the labia majora. Then spread the labia to wash the folds between the labia majora and the labia minora. Use separate quarters of the washcloth for each stroke, and wipe from the pubis to the rectum. For, menstruating women and clients with indwelling catheter, use clean wipes, cotton balls, or gauze. Take a clean ball for each stroke. Rinse the area well. You may place the client on a bedpan and use a periwash or solution bottle to pour warm water over the area. Dry the perineum thoroughly, paying particular attention to the folds between the labia.
Inspect the perineal orifices for intactness. Inspect particularly around the urethra in clients with indwelling catheters. Clean between the buttocks. Assist the client to turn onto the side facing away from you. Pay particular attention to the anal area and posterior folds of the scrotum in males. Clean the anus with toilet tissue before washing it, if necessary. Dry the area well. For postdelivery or menstruating females, apply a perineal pad as needed from front to back. Document any unusual findings such as redness, excoriation, skin breakdown, discharge or drainage and any localized areas of tenderness.
Evaluation:
Relate current assessment to previous assessments. Conduct appropriate follow-up such as prescribed ointment for excoriation. Report any deviation from normal to the physician.
