Providing Perineal Care for a Patient

 

Each and every patient requires to be given perineal care several times a day. For instance, after a patient becomes incontinent, urinates or uses a bedpan; he needs to be cleaned in the perineal region. Also, in order to keep the patient active and comfortable, a certified nursing assistant needs to give him perineal care. These frequent checks ensure that the patient remains distant from diseases and infections. With daily perineal care, a CNA will be able to spot problems like, swelling in the perineal area, lesions and other signs of infections and hence, the patient will be saved from more serious diseases and infections that can occur in future. Regular and proper care will decrease the chances of infections in urinary tract, which can cause kidney and bladder related issues in future.

Before you begin with providing perineal care to the patient, you must wash your hands in a proper way. You can follow the hand washing skill video for that. After that, you need to put on a pair of gloves. Then greet the patient properly and explain him that you will be giving him perineal care.

Steps to Follow for Providing Perineal Care

  • If the patient is physically capable, ask him to spread his legs. However, if he is not able to do that, you will be required to open his legs in a gentle way.
  • Clean the skin in the perineal region, using a washcloth and warm water. Cleaning should be done from front to back. Never move from back to front because the germs from the anal area may get to urethra. This is important because the urethra is one of the major sources of infection in the urinary tract.
  • After you complete the cleaning of perineal area, dry the region properly. This stops the skin from turning chapped.
  • Always remember that you should not use the same linens you used to clean the perineal region, to clean other parts of the body. You must use a neat washcloth, to clean only the perineal area because this will avoid the spreading of germs to other parts of the body.
  • In case, the linens on the bed get wet or soiled, you will be required to replace them immediately.
  • Dispose the used linens in an appropriate receptacle. Take off your gloves and dispose them properly.
  • Ask the patient, if he is comfortable in the current position. If not, help him get into a comfortable situation. Make necessary adjustments in the position of the blanket and the sheet too.
  • After you are done with the cleaning process and disposing the gloves and used linens, you must wash your hands in the correct way. You can look at the hand washing skill demonstration for this.

While working with the patient, you must try to see the signs of infections in the perineal region. These frequent checks ensure that the patient remains distant from diseases and infections. An individual will be able to spot problems like, swelling in the perineal area, lesions and other signs of infections and hence, the patient will be saved from more serious diseases and infections that can occur in future. Regular and proper care will decrease the chances of infections in urinary tract, which can cause kidney and bladder problems. Various signs of infections may include sores, rashes, tenderness or boils in the area. In case, you notice any of these things, you must inform the nurse about it immediately. Regular and proper care will help the patient in attaining comfort during the recovery process.

What Does the Examiner See when You Perform this Skill?

Here is a list of things that the examiner notices when you perform this skill:

  • If you have done the things you had to, in the start.
  • If you loaded an appropriate amount of water in the basin and if the temperature of water was right (according to the preference of the patient, if applicable).
  • If you covered the patient appropriately, to keep up his self-respect and avoid exposure of his vital parts.
  • If you positioned a waterproof pad below his buttocks.
  • If you positioned the patient for the process appropriately.
  • If you applied cleansing lotion and got the wet clothes washed.
  • If you cleaned and washed the perineal region properly.

    • For a Female Patient: If you parted the labia and used downward strokes to clean the region, in front to back motion. Clean cloth (or clean areas of the same cloth) should be used for each and every downward motion. If you used additional clothes in need.
    • For a Male Patient: If the patient is uncircumcised, you retracted the foreskin or not. After getting hold of his male part, you used a circular motion to clean the tip of his part, washed down the shaft of his part, and washed his testicles properly or not. If you replaced the foreskin of the patient (uncircumcised).
  • If you rinsed the perineal region of the patient properly (if applicable).
  • If you made the patient lie down on his side (with his face away from your side) and used a front to back motion to clean his anal area.
  • If you patted the perineal area, to make it dry (if applicable).
  • If you took off the waterproof pad and disposed in properly, in an appropriate receptacle.
  • If you disposed the gloves in a proper way.
  • If you washed your hands for at least a minute (because you might have come in direct contact with his urine and as you have touched his perineal body part).
  • If you have done the things you had to, at the end.

Video Demonstration

Here is a video that will show you the best way to provide perineal care to the patient during the CNA skill test. Have a look:

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