Perineal care
PERINEAL CARE DEMONSTRATION
OBJECTIVE:
·To give comprehensive perineal care;
· To explain the procedure of perineal care and collect necessary
information;
· To perform perineal examination;
· To identify normal and abnormal changes during perineal
examination;
· To list the articles required for perineal care.
· To conduct physical examination;
· To differentiate normal and abnormal findings during obstetrical
examination;
· To identify women and men at risk during perineal care and
examination; and
· To assess health education needs of women and conduct need
based health education.
Introduction:
Perineal injury is the most common maternal morbidity
associated with vaginal birth. Anal sphincter injury is a major
complication that can significantly affect women’s quality of life.
Perineal hygiene involves cleaning external genitalia and surrounding
area. The perineal area is conductive to growth of pathogenic organisms
because so the pathogenic organisms enter into body many orifice in
situated in this area .it is less ventilated. Since Delivery is the physical
strengthen, effort done by the mother during their delivery period and
suffer from birth canal injuries, episiotomy incision, perineal tear
laceration may be occur so staff nurses provided perineal care to the
patient in the hospital at least minimum twice a day and try to recover
the patient in early healing
Definition:
Perineal care is an aseptic irrigation of the vulva and perineum after
voiding or defecation in specified period following delivery or an
operation of birth canal, perineum, urinary meats or anus.
cleansing the area between the anus and vulva in female, or the anus and
scrotum in male; promotes comfort and prevents odor kin excoriation,
and infection. usually given along with a complete bed bath, but may
have to do more often (e.g. incontinent of urine or feces)
Perineal care is the term applied to the external irrigation or cleansing of
the vulva and perineum region as a means of prevent infection, promote
healing of the stitched perineum and making the patient comfortable.
It cleansing procedure prescribed for the genital and anal areas as part
of the daily bath or after various obstetrical and gynecological
procedures
PURPOSE
1. To clean the skin and mucous membrane of the vulva and
perineum.
2. To eliminate the bacterial growth by application of antiseptic
solution.
3. To increase the healing of perineal tissues.
4. To relieve itching, pain, discomfort of the perineal area.
5. To prevent the infection in to the genital area.
6. To minimize pain, tenderness and edema due to operational trauma
after Episiotomy
7. To observe the colour, nature and characteristics of lochia.
Indication Of Perineal Care:
1) Postpartum patients especially with stitches in the perineum.
2) Persons with surgery of the genitourinary tract.
3) Patients with lesions, ulcer or surgery of the perinea area or
rectum.
4) Patient having indwelling catheter.
5) Patients having excessive vaginal discharges.
6) Patients with incontinence of urine or stool
7) Patient should not perform the perineal care by herself.
General Instruction:
1) Maintain strict aseptic technique during the procedure.
2) Provide privacy to the mother.
3) Observe the colour, nature and characteristics of lochia.
4) Don’t touch inner area of the sterile tray.
5) Use the one swab for each stock from upward to downward.
6) If the glove is soil before procedure change it.
7) To observe the patient for discomfort during procedure.
8) Discard all the swabs and pad in the paper bag or dustbin
9) Used mild antiseptic solution or plain warm water for perineal care.
Preliminary Assessment:
1) Identify the patient.
2) Check the doctor’s order for any specific precautions.
3) Identify any specific contraindications present.
4) Any contra indications to the applications of perineal care in the
patient.
5) General condition of patient and ability to follow instruction.
6) Check the articles available in patient unit.
Preparation Of The Articles :-
Sr Articles Use
no.
1. Soap dish, towel For hand washing before and after
procedure
2. Curtain To maintain privacy
3. Spot light / torch For focusing the perinea area
4. Plastic apron To protect her self
5. Bath blanket To cover the patient
6. Mackintosh ,draw To protect the bed linen
sheet
7. Paper bag and To receive the waste
Kidney tray
8. Sterile tray:
Gloves To maintain sterile technique
Artery forcep To remove the previous dressing
Sponge holder To hold the swab and clean the
Sr Articles Use
no.
perineum To clean the perineum
Bowl containing To clean the vulva and perineum
savlon solution
Cotton swab To clean the perineum with
antiseptic solution
Gauze piece apply the antiseptic cream on sutures
Cotton pad To apply over the perineum
9. Bandage or under To support the cotton pad and bind T
garments bandage
10. Bed pan To collect the excreta if needed
Preparation Of Patient And Environment:
1) Identify the patient with the name and explain the procedure to the
patient to win the confidence and co-operation.
2) Advice the patient to empty the bladder and bowel.
3) Provide privacy.
4) Arrange the articles at the bed side locker
5) Position the patient in dorsal recumbent.
6) Place the mackintosh and towel under the patient to protect the bed.
7) Provide adequate light by placing extra spot light.
8) Drape the patient and open only vaginal area.
9) Give extra pillows to raise the head.
10) Use the bed pan if you perform the procedure in bed.
PROCEDURE
STEPS RATIONAL
Explain the procedure to the To gain the confidence and co-
patient. operation of the patient.
Spread the mackintosh and To prevent soiling of bed.
draw sheet under the buttocks.
Pour lotion into the bowl To clean the perineum
Hand wash To prevent cross infection
Wear the gloves To prevent cross infection. To
maintain universal precaution
Holding the perineal pad or To identify any abnormality.
dressing with artery forceps
and observe characteristics of
the secretion, lochia, amount
colour, odour and discard soil
pad
Hold the swab with swab To clean the perineum
holder
Clean the perineum with To prevent Ascending infection
sterile wet swab from upward
STEPS RATIONAL
to downward.
First clean the stitches and To prevent infection as stitches
then other area. consider more sterile than the other
area.
Clean vulva and perineum To clean the perineum and to
using each sponge once only prevent infection.
and start from upward to
downwards making as little
pressure as possible on the
tissue work from the midline
outward.
Inspect perinea stitches for To give the treatment
infection
Turn the patient on one side Clean and dry the buttocks
Apply antibiotics ointment To discourage of bacterial growth
Apply the dressing and avoid To prevent contamination of area
touching the surface of this will come in contact with the
dressing that comes in contact perineum.
with vulva and perineum.
Apply dressing, cotton pad and To secure the pad
“T” bandage.
After Care of The Patient And Articles:
1) Remove the mackintosh and bedpan.
2) Change the linen if necessary. Straighten the bed Arrange the bed
linen.
3) Give the comfortable position to the patient.
4) Take the bedpan to the sanitary use. Remove the cotton swabs If
any And empty the contents into the toilet. Rinse the bedpan with
cold water using a brush. Immerse It In lotion to disinfect it.
5) Wash and dry well and keep it on the bedpan rack. Ready for the
next use.
6) Take all the articles to the utility room, clean it and replace it.
7) Boil the forceps. Replace the articles.
8) Remove the screen and tidy up the unit.
9) Wash hands.
10) Record the procedure with date and time and the observations
made.
Recording and Reporting:
Record the procedure in patient's chart.
1) Record amount, colour and odours of lochia.
2) Note consistency of uterus.
3) Record if dry heat is applied.
4) Record the condition of stitches.
5) Report any abnormality if observed.
BIBLIOGRAPHY:
a) Inamdar Madhuri, Nursing Arts (Principles and Practice)
Part-II; 1st edition, 1998; Vora Medical Publication, Bombay;
Pp: 98-100
b) Sr. Nancy, Principles and Practice of Nursing; Volume-1; 5 th
edition, reprinted ,2001; N.R. Publication, Indore; Pp: 234-
233
c) Spencer May and Tait Katherine M., Introduction to Nursing;
4th edition, 1978; Blackwell scientific publication, oxford
London; Pp: 87
d) Thresyamma C. P., Fundamentals of Nursing Procedure
Manual for General Nursing And Midwifery Course; 1 st
edition, reprint 2004; Jaypee Brothers Medical Publishers,
New Delhi; Pp: 392-395
