Perineal Care and Incontinence.
Determine whether the client can wash his/her own private areas. If they can’t, follow the procedure for “peri-care”:
- Put on disposable gloves.
- Help the client to back-lying or side-lying position with knees apart and legs bent.
- Expose only the client’s genital area.
- Provide drapes.
- Place towel under hips.
- Wash perineal area. Start with the upper, inner thighs.
- Wash genitals on the outside – front to back.
- Spread labia gently to wash inside, front to back, using separate corners of the washcloth for each stroke.
- Wash the rectal area. Rinse and dry in the same fashion.
- Apply moisture barrier cream to the genital/rectal area, if requested on the care plan.
- Wash and dry the penis, using firm strokes. (Handling the penis firmly may prevent an erection.) Gently push back the foreskin on uncircumcised males and clean behind the glans.
- Rinse and pat dry. Replace foreskin.
- Wash and dry the scrotum and around the rectum. Rinse and dry.
- Apply moisture barrier cream, if necessary, around the rectal/perinea) area.
- Note and report any chapped areas: redness, swelling, discharge, or discomfort.
- Remove and discard gloves.
- Wash hands. (Lotion can be warmed in the basin of hot water for additional comfort.)
- Offer or apply deodorant, lotion, or powder.
- Assist the client to dress.
- Assist with hair care; nail care, and oral care.
- (For some, mouth care may have occurred before the bath – a personal preference.)
- Position the client comfortably and re-make the bed.
- Clean up the area and put away supplies.
- Wash your hands.
Complete your note for the visit.
- Specify the type of bath you gave.
- Call the supervisor with any new information or if the care plans need changing.
Perineal Care and Incontinence
- Perineal care (also known as “peri-care” or genital care) is an important part of personal hygiene.
- Some clients are unable to control the flow of urine or the movement of their bowels and need varying degrees of help with managing this problem.
- Many patients just need a helping hand with gathering supplies to change pads and clean their skin.
- Some patients need direct care – from start to finish – including cleaning the skin and putting on clean pads.
Encourage as much independence as possible:
- Patients with incontinence problems are often embarrassed about their conditions. Every effort should be made to provide privacy and to protect the dignity of these patients.
- Some patients wear absorbent pads or underclothes and change their pads while on the toilet.
- More confused or infirmed patients need help changing their pads.
- PCW/P’ s should be knowledgeable about different products and know-how to how to use them in case a client needs more than supervision.
- Incontinence supplies with elastic side straps and buttons seem to be easier for clients to use because they can be worn like underwear and slide over the feet.
Changing Incontinence Pads and Peri-Care
- Gather Supplies:
a) Disposable gloves;
b) Roll of toilet tissue;
c) Basin or sink with warm water;
d) Soap or other skin cleanser OR disposable wipes;
f) Special powders or skin protectors, and moisture barrier cream, if ordered;
g) Plastic trash bag or trash can with plastic liner;
h) Dry replacement pad;
i) Possibly, a change of clothing
- Explain what you will be doing or how you will help.
- Wash hands and put on gloves.
- Assist the client in a comfortable position – sitting on the toilet, standing, or lying down.
- Drape for privacy, as possible. If lying in bed, have the client roll to the side or lift hips.
- Place a waterproof pad under hips.
- Remove the soiled pad and fold, soiled side inward.
- Place in the trash receptacle.
- If the pad is soiled, not just wet, the client will need to be carefully cleaned.
- Wrap toilet tissue around the gloved hand. Wipe from urinary area to anal area in one swipe.
- Discard tissue and repeat this process until clean.
- Assist client to clean or wash the genital area with warm soapy water or the disposable wipe.
- Females should be washed from front to back, a cleaner area first, more soiled area last. Take care to clean in the creases and folds.
- Males should be cleaned around the penis first and then the scrotum. Uncircumcised males will need to have the foreskin gently pushed back to allow for complete cleaning.
- Rinse the genital area in the same, thorough fashion. There is no need to rinse if using disposable wipes.
- Apply moisture barrier cream, if ordered.
- Apply a dry pad, plastic side out. Have client bend knees, lift hips off the bed, or roll onto their side.
- Assist the client to re-dress as necessary.
- Remove and discard gloves.
- Close the trash bag and discard it.
- Wash hands thoroughly.