PROVIDING PERINEAL-GENITAL CARE

Perineal-Genital Care – Is also referred to as perineal care or pericare. Perineal care as part of the
bed bath is embarrassing for clients. Nurse also may find it embarrassing
initially, partially with clients of the opposite sex

- The nurse needs to provide perineal-care efficiently for dependent client.

Nurses should wear gloves while performing or providing this care for the
comfort of the client and to protect themselves from infection.
Purposes:

1. To remove normal perineal secretions and odors.

2. To provide cleanliness and comfort for clients.

Equipment:
Tray containing:

1. Jar with cotton balls

2. Jar with cotton balls and cleansing solution
3. Pitcher with sterile warm water
4. Kidney basin for soiled cotton balls
5. Bed pan
6. Movable screen (for ward use)
7. Forceps
8. Gloves
9. Perineal pads
10. Tissue paper

Procedure:

STEPS RATIONALE

1. Assess for the need of doing perineal care. To avoid embarrassment to both the client and the
nurse.

2. Wash hands, assemble all equipment Deters spread of microorganism. Save time and
needed. energy.

3. Identify the client and explain procedure. To make certain that it is the right client. To gain
cooperation.

4. Screen the patient, close the door/windows. To provide privacy.

For Female:

5. Position the client in a back-lying This position facilitates proper viewing of the
position with the knees flexed and perineal area.
spread well apart.
6. Drape exposing only parts to be Avoid undue exposure of the client’s body part
cleansed. to lessen embarrassment.
7. Place bed pan under the client buttocks Served as collector of water drainage.
or Kelly pad.
8. Don gloves To minimize spread of microorganisms.
9. Using pick up forcep get cotton ball Minimize spread of microorganisms.
soaked in cleansing solution and clean
from midline of symphysis pubis down
to anus NEVER retrace stroke.
10. Using your non-dominant hands spread Secretions that tend to collect around the labia
the labia to wash the folds between the minora facilitate bacterial growth.
labia majora and minora.
11. Get another cotton ball, clean starting Cleansing from area of least contamination (the
from mons veneris in figure of 7motion pubis) to that of greatest contamination (the
by way of external labium towards anus rectum) minimizes the spread of organism.
then discard.
12. Do likewise on opposite side.
13. Clean the groin from inner to outer
portion in a zigzag motion going out to
the thigh then do it the other side.
14. Flush thoroughly with sterile warm
water.
15. Dry using the same stroke as above. Moist support the growth of many
microorganisms and wet perineal area is
uncomfortable.
16. Inspect perineal area. Watch for signs of inflammation and infection.
17. Remove bed pan. Position client
properly.
18. Spray antiseptic if needed.
19. Put perineal pads with an upward
motion if needed.
For Male:

1. Asses for the need of doing perineal care. To avoid embarrassment for both the client and
the nurse.
2. Wash hands, assemble all equipment Deter spread of microorganism. Save time and
needed. energy.
3. Identify the client and explain procedure. To make certain that it is the right client, to gain
cooperation.
4. Screen the patient, close the To provide privacy
door/windows.
5. Position the client in a supine position This position helps in proper viewing of the
with knees slightly flexed and hips slightly perineal area.
externally rotated.
6. Drape exposing only the parts to be Avoid undue exposure of the client’s body parts
cleaned. to lessen embarrassment.
7. Place bed pan under the client’s buttocks. Serves as the collection of water drainage.
8. Don gloves. Deters spread of microorganism.
9. Using pick-up forcep get cotton balls
soaked in a cleansing solution.
10. Hold the penis and cleanse the foreskin in To minimize spread of microorganism.
circular motion starting from tip (the
glans) to base.
11. If the client is uncircumcised, retract the Retracting the foreskin is necessary to remove
prepuce to expose the glans penis. the smegma that has collected under the
foreskin, which facilitates bacterial growth.
12. Replace the foreskin after cleansing the Replacing the foreskin, prevents constriction of
glans penis. the penis, which may cause edema.
13. Wash the scrotum. The posterior folds of The scrotum tends to be more soiled than the
the scrotum to be cleansed when the penis because of its proximity to the rectum;
buttocks are cleansed. thus, it is usually cleaned after the penis.
14. Dey using the same stroke. Wet perineum causes uncomfortable feeling.
15. Inspect perineal orifice for intactness A catheter may cause excoriation around the
especially if the client is having catheter. urethra.
16. Remove bed pan and discard properly. Follow the principles of aseptic technique.
17. Position the client properly and
comfortably.
18. Change wet linens.
19. Remove gloves and discard properly. Follow infection control policy.
20. Do after care of the equipment.
21. Document procedure done and the
client’s reaction, and observation made.
Strokes used in Perineal Care:

1. Mons veneris
2. Midline of symphysis pubis down to anus
3. For labia minora
4. Left labia majora
5. Right labia majora
6. Left leg
7. Right leg
8. Anus
 PERFORMING URETHRAL URINARY CATHETERIZATION

Definition: Urinary Catheterization is the introduction of a catheter into the urinary bladder via
the urethral canal.

Purposes:

1. To relieve discomfort due to bladder distension or to provide gradual decompression of a

distended bladder.
2. To assess the amount of residual urine if the bladder empties incompletely.
3. To obtain a sterile urine incompletely
4. To empty the bladder completely prior to surgery.
5. To facilitate accurate measurement of urinary output for critically ill clients whose output
needs to be monitored hourly.
6. To provide for intermittent or continues bladder drainage and/or irrigation.
7. To prevent urine from contacting an incision after perineal surgery.
8. To manage when other measures have failed.

A. FEMALE CATHETERIZATION

EQUIPMENT:
1. Perineal care tray
2. Bed pan with cover
3. Waterproof underpad/drawsheet
4. Bath blanket
5. A tray containing the following:
a. Pick up forcep and working forcep
b. Water soluble lubricant
c. Sterile gloves of your size
d. Betadine solution
e. Dry CB-sterile
f. Catheter of appropriate size
- FR. 12-14 adult
- FR. 8-10 for children
g. Sterile catheterization kit
- g.1 eye sheet
- g.2 OS
- g.4 specimen bottles-2
- h. Equipment for indwelling catheter
- h.1 foley catheter
- h.2 sterile 10cc syringe filled with sterile water
- h.3 vial type of distilled water
- h.4 plaster (hypoallergenic)
- h.5 collection bag and tubing
6. Standing lamp – for adequate lighting
Procedure:

STEPS RATIONALE
1. Check for doctor’s order. Catheterization is only done if with doctor’s
order.
2. Wash hands properly. Reduce microorganisms and avoid
contamination and nosocomial infection.
3. Bring the equipment to the Explaining the procedure properly will help the
patient’s room and explain the patient reduce anxiety and will help the nurse
procedure to the patient. gain his/her cooperation.
4. Assess whether the client is allergic Povidone iodine is often used to cleanse the
to iodine or plaster. vuln before catheterization.
5. Screen the client/close door. Client has the right to be protected from being
seen by others.
6. Replace top sheet with bath Protecting the bed linen from being wet.
blanket place water proof pad
under the buttocks of the client.
7. Provide adequate lighting. Good lighting is necessary to see the meatus
clearly.
8. Place client on a dorsal recumbent Good visualization of the meatus is important.
position with the feet apart and Embarrassment, chilliness and tension can
drape the client. interfere with introduction of the catheter.
9. Bring all the needed equipment Placement of the equipment near the work site
near the perineal area. increases efficiency.
10. Do perineal care. Cleaning the area, decreases the possibility of
introducing organisms into the bladder.
11. Squeeze a small amount of Organization promotes efficient time
lubricant over the sterile OS placed management.
in the sterile field.
12. Gets 2 CB’s with betadine from the
jar and place on the sterile field on
top of the several OS. Open the
covers of the specimen bottles.
13. Don gloves. Deter spread of microorganisms.
14. Grasp the upper corner of the eye A drape provides a sterile field where the
sheet and unfold it. Place it equipment and hands will be placed.
aseptically over the vulvar area
exposing the labia.
15. Lubricate 1-2 inches of the catheter Lubrication facilitates the insertion of the
tip. catheter and reduces trauma to the tissues.
16. With the thumb and forefinger of Separating the labia helps expose the meatus
your non-dominant hand, spread so its location is visible.
the labia and identify the urinary
meatus.
17. With the dominant hand disinfect
the meatus twice using CB with
betadine. Maintain the hold until
the catheter has been inserter.
18. Insert the tip of the catheter into The female urethra is about 3.5 cm to 6.2 cm
the dimple – like structure below long. Applying force on the catheter is likely to
the clitoris which is the meatus injure mucous membranes. The sphincter
about 2-3 inches or until urine relaxes and the catheter can enter the bladder
flows. Do not force the catheter easily when the patient relaxes. Advancing
through the urethra. Ask the catheter an additional ½ inch to 1 inch ensures
patient to breathe deeply while the placement within the bladder and facilitates
catheter is inserted. inflation of the balloon without damaging the
urethra.
19. Hold the catheter securely with Movement, even though it is slight, increases
your non-dominant hand while the the risk of introducing organisms within the
bladder empties. Collect a urethra. In general, no more than 750ml of
specimen if required. urine should be removed at one time. Pelvic
floor blood vessels may become engorged from
the sudden release of pressure leading to a
possible hypotensive episode.
20. Remove the catheter smoothly and The catheter is only needed to drain urine
slowly (if straight catheter is used). present in the bladder and is not intended for
continuous use.
21. If a foley catheter is used, introduce Creates a balloon to ensure catheter retention.
5cc – 10cc of distilled water to Maximizes continuous bladder drainage. Proper
secure the catheter. Gently pull the attachment prevents trauma to the urethra and
catheter until the retention balloon meatus from tension on the tubing.
is snuggled against the bladder
neck (resistance will be met).
Remove the eye sheet.
22. Tape catheter to the inner thigh.
23. Attach catheter to urine bag below Drainage is prevented when the urinary bag is
the level of the bladder. placed above the abdomen. Prevent urinary
reflex which may cause UTI.
24. Remove and clean the equipment Urine kept at room temperature may cause
and make patient comfortable. organisms to grow and distort laboratory
Label the urine specimen and send findings.
to the laboratory promptly.
25. Removes gloves, wash hands Infection control.
thoroughly.
26. Record the time of the procedure A careful recording is important for both the
done, the amount of urine client and the nurse.
removed, description of urine; the
patient reactions to the procedure.
 B. MALE CATHETERIZATION

EQUIPMENT:
1. Foley cath of the appropriate size Fr. 12-14 adult/Fr. 8-10 children.
2. Bath blanket
3. Water proof underpad/draw sheet
4. Plaster hypoallergenic
5. Standing lamps
6. Lubricate (water soluble)
7. Sterile pick up forcep
8. Gloves of your size
9. Betadine solution
10. A jar with CB in SSS
11. A jar with CB in sterile water
12. Packed sterile dry CB
13. Sterile catheterization kit
- Eye sheet
- OS
- Kidney basin
- Specimen bottle
14. Sterile 5-10cc syringe filled with sterile water
15. Distilled water

Procedure:

STEPS RATIONALE
1. Check for doctor’s order. Catheterization is only done if with doctor’s
order.
2. Wash hands thoroughly. Reduce microorganisms and avoiding
contamination and nosocomial infection.
3. Bring the equipment to the Explaining the procedure properly will help the
patient’s room and explain the patient reduce anxiety and will help the nurse
procedure to the client. gain his/her cooperation.
4. Assess whether the client is Povidone/iodine is often used to cleanse the
allergic to iodine or plaster. vulva before catheterization.
5. Screen the client/close door. Client has the right to be protected from being
seen by others.
6. Provides adequate lighting. Good lighting is necessary to see the meatus
clearly.
7. Place the patients in supine
position and knees slightly
apart.
8. Drape by fain folding the bed Draping keeps the patient warm and reduces
covers down to the midthigh embarrassment.
exposing the perineal area. Use
 bath blanket to cover the trunk.
Place the water proof
underpad under the buttocks.
9. Don working gloves. Do Cleansing the area decreases the possibility of
perineal care; remove and introducing bacteria into the bladder.
discard gloves properly.
10. Bring all needed equipment on Supplies must be of reach. It promotes efficient
the bed at the level of the hips. time management.
Bring the sterile CB near the
working area.
11. Squeeze a small amount
lubricant over the sterile OS
placed in the sterile field.
12. Get 2 CB’s with betadine form
the jar and placed on the sterile
field on top of the several OS.
Open the covers of the
specimen bottles.
13. Don gloves (sterile)
14. Place the opening of the sterile Maintain sterility of work area.
drape over the penis and onto
the perineum without touching
the upper top surface,
15. Lubricate around 3-4 inches of Prevents undue trauma when inserting the
the catheter. catheter into the urethra.
16. With the non-dominant hand Straighten urethral canal to ease cath insertion.
lift penis to position Disinfect the area and prevents the spread of
perpendicular to patient’s body microorganisms.
and cleanse the glans in a
circular motion moving
outward from the meatus with
the use of CB with betadine. Do
it 2x with the CB with betadine.
17. Continue to hold the shaft of
the penis.
18. Pick up the lubricated catheter Relaxation of external sphincter aids in
with your dominant hand. Pull insertion of catheter.
the penis slightly upward and
ask the client to bear down as if
to void. Slowly insert the
catheter in the meatus about 7-
9 inches using a rotating
motion until urine flows.
19. Gently push the catheter in 1-2 Further advancement of catheter ensures
inches more after urine starts proper placement.
to flow. As the bladder
empties, collect the specimen if
required. Remove the catheter
smoothly and slowly (if straight
cath is used).
20. If foley catheter is used, inject Maximize continuous bladder drainage.
 the contents of the pre-filled
syringe to secure the catheter.
Gently pull the cath until
retention balloon is snuggled
against the bladder neck.
21. Remove the eye sheet and tape Proper attachment prevents trauma to the
cath on the anterior thigh or urethra and meatus tension on the tubing.
lower abdomen.
22. Attach the cath to the Drainage is prevented when the urinary bag is
collection bag or urinary bag placed above the abdomen. Prevents urinary
below the level of the bladder. reflex which may cause UTI.
Coil excess tubing on the
mattress and secure it on the
bed frame.
23. Remove and clean the Urine kept at room temperature may cause
equipment and make the organisms, (if present) to grow and distort
patient comfortable. Label laboratory findings.
urine specimen and send to the
laboratory promptly.
24. Wash hands. Deters spread of microorganisms.
25. Records the time of For future references.
catheterization, amount of
urine removed, description of
urine and client’s reaction.

Note: For Condom cath

- If the client uses condom cath; you follow the same procedure with male catheterization
using foley cath, only you used condom.