Bathing
Performing Perineal Care for a Female Patient
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Safety
- Always wear clean gloves, due to the risk of contact with infectious microorganisms.
- Assess the water temperature, and avoid hot or excessively cold water. Use a mild cleansing agent to minimize irritation.
- Avoid using force or excessive friction during cleansing.
- Avoid placing tension on an indwelling urinary catheter, if present. Clean the area around it thoroughly.
- Wash downward from the pubic area toward the rectum, to prevent contamination of the vagina and urethral meatus with microorganisms.
- Report any signs of impaired skin integrity to the nurse in charge or to the health care provider.
Equipment
(Roll cursor over items to see labels)
Disposable wipes
Waterproof pad & bedpan
Basin
Bath blanket
Bath towels & washcloths
Clean gloves
Cleansing product
Solution bottle for prescribed rinsing solution
Linen bag
PrintableDelegation
The skill of perineal care can be delegated to nursing assistive personnel (NAP). Before delegating, be sure to inform NAP of the following:
- Any physical restrictions that affect the proper positioning of the patient
- The proper ways in which to position a patient with an indwelling urinary catheter
- The need to inform you of any perineal drainage, excoriation, or rash
- Any cultural differences that may affect the perineal care process
Preparation
- Assess the patient’s need for perineal care. Patients at risk for infection need more frequent care. These include patients with incontinence-associated dermatitis (IAD), patients with an indwelling urinary catheter, postpartum patients, and those recovering from rectal or genital surgery.
- Assess the environment for safety; check the room for spills, make sure equipment is working properly, and ensure that the bed is in the locked, low position.
- Assess the patient’s tolerance of perineal care.
- Evaluate the patient’s knowledge of perineal hygiene.
- Note any restrictions or limitations on patient positioning.
- Determine how much of the perineal care the patient wants to complete herself.
- Offer the patient a bedpan.
- Fill a washbasin two-thirds full with warm water.
Follow-up
- Observe the perineum, particularly noting areas that were previously soiled or reddened, or that had swelling, discharge, irritation, or signs of skin breakdown.
- Have the patient rate her level of comfort (on a scale of 0 to 10).
- Ask the patient if she feels fatigued.
- Assess vital signs if the patient is experiencing distress or restlessness.
Documentation
- Record the procedure, including how much the patient participated and how she tolerated the procedure.
- Record the condition of the patient’s skin and any significant findings, such as reddened areas, bruises, nevi, and joint or muscle pain.
- Report any evidence of altered skin integrity, any break in a suture line, or increased wound secretions to the nurse in charge or to the health care provider.
Review Questions
1. The nurse is delegating to nursing assistive personnel (NAP) the perineal care of a female patient who is totally dependent and confined to bed. Which statement by the NAP requires the nurse's follow-up?
"I'll ask for assistance if I need help positioning her."- "I'll see if she's up to the care right now."
- "I'll let you know if I notice any signs of redness or discharge."
"I'll be sure to use hot, soapy water, since she has been incontinent."
INCORRECT. Positioning a totally dependent patient is likely to require more than one person, so this statement requires no follow-up.
INCORRECT. It is appropriate to evaluate the patient's ability and willingness to have the care performed at this time, so this statement requires no follow-up.
INCORRECT. Observing the patient's perineal area for signs of skin damage or discharge is appropriate, so this statement requires no follow-up.
CORRECT. To minimize skin irritation, warm water and mild soap should be used when cleansing the perineal area, so this statement requires the nurse's follow-up.
2. The nurse is preparing to provide perineal care for a female patient who is on bed rest. Which patient position should the nurse use for this care?
INCORRECT. The supine position is not used when performing perineal care.
INCORRECT. The prone position is not used when performing perineal care.
INCORRECT. The side-lying position is not used when performing perineal care.
CORRECT. Dorsal recumbent is the correct patient position to use when performing perineal care.
3. As the nurse is preparing to provide perineal care to a female patient with limited mobility, the patient says, "I can do that myself." Which action would be the priority?
- Provide all the necessary supplies and linen for this task.
- Assess the patient's ability to perform proper perineal care.
- Ensure that the patient has privacy while performing perineal care.
- Document any complaints of irritation or pain in the perineal area.
INCORRECT. Although it is a nursing responsibility to provide all the items necessary for the patient to perform this task, doing so would not take priority over assessing the patient's ability to perform perineal care.
CORRECT. Determining the appropriateness of self-care by assessing the patient's ability to provide her own perineal care is the priority action.
INCORRECT. Although it is a nursing responsibility to ensure the patient's privacy during perineal care, doing so would not take priority over assessing the patient's ability to perform this task.
INCORRECT. Although documenting patient complaints is a nursing responsibility, doing so would not take priority over assessing the patient's ability to provide her own perineal care.
4. How can the nurse promote infection control while providing perineal care for a female patient who has a catheter?
- By avoiding the application of tension on the catheter
- By patting, not rubbing, the skin dry after thoroughly rinsing it
- By cleansing the patient's labia from the pubic area toward the rectum
- By using warm water to cleanse the patient's entire perineal area
INCORRECT. Although avoiding tension on the catheter is encouraged in order to prevent its accidental dislodgment, this precaution does not pertain to infection control.
INCORRECT. Patting the skin dry, rather than rubbing it, helps minimize skin damage, but this action does not pertain to infection control.
CORRECT. Cleansing the labia from the pubic area toward the rectum minimizes the risk of introducing microorganisms from the rectum to the urethra and vagina.
INCORRECT. Cleansing with soap and water reduces the number of microorganisms in the perineal area. Using warm water alone, however, has little effect.
5. The nurse is delegating a female patient's perineal care to nursing assistive personnel (NAP). What instruction would the nurse give to ensure the NAP's safety while performing this care?
INCORRECT. Wearing sterile gloves is not necessary to ensure the NAP's safety while performing perineal care.
CORRECT. Wearing clean gloves is the best way to ensure the NAP's safety while performing perineal care.
INCORRECT. Wearing an isolation gown is not necessary to ensure the NAP's safety while performing perineal care.
INCORRECT. Using hot water would not ensure the NAP's safety while performing perineal care, and doing so could be harmful to the patient.
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