Bathing
Performing Perineal Care for a Male 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.
- Wash downward from the pubic area toward the rectum, to prevent contamination of the urethral meatus with microorganisms.
- After administering perineal care for an uncircumcised male, make sure the foreskin is in its natural position.
- 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)
Waterproof pad
Basin
Clean gloves
Cleansing product
Bath blanket
Bath towels and washcloths
Disposable wipes
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, 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 himself.
- Offer the patient a bedpan or urinal.
- 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. Take steps to relieve pressure if you notice redness, blistering, or other signs of skin irritation.
- Have the patient rate his level of comfort (on a scale of 0 to 10).
- Ask the patient if he 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 he 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 alterations in 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. Which of the following interventions directly related to patient safety must the nurse consider when providing perineal care to an elderly male patient with a catheter?
Wear clean gloves during care.
Assess the patient's ability to provide self-care.- Encourage the patient to report any pain originating from the catheter.
- Monitor the amount of urine in the drainage bag to prevent overflow.
CORRECT. The use of gloves is directed toward preventing the transmission of infection and is therefore directly related to patient safety.
INCORRECT. Assessing the patient's ability to provide personal hygiene pertains to patient autonomy and is not directly related to patient safety.
INCORRECT. Although encouraging the patient to report pain and attempting to identify its origin is appropriate, it is not directly related to patient safety.
INCORRECT. Monitoring the amount of urine in the drainage bag to prevent overflow of urine is an appropriate intervention; however, it does not necessarily pertain to male perineal care and is not directly related to patient safety.
2. The nurse observes the nursing assistive personnel (NAP) providing perineal care to a male patient. Which observation of care requires the nurse's follow-up?
- Assisting the patient into the supine position in bed
- Cleansing the tip of the penis with a circular motion, starting at the meatus
- Reserving the cleansing of the tip of the penis as the final step in perineal care
- Using a gloved hand to grasp the shaft of the penis in order to retract the foreskin
INCORRECT. Unless the supine position is contraindicated for this patient, this action is appropriate and requires no follow-up.
INCORRECT. This technique is correct and requires no follow-up.
CORRECT. Proper cleansing requires that the tip of the penis be cleansed first, to minimize the introduction of pathogens to the meatus. The nurse's observation of improper technique requires follow-up teaching.
INCORRECT. This technique pertaining to infection control is correct and requires no follow-up.
3. A male patient receiving perineal care tells the nurse "It has started to hurt a little down there." What is the nurse's best response?
- "When did you start experiencing the pain?"
- "Rate the pain on a scale of 1 to 10."
- "I'll assess your perineal area for the possible cause of the pain."
- "Would you like some pain medication before I continue with your care?"
CORRECT. This is the best response for the nurse. A nurse should ask the patient about his concerns and the perineal pain first.
INCORRECT. The nurse should assess the area before asking the patient to rate the amount of pain on a scale of 1 to 10.
INCORRECT. The nurse should assess the perineal area for the cause of pain after she has asked the patient about his concerns and the perineal pain.
INCORRECT. The nurse must assess the area before offering pain medication.
4. The nurse has delegated a male patient's perineal care to the nursing assistive personnel (NAP). Which statement made by the NAP requires the nurse's follow-up?
- "I will check to see if he cleans himself well."
- "I will let you know if I see any redness or drainage."
- "I will ask him if he is experiencing any pain in that area"
- "I will be sure to use hot, soapy water to be sure he's clean."
INCORRECT. This is an appropriate statement reflecting attention to the patient's ability to effectively provide perineal cleansing and so requires no follow-up.
INCORRECT. This is an appropriate statement regarding observation of the patient's skin and so requires no follow-up.
INCORRECT. This is an appropriate statement regarding observation of the patient's comfort level and so requires no follow-up.
CORRECT. This is an inappropriate statement since warm, not hot, water and mild soap should be used when cleansing the perineal area to minimize irritation. This statement requires the nurse's follow-up.
5. What is the primary reason for performing perineal care on a male patient with incontinence?
- To provide comfort and a relaxed, refreshed feeling
- To promote personal hygiene while minimizing perineal odor
- To remove all microorganisms from the patient's perineal area
- To reduce the risk of skin breakdown in the patient's genital and perineal area.
INCORRECT. Although comfort is a reason for performing male perineal care, it is not the primary reason for providing such care to a male patient with incontinence.
INCORRECT. Although promoting personal hygiene and minimizing perineal odor are expected outcomes of performing male perineal care, they are not the primary reasons for providing such care to a male patient with incontinence.
INCORRECT. Proper perineal cleansing reduces the number of microorganisms on the skin, but it cannot eliminate them.
CORRECT. Incontinence increases the risk of skin breakdown, but proper perineal care minimizes the damaging effect that urine and feces have on the patient's skin.
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