Perineal care

Proper perineal care allows for inspection of the skin. It keeps the perineal area clean and less likely to break down. It also decreases the risk for urinary tract infections.

1. Perineal preparation for labour Presented By:- Ms.Samreen Bano Bsc Nursing 4 Th Year Era College Of Nursing GUIDED By:- Dr.Anjalatchi Muthukumaran Vice principal Era College Of Nursing

2. Content to be learn Introduction Definition Purpose Principlaes Indication Contra indication Pre assessment of the patients and environment Procedure After care Parts preparation before delivery

3. Introduction Labor usually starts within 2 weeks of (before or after) the estimated date of delivery. Exactly what causes labor to start is unknown. On average, labor lasts 12 to 18 hours in a woman's first pregnancy averaging 6 to 8 hours, in subsequent pregnancies

4. It is also defined as perineal -genital care. The perineal area is condusive to the growth of pathogenic organisms because it is warm, moist and it is not well-ventilated. Since there are many orifices example, urinary meatus , vaginal orifice and the anus situated in this area, the pathogenic organisms can enter into the body. Thoroughly cleanliness is essential to prevent bad odor to promote comfort.

5. Definition: Perineal care involves washing the external genitalia and surrounding with soap and water or with water alone or in combination with any commercially prepared peri -wash.

6. Principle: Clean the perineum from the cleanest to less clean area. Patient who require special attention to perineal area. 1. Patient who are unable to do self-care. 2 . Patient with genitor-urinary tract infection. 3 . Patient with incontinence of urine and stool. 4 . Patient with indwelling catheters. 5 . Postpartum patients. 6 . Patients after surgery on the genitor-urinary system. 7 . Patients with injury, ulcer or surgery on perineal area.

7. What is perineal preparation Perineal preparation means cleansing the genital area and anus area . _ clean external genital area and anus .

8. Definition of labour Labour is  series of events that takes place in the .  genital organs in an effort to expel the viable product of   conception  out of the womb through the vagina into the outer world.” - D.C.Dutta.

9. Purpose To prevent infection Provide comfort to the patient For maintaining the hygiene Remove secretion

10. Indication To Remove secretion To prevent odour . To maintain hygiene

11. Contraindication Inflammatory bowel disease Perineal malformation

12. Preliminary Assessment: (For Female Client) 1. Assess the condition of perineal skin-any itching, irritation, ulcers, oedema , drainage etc. 2 . Assess the need and frequency of perineal care. 3 . Assess whether perineal care should be done under an aseptic technique or a clean technique. 4 . Check the physician’s order for any specific instructions. 5 . Assess the patient ability for self care. 6 . Assess the patient mental state to follow instructions. 7 . Check the articles available in patients unit.

13. Articles preparations A clean tray containing:- Kidney tray - for collect the wet waste Gloves - for prevent infection Soap with soap disc - for hand washing Sponge holder - To hold swabs for cleaning Antiseptic solution –f or cleaning the genital area Betadine - for disinfection

14. Bedpan- if the patient needs to pass stool or urine Towel- to wipe the perineum Razor- for hair removal Mackintosh- protect the bed Warm water - to clean the perineum Cotton swab – for cleaning purpose

15. Preparation of Articles: A Tray containing Mackintosh-Purpose : To protect the bed. Wet cotton ball or rag pieces in a bowl .-   Purpose: To clean perineum. A jug with warm water or antiseptic solution.-Purpose : Gauze or rag pieces in a container. Long artery forceps in kidney tray -   Purpose: To hold swabs for cleaning. Paper bag.-Purpose : To receive wastes. Clean linen, pads, dressing etc as needed -  Purpose: To keep patient clean. Bed pan.-Purpose : if the patient is in need to passing urine or stool.

16. Patients preparation Assess the condition of the patient. Explain procedure to the patient. Provide privacy by screening . Remove all articles that may interfere with the procedure. provide psychological support to patient.

17. Preparation of Patient: 1 . Explain procedure to the patient. 2 . Provide privacy by screens and drapes. Drape the patient as for vaginal examinations. 3 . Remove all articles that may interfere with the procedure e.g. air cushion. 4 . Give extra pillows to raise the head. 5 . Roll the draw sheet to opposite side to prevent soiling when bedpan is placed under buttocks, over draw sheet. 6 . Offer bed pan. Keep the clean bed-pan on the bed on your working side. 7 . Untie the pads, if any and observe the discharges its color, odor, amount etc. 8 . Leave the patient for sometime so that she may pass urine or stool if necessary. 9 . Get the toilet tray and arrange the articles conveniently on bed side table.

18. Environment preparation Good lighting Screening Provide comfortable environment

19. Procedure: Steps : 1. Wash hands-Reason : To prevent cross infection. 2. Pour water over perineum .- Reason: To wash off the discharge from the perineal area. 3. Clean the perineum using the wet swabs.-Reason : To prevent the entrance of bacteria from the colon into urinary tract. 4. Hold the swabs with forceps and clean from above. 5 . Use one swab for one swabbing. 6 . Clean perineum from the midline outward in following order            a.  The vulva            b. The labia            c. Inside of labia on both sides.            d. Outside of labia on both sides. 7 . Clean the perineal region and anus thoroughly. 8. Remove the bed pan by supporting the hip as before. Turn the patient to one side and dry the buttocks with dry rag piece.

20. Perineal massage Step 1. Wash your hand Every massage session by washing your hands. Use a mild soap. Step 2. Find comfortable position. provide l ithotomy position Step 3. Privacy Maintain privacy of the patient.

21. Continue Step 4 procedure use natural oils,   sunflower ,   coconut ,  almond , Apply the oil on clean hands. Then continue on by moving your thumbs outward and inward in a slow U-shaped motion.  Perineal massage should be Performed for 3 to 5 minutes .

22. Placing one or both of your thumbs about ½ inches inside your vagina we don’t want to press too hard, to feel a stretching and even slight burning sensation Record and reporting

23. After Care: 1. Apply the medicine and pad if necessary. 2 . Remove the mackintosh if extra one is used . 3. Change linen if necessary straighten the bed clothes. Arrange the bed linen. 4 . Make patient comfortable. 5 . Take the bed pan to sanitary annex. Remove cotton swabs, and empty the contents into toilet. 6 . Clean all articles. 7 . Boil forceps. 8 . Replace articles.

24. Part preparation Asses the condition of the patient handwashing Introduce self identity Explain the procedure to the patient Maintain the privacy of the patient close door and curtain Take consent

25. Put Mackintosh on bed Put the gloves provide lithotomy position Hold the swabs With sponge holder and clean the genital area with antiseptic solution Wash the genital area with warm water

26. Use Razor to remove hair Clean with betadine swab Dry the area with towel Maintain privacy Discard all the articles Hand washing Record and reporting

27. Bibliography ✓ Essential of DC Dutta A text book of obstetrics 9Edition Published by jaypee brother ✓ Sandeep Kaur A Text book of midwifery and Obstetrical nursing Edition 1 published by Dr. Sunita Lawrence ✓ Kamin Rao The text book of midwifery and Obstetrical nursing ✓ https 11 www Mobile Slide share .com ✓ https 11 www web .com