Overview : The vulva is a part of the female reproductive system and is also part of the external genitalia. The vulva consists of labia minora, labia majora, mons pubis, clitoris, vestibular bulb, vulval vestibule, urinary meatus the vaginal opening, hymen, and Bartholin's glands. other parts of the vulva include sebaceous glands, urogenital triangle, and pudendal cleft. Pelvic floor muscles support the structures of the vulva and vulva including the entrance to the vagina. Vulva goes through changes during childhood, puberty, menopause, and post-menopause. Structure: A) Mons pubis: it is present in both sexes and act as a cushion during sexual intercourse and is more pronounced in female. the mons pubis is a soft fatty tissue at the front of the vulva in the pubic region covering the pubic bone. the lower part of the mons pubis is divided by a fissure called pudendal cleft. it separates mons pubis and labia majora, the mons pubis, and labia majora get covered by pubic hair at pu...
Perineal care also called peri-care or perineal genital care is a procedure involving washing of the perineal area with soap and water or by any commercially prepared peri-wash.
The perineal area is prone to infections as it is warm, moist, and not well ventilated.
In a normal person, a daily bath is enough to prevent any perineal infections but, in some cases, perineal care is required for a certain period of time.
What are indications of perineal care :
1)Postpartum females with repaired perineal tears.
2)Patients with genitourinary tract infections.
3) Patients recovering from surgeries of the genital region.
4) Patients suffering from incontinence.
5) Patients who are unable to do self-care.
Preparation of the patient :
Thoroughly wash your hands and medical gloves before you begin the procedure.
Explain the procedure to the patient and take the consent before starting the procedure.
Tell the patient to separate legs if the patient is unable to do that caregiver will need to offer some help. keep patients' bodies covered to prevent unnecessary exposure and to help promote a sense of dignity.
Assess the condition of the perineal skin look for any ulcers, itching, irritation, edema, discharge, etc.
One of the most important aspects of peri-care is checking for the signs of infections these include swelling, lesions, rashes, sores, and boils as these symptoms can lead to serious conditions if not diagnosed early and treated properly.
Assess the need and frequency of perineal care. ideally, perineal care should be done at least once a day.
Assess the patient's mental state to follow instructions.
Check for physician's orders for any specific instructions and maintain privacy and respect throughout the task.
Procedure :
A) Female :
1)Pour water over the perineal area to wash off any discharge.
2)Clean the area using a wet cloth
3)Perineal area should be cleaned in the following order :
a)Vulva
b)Labia- separate the labia and then inside of the labia should be cleaned on both sides first and then the outside of both the sides.
c)groin- rinse the cloth or use the new cloth, clean the groin from outside of the labia, and then going to the inside of the thighs.
4)then rinse the cloth or use the new cloth
5)Turn the person to the side and wash, rinse and dry the rectal area.
B) Male :
The first two steps are the same as female
Perineal area in males should be cleaned in the following order ;
a)Groin- wash the groin from front to back starting at the root of the penis and then going to the inside of the thighs.
b)Penis- rinse the cloth or use the new cloth. pull back the foreskin if the patient is not circumcised. wash and rinse the tip of the penis downward while using gentle and circular motions and finally clean the scrotum.
Turn the person on their side and wash rinse and dry the rectal area.
Significance of the perineal care :
Cleaning of the perineal area is very important as it is prone to infections. it should be cleaned at least once daily and in cases where the patient suffers from incontinence perineal care is needed at least twice a day.
Regular perineal care prevents urinary tract infections, genital infections and also minimizes odors. typical times of performing perineal care include as a part of the daily bathing, following episodes of incontinence, and after the use of the bedpan.
Special points to remember :
A)Maintain privacy and respect throughout the procedure.
B)Always be gentle as this area of the body is very sensitive.
C)After you complete the procedure make sure the area is dry as moisture can lead to bedsores.
D)Patients with dementia - dementia is a disease where patient losses his or her memory and may be confused speak calmly to such a patient. Be prepared as patients with dementia get agitated quickly.
Address the patient by name repeat your name often during the procedure to reduce confusion.
If a patient panics or becomes distressed stop immediately and find out the reason for the distress and try to calm the patient. In some cases, you may have to postpone the procedure to a later time.
E)As a caregiver you should be very comfortable while performing the procedure. Remember, the more comfortable and relaxed you are during the procedure the more comfortable patient will feel but if you perform perineal care awkwardly, your patient's discomfort will be amplified.
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