EXPLAIN THE PRINCIPLES INVLOVED IN PERINEAL CARE AND PERILITE

EXPOSURE

WHY IS PERI-CARE IMPORTANT

Peri-care -- also known as perineal care -- involves cleaning the private areas of a patient. Because this
area is prone to infection, it must be cleaned at least daily, and more if your loved one suffers from
incontinence. Typical times to perform peri-care include as part of daily bathing, after the use of the
bedpan, and following episodes of incontinence.
Regular peri-care can not only minimize odors, it can also can help prevent urinary tract, bladder and
kidney infections.

Principle in peri-care:

1. Clean the perenium from the cleanest to the less clean area.
2. Ensure patient privacy.
3. Wipe from front to back (vagina toward rectum) on female patients to avoid contaminating the vagina
or urethral meatus.
4. Do not use the same washcloth for any other portion of the patient's bath.

IMPORTANCE OF PERILITE EXPOSURE

1. Relief of pain and muscular spasm

2. -provides comfort by relief pain
3. -it relaxes muscles and capillaries making pain tolerable
4. Increases blood circulation
5. Hastens wound healing following an episiotomy repair
6. -increases circulation of blood
7. -increases supply of oxygen and nutrient which promotes wound healing
8. Reduces edema and soreness
9. -it releases dry heat and thus help reduce edema and soreness
10. -alleviated by relax muscles and capillaries

Principles in Perilite Exposure:

1. HUMAN ANATOMY AND PHYSIOLOGY

- through blood vessels and nerves, skin and connections they make with nerves and blood vessels of
body, practically all parts of body maybe influenced by application of heat to skin.
2. MICROBIOLOGY
- the application of heat to open wounds of lesions may rapture demands a sterile technique.
3. BODY MECHANICS
- position of mother is dorsal recumbent with legs and knees flexed to allow proper exposure of area to be
treated
4. PHYSICS
- application of heat employs physical agents: heat, water and light. Heat maybe transferred from one
place to another by radiation (perilite exposure) and convection (hot sitz) bath.
5. PSYCHOLOGY
- nurse explains purpose of treatment in order to gain cooperation.
6. SOCIOLOGY
- the patient needs to cooperate with nurse in order for treatment to be effective and to add patients early
recovery.

NURSING RESPONSIBILITIES BEFORE, DURING AND AFTER PERINEAL CARE

AND PERILITE EXPOSURE

PERINEAL CARE

BEFORE
1. Explain procedure to the patient.
2. Provide privacy by screens and drapes. Drape the patient as for vaginal examination.
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.

DURING
1. Provide privacy.
2. Client should be in back-lying or side-lying position; place towel or bedpan under hips.
3. Fill basin with warm water.
4. Cover client with a towel or sheet.
5. Expose perineal area. Using a circular motion, gently wash the penis by lifting it and cleaning from
the tip downward. Rinse and dry.
6. Wash and rinse the scrotum.
7. Wash and rinse other skin areas between the legs.
8. Wash and rinse the anal area.
9. Pat the peri area dry.
10. May apply a light dusting of powder under scrotum to prevent rubbing on skin (optional) as per
service plan.
11. Remove towel or sheet.
12. Remove and dispose of gloves.
13. Remove, clean, and store equipment.

AFTER
1. Wash hands.
2. Make the client comfortable.
3. Record observations and report anything unusual to nurse/supervisor.

PERILITE EXPOSURE

BEFORE:
• Check the client’s condition before applying the procedure.
• Check all electrical equipment for defects or try to switch it on and off.
• Always handle equipment with dry hands
• Check physicians order for each area to be treated and duration of therapy
• Do perineal flushing

DURING:
• Position client comfortably with only area where heat is to be applied
• Position lamp at a safe distance from where it is to be applied
• Inspect skin and see to it that its clean and dry before applying heat
• Place bed cover over lamp but not allowing bed sheet to touch the light bulb
• Check skin every 5 minutes interval throughout duration of procedure
• Monitor any untoward response
• Perilite exposure should be given 24 hours after delivery
• Place bed cover after pulling lamp and provide privacy
• Position lamp at 18-24 inches away from the body part to be exposed.

AFTER:
• Assist the client
• Do after care
• Monitor clients response
• Do recording; record on patients chart
- time when it started
- patients reaction
- condition of perineum
- inspect sutures and episiotomy after procedure
• Inspect condition of part being treated

DEMONSTRATE THE BEGINNING SKILLS IN PERINEAL CARE (MALE AND FEMALE)

AND PERILITE EXPOSURE

PERINEAL

STEPS
1. Identify clients at risk for developing infection of genetalia, urinary tract, or reproductive tract.
2. Assess client’s cognitive, visual, and musculoskeletal function and activity tolerance.
3. Apply clean gloves, and assess genitalia for signs of imflammation, skin breakdown, or infection.
Discard gloves and perform hand hygiene.
4. Asses clients knowledge of importance of perineal hygiene
5. Explain procedure and its purpose to client.
6. Prepare necessary equipment and supplies.
7. Pull curtain around client’s bed, or close room door.
8. Raise bed to comfortable working position.
9. Apply clean gloves
10. If fecal material is present, enclose in a fold of underpad or toilet tissue, and remove with
disposable wipes or tissue. Cleanse buttocks and anus, washing front to back.
11. If gloves are soiled, perform hand hygiene and apply new gloves
12. Fold top bed linen down toward foot of bed, and raise clients gown above genital area.
13. Raise side rail. Fill washbasin with warm water.
14. Place washbasin and toilet tissue on over-bed table. Place wash cloths in basin.
15. Provide perineal care.
16. If client has had urinary ir bowel incontinence, apply thin layer of skin barrier containing
petrolatum or zinc oxide over anus and perineal skin.
17. Remove clean gloves, dispose in proper receptacle, and perform hand hygiene.
18. Assist client in assuming a comfortable position, cover with sheet.
19. Remove bath blanket, and dispose all soiled linens
20. Inspect surface of external genitalia and surrounding skin after cleansing.
21. Ask if client feels sense of cleanliness.
22. Observe for abnormal drainage or discharge from genitalia.

FEMALE
1. Assess client to dorsal recumbent position
2. Lower side rail, help client flex knees and spread legs.
3. Fold lower corner of bath blanket up between clients legs onto abdomen. Wash and dry clients
upper thighs.
4. Wash labia majora. Use non dominant hand to gently retract labia from thighs; with dominant
hand, wash carefully in skin folds. Wipe in direction from perinuem to rectum (front to back).
Repeat on opposite side with different washcloth. Rinse and dry area thoroughly.
5. Separate labia with nondominant hand to exposure urethral meatus and vaginal orifice. With
dominant hand, wash downward from pubic area toward rectum in one smooth stroke. Cleanse
thoroughly around labia minora, clitoris, and vaginal orifice.
6. If client uses bedpan, pour warm water over perineal area. Dry perineal area thoroughly, using
front to back method.
7. Fold lower corner of bath blanket back between clients legs and over perineum. Assist client to
lower legs and assume comfortable position.

MALE
1. Lower side rails, and assist client to supine position.
2. Fold lower corner of bath blanket up between client’s legs onto abdomen. Wash and dry clients
upper thighs.
3. Gently raise penis, and place bath towel underneath. Gently grasp shaft of penis. If client is
uncircumcised, retract foreskin. If client has erection, defer procedure until later.
4. Wash tip of penis at urethral meatus first. In a circular motion, cleanse from meatus outward.
5. Return foreskin to its natural position.
6. Wash shaft of penis with gentle but firm downward strokes. Pay attention to undelying surface of
penis.
7. Gently cleanse scrotum. Lift it carefully, and wash underlying skin folds. Rinse and dry.
8. Fold bath blanket back over clients perinuem and assist client turning to side lying position.

UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS

1. Skills and genitalia are inflamed, with localized tenderness, swelling, and presence of foul
smelling discharge.
a. Bath area frequently
b. Obtain order of sitz bath
c. Apply protective barrier
d. Notify health care provider

2. Client expresses discomfort

a. Increase frequency of perineal care correctly
b. Asses perineum for signs if irritation or discharge

3. Client unable to perform perineal care correctly

a. Review perineal
b. Position client and have client observe cleansing procedure