EXTERNAL DOUCHES

OR PERINEAL CARE
DEFINITION:

- the washing of the perineal area

with warm water.
PURPOSES
1.To cleanse the perineum in the following:
- after bowel or bladder elimination
- prior to any vaginal examination or
treatment.
2. To prevent perineal wound infection and
unpleasant odor.
3. To provide for personal cleanliness and
comfort.
4. To remove normal perineal secretions and
others
ASSESSMENT

• Assess for the presence of:

• Irritation, excoriation, inflammation
• Excessive discharge
• Odor, pain or discomfort
• Urinary or fecal incontinence
• Recent rectal or perineal surgery
• Indwelling catheter
SPECIAL
CONSIDERATIONS
• 1. Use the right temperature of the
flushing water to avoid injury to
the patient.-(43 -46 degree
Celsius/110-115 F)
• 2. Observe special care in order to
avoid discomfort when a patient
has perineal wound or stitches
• 3. Drape patient properly to avoid
unnecessary exposure
4. Observe aseptic technique.

5. If the patient defecated, empty the

bedpan first before giving perineal
flushing.
PATIENT AND UNIT

• 1. Screen the patient

• 2. Request the companion to leave the
room
• 3. Remove the perineal pad if any and
wrap it with paper.
 Male
Perineal
Flushing
Washes the perineal area.
1. Prepare materials needed:
a. bedpan
b. flushing tray with the ff:
- clean gloves
- jar of cotton balls
- flushing pitcher with tepid water
- emesis basin lined with paper
- pick-up forcep soak in antiseptic
solution
- flushing pitcher with soap solution
• - rubber protector
2. Place the rubber protector.

R- Rubber protector protects the beddings.

3. Does the diamond draping then place the

bedpan.

R- to provide privacy to the client

4. Gently raise and grasp shaft of the
penis.
5. Cleanse the shaft of the penis with
gentle but firm downward strokes.
Rinse and dry thoroughly.
R-Handling the penis firmly may prevent an
erection
6 If circumcised retract the foreskin.
R- Retracting the foreskin is necessary to
remove the smegma that collects under the
foreskin and facilitates bacterial growth
7. Wash the tip of penis and urethral
meatus first after circular motion.
Cleanse from meatus onward. Rinse
and dry gently. Return foreskin to
its natural position.
R- Replacing foreskin prevents constriction
of the penis, which may cause edema
8. Instruct the patient to spread legs apart to
expose the scrotum. Cleanse it.
9. Lift it carefully and wash underlying
skinfold. Rinse and dry.
R-The scrotum tends to be more soiled than
the penis because of its proximity to the
rectum; thus it is usually cleaned after the
penis
10. Remove the bedpan. Put on a clean gown.
11. Position the client.
12. Evaluates patient’s reaction.
13. Discard dirty linens into a hamper
and return used articles.
14. Document any unusual findings
such as redness, skin breakdown,
discharge or drainage and may
localized areas of tenderness
 FEMALE
PERINEAL
FLUSHING
 Washes the perineal area.
1. Prepares materials needed
a.1. bedpan
b.2. flushing tray jar of cotton balls
c.3. flushing pitcher with tepid water
d.4. emesis basin lined with paper
e.5. pick-up forcep soak in antiseptic
solution
f.6. flushing pitcher with soap
solution
g.7. rubber protector
h.8. clean gloves
2. Position the female in the back lying
position and knees slightly flexed and
hips slightly external rotated.
3. Put on gloves. Inspect the perineal
areas of inflammation especially
between the labia.
-Also note excessive discharge or
secretions from the orifices and the
presence of odors
4. Places the rubber protector.

5. Does the diamond draping then place the

bedpan.

6. Pour water over the vulva.

6. Gets the forceps and starts cleaning
the area with cotton balls with soap
in gentle downward strokes from top
to bottom or applies seven strokes in
cleaning.
R- Downward stroke prevents
the spread of organisms from
a more contaminated area to
a less contaminated area
6. Rinse the vulva by pouring water.

7. Dries gently repeating same stroke.

• R- to keep the patient dry and
comfortable
8. Remove the bedpan. Put on a
clean gown, comb hair.
9. Apply medications as
ordered/Place perineal pad as
needed
R- Medication promotes
healing/Perineal pad
absorbs discharges
10.Position the client.
11. Evaluates patient’s
reaction.

12. Discard dirty linens into a

hamper and return used
articles.
HYGIENIC MEASURES

Because of the varying needs of

clients, many different baths are
involved when giving direct care,
including the complete bed bath,
partial bed bath, tub bath, shower,
lotion bath, towel bath and
therapeutic bath. Although
techniques may vary, certain
principles are basic to giving any
type of bath:
1. The type of bath must be in
accordance with the clients’
tolerance for energy
expenditure
2. The client who has limited
energy to spend may need to
be bathed in stages to allow
for rest periods; bed making
can also be performed after
the rest period
3. The client must be protected
from falls.
4. The client must be protected
from burning or an
uncomfortably hot or cool water
temperature.
5. The client must not become
chilled.
6. All body areas must be
cleansed
7. Wet skin should be patted dry.

8. All aspects of the procedure

should incorporate the
principles of medical asepsis.
HYGIENIC BATH (BED
BATH)
Definition: It is a bath given to a
patient in the bed.

Purposes:
1. To cleanse, refresh, and give
comfort to patient who must
remain in bed
2. To stimulate circulation and
aid in elimination.
3. To provice for a opportunity to
inspect the patients’ body for
any signs of abnormality.
4. To help the patient have some
form of movement and exercise.
5. To provide an opportunity for a
nurse-patient interaction
Special Considerations:
1. Avoid unnecessary exposure
and chilling.
a.) Expose, wash, rinse and dry
only a part of the body at one
time.
b.) Avoid draft.
c.) Use correct temperature of
water.
2. Observe the patient’s body
closely for physical signs such
as: rashes, swelling,
discolorations, pressure sores,
burns, abnormal discharges,
body line, etc.
3. Give special attention to the
following body areas: behind the
ears, axilla, under the breasts.
Umbilicus, pubic region, groin
and spaces between the fingers
and toes.
4. Do the bath quickly but
unhurriedly, and use even,
smooth but firm strokes.
5. Use adequate amount of water
and change as frequently as
necessary.
6. If possible, do such procedures
as vaginal douche, enema
shampoo, oral care, etc., before
the bath.
THERAPEUTIC BATHS

A therapeutic bath is done to produce

a specific effect. It consist of
emmersing the entire body or a part
of it in water or wetting the body
surface with the use of washcloth or
a sponge. The desired effect defends
upon the temperature of water and
on medications added.
The Cold or Tepid
Sponge Bath
Definition: It is a type of
therapeutic bath done by
sponging the body with wash
cloth wrung from cold or tepid
water.
Purposes:
1. Avoid chilling by:
a) Providing adequate cover during
the procedure
b) Avoiding draft
c) Placing a hot water bag over the
feet
2. Minimize patient’s movement.
3. Avoid producing friction. Use long
light strokes in sponging and drying
body parts. Do not rob or pat.
4. Be sure that there are two or
more washcloths.
5. Keep the washcloths
adequately saturated and
sponge each body area two or
three times.
6. Be sure that there is an ice cap
over the head at the start of the
procedure.
7. For maximum effectiveness
a) Make the bath last 25-30
minutes, using the correct
technique.
b) Keep saturated washcloth
over the axillary and inguinal
areas.
8. Take temperature before and
thirty minutes after the
procedure.
Alcohol Sponge Bath

Definition: It is a type of
therapeutic bath which consists
in sponging the body with
washcloths wrung from a
mixture of alcohol and ordinary
water. The proportion is one
part alcohol to 3 parts water if
the stock of alcohol is 70%.
Purpose
• To reduce body temperature
• To refresh the patient thereby
promoting comfort

Special Consideration:
Same as in Cold or Tepid Bath.
Technique:
• The technique is the same as in
Tepid Bath
• Alcohol is added to the water
after sponging the face.
Hip or Sithz Bath

Definition: A therapeutic bath

which consists in the immersion
of the pelvic region and the
upper thighs in the tub of hot
water.
Purposes:
1. To minimize congestion and
pain in the pelvic region.
2. To relieve pain and hasten
healing after the
hemorrhoidectomy.
3. To induce urination in same
cases of urinary retention.
4. To produce muscular
relaxation.
Special Considerations:
1. Be sure that there is a written
order from the physician.

Follow the prescribed duration

but discontinue if the patient
shows any signs of untoward
reaction.
2. Check the patient’s pulse and
respiratory rate before and
during the treatment.
3. Protect the patient from
chilling by:
a) Avoiding draft.
b) Cover the patient adequately
during the procedure.
c) Maintain the correct
temperature of the water 110-
115°F
4. Remove dressing of the post-
hemorrhoidectomy patient before
emersion and redress the wound
after the procedure.
5. Let that patient void before the
procedure.
6. Keep the patient comfortable
throughout the procedure:
a) Place the rubber ring on the tub if
patient has perineal wound (as in
hemorrhoidectomy)
b) Line the rim of the tub with towel.
Bed Bath and Perineal Flushing
(procedures)
1. Explains the procedure to the client.
2. Prepares the materials needed for the
procedure as follows:
• 1 basin with ½ - 2/3 full of comfortably
warm water
• 1 basin of extra water
• Soap and soap dish
• Linens, bath blanket, bath towels,
washcloth, clean gown
• Gloves
• Personal hygiene articles (deodorant,
powder and lotion)
• Shaving equipment
• Table for bathing equipment
• Laundry hamper
3. Prepares environment and
provide privacy.
4. Washes hands and wear gloves.
5. Loosens linens, place blankets,
removes patient gown and top
sheet.
6. Wet washcloth and squeeze out
excess water. Wrap it around
the palm and fingers to form a
mitten then apply soap. Spread
a towel across the patient’s
chest.
7. Use separate cover of the
wash cloth for each eye wiping
from the inner to outer canthus.
Bath face, neck and ears using
circular strokes, rinse and path
it dry.
8. Spreads towel lengthwise
under the farther arm. Wash the
arm, forearms and axilla using
firm strokes in distal to
proximal direction. Rinse and
pat it dry.
9. Washes the chest, abdomen,
beneath the breast and
umbilicus. Rinse and pat it
dry.
10. Turns the patient back to
dorsal position. Wash the
back, buttocks using long firm
strokes, rinse and pat it dry.
Rub with lotion followed by
powder.
• THANK YOU……