PERILIGHT EXPOSURE

Perineum is the anatomical region between the urethra, the tube

that carries urine from the bladder, and the anus. For women,
perineum involves the opening of the vagina. This region
undergoes a lot of stress and transition during pregnancy and
childbirth. Some women have a surgical cut called episiotomy
when they give birth to a baby. It is done to speed a delivery.
Thus, the perineum needs special treatment afterwards.

Most women after delivery or childbirth have difficulty in moving

around easily and comfortably. Healing process takes time and
helping them lessen the pain that they are having is very
important. One of this comfort measures that we can provide is the perilight exposure.

KEEP IN MIND
DEFINITION OF TERMS:

1. Perilight Exposure is the application of dry heat to perineal area in order to provide comfort and
increase blood circulation and hasten wound healing by means of perineal lamp.
- 20- 50 centimeters of 18 – 24 inches away from the body to be exposed.
2. Heat application – is a process of applying heat through radiation and convection.
3. Dry Heat – requires a higher temperature and a longer period of heating.
4. Moist heat – utilizes hot air that is heavily laden with water vapor.
5. Episiotomy – refers to an incision through the perineum that allows for less pressure on the fetal
head during delivery and prevents lacerations of the perineum.
6. Episiorraphy – operation for repairing the episiotomy
7. Perineorrhaphy – operation for repairing laceration of perineum usually following delivery.

PROCESS OF HEAT TRANSFER

1. Conduction
2. Convection
3. Radiation

PHYSIOLOGICAL RESPONSE TO HEAT

1. Vasodilation or increase in capillary surfaces

- Heat causes vasodilation and increases blood flow to the surfaced area bringing oxygen
nutrients, antibodies, and leukocytes.
2. Increase in capillary permeability
- Heat increases capillary permeability which allows extra cellular fluid and substances such as
plasma proteins to pass through the capillary walls and may result in edema or an increase in
pre-existing edema.
3. Increase blood flow
4. Increase cell metabolism
 5. Increase supply of nutrients
6. Increase removal of wastes
7. Relaxation of muscles
8. Softening of exudates
9. Increase peristalsis
10. Increase body temperature

VARIABLES THAT INFLUENCES THE EFFECTIVENESS OF HEAT

1. Individual tolerance
- Tolerance is influenced to some degree by age, condition of skin, the condition of nervous and
circulatory system. Young children, elderly clients, diabetic clients and individuals with
circulatory or sensory alterations have low tolerance for heat.
- The very young and the very old generally have the lowest tolerance. Persons who have
neurosensory impairments may have a high tolerance, but the risk of injury is greater.
2. General conditions of patient
- Shock or metabolic disorders such as diabetes increase the hazard of tissue damage. Impaired
perception because of individual’s level of consciousness, medications and mental impairment
may make it difficult to determine patient’s response to end potential damage from application
of heat.
3. Intactness of the skin
- Injures skin areas are more sensitive to temperature variations whether the heat is moist or dry
- Moist heat penetrates more deeply than dry heat because water is a good conductor of heat.
Application of moist heat should be a lower temperature than applications of dry heat.
4. Size of skin area to be treated
- The greater the body area to be treated, the lower the temperature should be.
5. Environmental temperature
- In warm or in humid environment, heat can’t be dissipated through evaporation to some
degrees that it can dry or cool circumstances.
6. Length of Exposure
- People feel hot applications most while the temperature is changing. After a period of time,
tolerance increases.

IMPORTANCE OF PERILIGHT EXPOSURE

1. Relief of pain and muscular spasm

2. Increases blood circulation
3. Hastens wound healing following an episiotomy repair
4. Reduces edema and soreness

INDICATIONS

➢ Patients who have undergone rectal or perineal surgery

➢ Postpartum patients with episiotomy wounds
➢ Patients having vaginal inflammation or bladder spasm

CONTRAINDICATIONS:

➢ Patients with hemorrhage

➢ Mother who had undergone CS delivery
➢ Multiparity with wound
 ➢ Before 24 hours of postpartum

GUIDELINES:

Explain procedure.
Instruct patient to do perineal flushing before perilight exposure
Check the equipment for any defects
Handle equipment with dry hands especially when you’re about to plug it.
Provide privacy during procedure
During exposure, keep lamp 20- 50 cm away from perineum
Heat lamp should be left in place for 15 minutes then removed
Perilight exposure process should be repeated 3 – 4 times a day
Washable parts of lamp should be wiped with antiseptic solutions before it is returned to storage
area, or used with another patient

ENEMA

DEFINITION: Enema is the instillation of a solution into the rectum and sigmoid colon.

PURPOSE:

1. Promote defecation by stimulating peristalsis.

2. To empty the bowel before diagnostic test, surgery (e.g. Cesarean Section) or childbirth.

TYPES OF ENEMA:

1. Cleansing
2. Retention
3. Return Flow
4. Carminative enema

SPECIAL CONSIDERATION:

1. Know the purpose for which the enema has been ordered.
2. Give the enema with the patient in bed, not sitting on a commode or toilet bowl.
3. Make sure that the patient is in a relaxed and comfortable position.
4. Avoid stimulating defecation while solution is being introduced by:
a. Keeping out of sight factors that may stimulate peristalsis.
b. Introducing the solution slowly and gently.
c. Maintaining a more or less even or same pressure.
5. When dealing with abdominal surgery, exercise special care to avoid increasing distension.
6. See to it that most of the solutions introduced are expelled
7. If the patient is weak or has a cardiac condition, do not leave the patient alone.
8. Ensure privacy.

PREPARE EQUIPMENT:
➢ Disposable gloves
➢ Water-soluble lubricant
➢ Bath blanket
➢ Toilet tissue
➢ Bedpan, bedside commode, or access to toilet
➢ Intravenous pole
➢ Enema bag administration.

Must Remember before doing the procedure:

1. The patient should be encouraged to empty both bladder and bowels before the procedure.
2. Before administering an enema, ensure the patient’s privacy by closing the door of the room.
3. Have the patient undress completely from the waist.
4. Position the patient on the bed on her left side with the top knee bent and pulled slightly
upward toward the chin.
 PROCEDURE RATIONALE
1. Defines perineal Care. A procedure that involves cleansing of the vulva, the
perineum and the anal regions.

2. States the indications of the procedure. 1. Who are unable to do self care
2. Patients with genito-urinary tract infections
3. With fecal & urinary incontinence
4. An Indwelling foley catheter
5. Who are recovering from rectal or genital surgery or
childbirth
6. Patients with excessive vaginal drainage
7. Patients with injury and ulcers
8. Uncircumcised males
9. Morbid obesity
3. States correctly the purpose in doing the It is a means to prevent infection, promote healing of the
procedure. stitched perineum and make the patient comfortable.
4. Observe pre-cautionary 1. Provide privacy to the patient.
measures/considerations in perineal 2. Use the one swab for each stroke from upward to
flushing. downward.
3. Observe the patient for discomfort during procedure.
4. Discard all the swabs and pad in the paper bag or dust
bin.
5. Used mild antiseptic solution or plain warm water for
perineal care.

5. Explain the procedure to the patient. To gain confidence and cooperation of the patient
6. Washes hand before starting the To avoid spread of microorganisms
procedure.
7. Gathers the equipment needed. To avoid leaving patient unattended to retrieve missing
equipment
Materials needed are:
• handwashing kit
• gloves
• bedpan
• forceps
• rubbersheet
• pitcher
• sterile solutions
• disposable containers
• dry cotton balls
• cotton ball with betadine solution
8. Provides privacy, places patient in a To provide privacy and comfort
dorsal recumbent position & drapes
patient properly.
9. Put the rubber sheet. To protect the linens
10. Raises the buttocks with one hand while To provide assistance and prevents discomfort
the other hand, places bed pan.
11. Pours water gently over the vulva.
12. Clean the vulva with cotton balls soaked cleaning from front to back reduces chance of transmitting
in a soap solution, using figure 7 starting fecal organisms to urinary meatus.
 from the mons pubis passing through the
center going down the anus.
13. Discard each cotton ball after single use
carefully & thoroughly.
14. Rinses the perineal region with warm
water.
15. Dries the area with cotton balls properly. Retained moisture harbors microorganisms
16. Removes bedpan & discards used cotton
balls properly.
17. Makes patient comfortable by changing
patient’s clothes and beddings.
18. Provides after care of equipment.
19. Washes hands thoroughly.
20. Chart or record any pertinent
information.