EXTERNAL DOUCHE

Definition: It is the washing of genitals and anal area with water, soap and/or
medicated solution.
Purposes:
1. To cleanse the area of secretion and excretions.
2. To reduce unpleasant odors.
3. To prevent skin irritation and excoriation.
4. To control the potential for infection.
5. To promote comfort.
Equipment:
1. Bedpan with cover.
2. Waterproof underpad.
3. Bath blanket (optional)
4. A tray containing the following:
a. Sterile covered flushing can with sterile water or solution to be used.
b. Sterile pick up forceps in a disinfectant solution.
c. A jar of dry sterile CB (optional).
d. A jar of sterile CB soaked in soap sud solution.
e. A jar of sterile CB soaked in antiseptic solution.
f. Kidney basin lined with paper for waste.
g. Toilet paper. (client’s supply)
h. A piece of paper to wrap vaginal pads.
i. Working forceps in a sterile pack
j. Working gloves (2 pairs)
k. Sterile bowl or sterile kidney basin
5. Adult diaper or sanitary pad (client’s supply; optional)
6. Perineal cream or lotion if needed

Procedure
Action Rationale
1. Assess the need for external douche.

2. Identify the patient and explain the Exchanging information allays fears and
procedure. promotes cooperation.

3. Wash your hands. Handwashing reduce the transient

microorganism thus, deters the spread to
client and self.

4. Assemble and bring equipment to Organization promotes efficient time

the bedside. management.

5. Screen the client and close the door/ This ensures the patient’s privacy.
windows if possible.
6. Raise the bed to working height.
7. Don gloves To protect the nurse from infection
8. Place waterproof pad, if available, as
well as change the top sheet with Cleansing may wet or soil an unprotected bed.
bath blanket if available.
9. Drape the client.
This provides warmth and respect the privacy
of the client.
10. Remove adult diaper/sanitary pad.
Roll with the contaminated inside
and wrap with a piece of paper.
Place it on the paper lining under the
bed.
11. Place the client on a bedpan in a
dorsal recumbent position. A bedpan will collect the water used during
perineal cleansing.
12. Change working gloves. Prepare
sterile pack. Open sterile bowl or
kidney basin. Place 7 or more CB
soaked in soap suds solution. Open
sterile working forceps and place it
on the sterile field with the handle at
the edge. Prepare tissue wipes at the
edge of the sterile field.

13. Lift the cover of the flushing can and

fold with sterile side inside. Test the To protect the inner side of the flushing can
from contamination. Testing the temperature
water temperature (105°F or 41°C)
of water prevents burns.
by pouring small amount of water
over the back of your hand and then
on the client’s thigh.
14. Flush the area with warm water or a
Water dissolves or dilutes dried secretions.
soapy solution until the area is clean.
Soap emulsifies fatty substances in the skin
15. With one cotton ball soaked in SSS, and reduces the ability of microbes to grow
wash the mons veneris in zigzag and multiply.
motion going upward toward the
lower portion of the hypogastrium.
16. Use a second cotton ball in SSS to
wash the inner aspect of the farther Thorough cleansing and care should be taken
thigh. Beginning in the crease of the to avoid introducing secretions and bacteria
groin and continuing outward toward into the opening through which urine is
the knee. These strokes are made release. Contamination of this area can lead to
with a back – and - forth motion and a urinary tract infection.
are carried well underneath the
thigh.
17. A third cotton ball in SSS is used to
wash the inner aspect of the nearer
thigh using similar stroke.
18. A fourth cotton ball in SSS is used to
wash the farther labia majora in a
downward stroke towards the groin.
19. Do the same on the other labia.
20. A sixth cotton ball in SSS is used to
wash, with one downward stroke,
from the clitoris, meatus, vaginal
opening to perineum.
21. The above step is repeated with a 7th
cotton ball in SSS, and to include the
anus.
22. Rinse with sterile water and pat dry
using toilet paper from front to back.
23. Remove the client from the bedpan. Moisture supports the growth of
Loosen the drape from the legs. Turn microorganisms and contributes to
to side and dry the buttocks. discomfort.

24. Apply lotion on the buttocks as An emollient helps to soothe excoriated

needed (optional). tissue.
25. Put on diaper or sanitary pad and or
underwear. Remove the waterproof
pad and replace the bath blanket
with topsheet. Make the patient
comfortable.
24. Bring equipment back to the utility Controlling the spread of pathogens is a
room and do the after care. primary principle of asepsis.

25. Remove gloves and wash your Handwashing deters the spread of
hands. microorganisms.

26. Document the performance of the Written information documents the

procedure, the objective and individualized care of the patient.
subjective findings and the patient’s
response.
 1
2 3

4 5

Legend:
1. mons 4. far labia
2. far leg 5. near labia
3. near leg 6. meatus to anus

Figure 2. Strokes Used in External Douche

SAMPLE DOCUMENTATION

Date Time Nurse’s Notes

4 – 28 – 2017 8:00 AM Perineal care provided. Moderate amount

of lochia rubra noted on perineal pad.Episiotomy wound and
perineum swollen.Bean-sized external
hemorrhoids noted. Verbalized feeling of
comfort after the procedure.

SAN PEDRO COLLEGE

 Davao City

PERFORMANCE CHECKLIST
EXTERNAL DOUCHE

Name__________________________________Grade:________________________
Year and Sec.: _________________ Date : ________________________

Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 –

Poor

Rating
5 4 3 2 1
1. Washes hands thoroughly.
2. Prepares equipment and adjusts bed to a comfortable
working height.
3. Brings preparation to the bedside. Identifies patient and
explains procedure.
4. Provides privacy to the patient. Positions the patient
supine.
5. Changes topsheet with bath blanket.
6. Places bed protector.
7. Drapes patient with bath blanket and exposes the
perineal area.
8. Places patient on bedpan in a dorsal recumbent position.
9. Tests temperature of the water (410C or 1050F).
10. Flushes the area with warm water.
11. Applies soap using CB soaked with soap sud solution
using zigzag motion starting from the mons pubis. Uses
one cotton ball on each stroke.
12. Applies another cotton ball on the far groin going up
using zigzag stroke. Uses the same stroke on the near
groin.
13. Separates labia and applies another CB on each labia
using gentle downward stroke.
14. Applies the 6th CB soaked in soap sud solution using
downward stroke from the clitoris, meatus, vaginal
opening and perineum. The stroke is repeated with the
last CB, including the anus.
15. Rinses the area well.
16. Dries area from top down using toilet paper.
17. Removes bedpan and turns client to side immediately.
Dries the buttocks with toilet paper.
18. Applies lotion as needed.
19. Removes bed protector by rolling it to the center.
20. Replaces blanket with topsheet and makes client
comfortable.
21. Examines the content of the bedpan and throws it into
the toilet bowl.
22. Brings equipment back to the utility room and does the
after care.
23. Removes gloves and washes hands.
24. Documents the procedure and other pertinent
observation.
25. Maintains body mechanics throughout the performance
of the procedures.
26. Manifests neatness in the performed procedure.
27. Receptive to criticisms.
28. Observes courtesy.
29. Shows calmness while performing the procedure.
30. Uses correct English.
31. Shows mastery of the procedure.

Remarks:

Criteria : I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date

DONNING and REMOVING STERILE GLOVES

(Open Glove Technique)

The sterile gloves provide a barrier between the nurse’s hands and the objects she
contacts. She is able to freely touch objects in a sterile field without fear of
contamination. When wearing sterile gloves, she should always remain conscious of
which objects are sterile and which are not.

Equipment:
A pair of sterile prepowdered gloves
Procedure

Action Rationale
To don gloves:

1. Perform thorough hand hygiene / Reduces number of microorganisms residing

scrub hands thoroughly. on surfaces of hands.

2. Remove carefully the outer package Prevents inner glove package from
wrapper by separately peeling apart accidentally opening and touching
the sides. contaminated objects.

3. Grasp inner package and lay it on a
clean flat surface just above waist
level. Open the package keeping the
gloves on the wrappers inside
surface.
Sterile objects held below your waist is
considered contaminated. Inner surface of
your glove package is considered sterile.

4. Identify right and left gloves. Each Proper identification of gloves prevents
glove has a cuff approximately 5 contamination by improper fit. Gloving of
cms. (2 inches) wide. Glove your dominant hand first improves your dexterity.
dominant hand first.

5. With thumb and first two fingers of Inner edge of cuff will lie against your skin
your non–dominant hand, grasp and that is not considered sterile.
edge of cuff of glove for dominant
hand. Touch only inside surface of
glove.

6. Carefully pull glove over your If glove’s outer surface touches your hand or
dominant hand, leaving a cuff and wrist, it is contaminated.
being sure that cuff does not roll up
to your wrist. Be sure that thumb
and fingers are in proper spaces.

7. With your gloved dominant hand, Cuff protects your gloved fingers. Sterile
slip your four fingers underneath touching sterile prevents glove contamination.
second glove’s cuff with the thumb
abducted.

8. Carefully pull second glove over Contact of gloved hand with exposed hand
your non–dominant hand. Do not results in contamination.
allow fingers and thumb of gloved
dominant hand to touch any part of
your exposed non dominant hand.

To remove gloves:
9. Use dominant hand to grasp the Contaminated area does not come in contact
opposite glove near cuff end on the with hands or waist.
outside exposed area. Remove it by
pulling it off, inserting it as it is
pulled, keeping the contaminated
area on the inside. Hold the
removed glove on the remaining
glove hand.

10. Slide fingers of ungloved hand

between the remaining glove and
wrist, remove it by pulling it off,
inverting as it is pulled keeping the
contaminated area on the inside and
securing the first glove inside the
second.
11. Discard gloves inside the wrapper Proper disposal reduces risk for infection,
into the appropriate container and transmission and contamination of othe items.
wash hands. Handwashing reduces the spread of
microorganism.

SAN PEDRO COLLEGE

Davao City

PERFORMANCE CHECKLIST
DONNING AND REMOVING STERILE GLOVES
Name:__________________________________ Grade: ___________________
Year and Sec.: _________________ Date : ___________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 –
Poor
 Rating
5 4 3 2 1
1. Washes hands.
2. Selects appropriate size of gloves.
3. Prepares adequate work area at waist height.
4. Opens wrapper correctly.
5. Places gloves with cuff end toward the body.
6. Grasps first glove touching inside only.
7. Turns to side of sterile field and pulls glove.
8. Lifts second glove by slipping gloved fingers under cuff.
9. Turns to side of sterile field and pulls glove on.
10. Unrolls cuff touching only outside of glove.
11. After use, removes gloves by turning them inside out
without touching outside surface with bare hands.
12. Drops used gloves onto wrapper.
13. Rolls gloves in wrapper and disposes them properly.
14. Maintains body mechanics throughout the
performance of the procedures.
15. Manifests neatness in the performed procedure.
16. Receptive to criticisms.
17. Observes courtesy.
18. Shows calmness while performing the procedure.
19. Uses correct English.
20. Shows mastery of the procedure.
Remarks:

Criteria : I Knowledge (quiz) 30%

II Performance 70%
100%
________________________________ __________________________
Student’s Signature Over Printed Name Date
________________________________ __________________________
Instructor’s Signature Over Printed Name Date