ESSAY In PERINEAL CARE

CASE SCENARIO:

A 32 year-old female client with G2P2 had delivered a live baby girl through normal spontaneous
delivery (NSD). She is on her first day post partum. In order to promote comfort and hygiene to the
client the nurse on duty will be giving her a penineal care as part of her morning routine. During the
procedure the nurse noticed her perineal pad is soaked with reddish vaginal discharge, with episiotomy
on left lateral side of the perineum, she regard these as normal findings because the client is on her Day
1 post partum.

Answer the following Questions and include its Rationale.

1. What is the importance in giving the perineal care to the client? Discuss
-The importance of perineal care is primarily to provide comfort and cleanliness to the client.
For example situation for female, new birth mother should be given a postpartum care after
excessive bleeding tendencies. It is nurse responsibility to provide cleanliness and provide
hygiene to the female patient by cleaning her perineal due to episiostomy created and the
secretions expelled in giving birth. In situations for male client that is self-care deficit due to
impaired physical mobility, we should maintain ADLs by providing them comfort, cleanliness and
hygiene despite of their health problems. Another thing that is important is to prevent infection
and other causative factors of formation of lesions in them. For applied situation, the female
client has secretions, this kind of environment will give opportunity to bacteria and other
microorganisms to proliferate and infect where some lesions may be formed. Another situation
is male is for example, a bed-ridden client with stroke that made him immobility. Perineal care
provide prevention of lesions by changing position frequently and cleaning the buttocks part
that are factors of lesions due to ineffective tissue perfusion and improper hygiene. Perineal
care also promote healing of wound as one of its purposes. For example, there are episiostomy
or other lesions cleaning the wound will help it to heal faster and applying other solutions
promoting repair of broken tissues. Also, perineal care is important as it provides preparation
for treatment and internal examination. For example, the female client after birth is required
for internal examination and internal visualization for further observations of OB physician.

2. What is Perilight and its indication?

Peri light or infrared lamp is a treatment used by application of heat to perineal area to provide comfort.
It helps stimulate blood circulation, and relieve edema and pain caused by episiostomy. It is indicated for
females with episiostomy, such as clients experiencing following circumstances: primigravidae as on
elective procedure, face to pubis delivery, narrow pelvic arch, delivering big baby, manipulative delivery
(breech, forceps), and fetal distress to ease the healing in this kind of wounds. It was said that
episiostomy is the cut in perineal part created by the physician to ease the delivery of the child.

3. What is/ are techniques in doing the perineal?

-Before doing the perineal, the nurse must introduce self and define what he/she gonna do by
defining its procedure and how they can cooperate in the said procedure this is to establish
rapport. Also, providing privacy is important by closing the door, providing bed screens, and
perform hand hygiene as aseptic technique to prevent infection and cross contamination. Then,
dorsal recumbent position in both female and male client and fold top linen to foot of bed and
drape the legs by tucking both corners of blanket under insides of legs. This is to ensure the
comfort and privacy to the client. Also, the bed pan will be then put in both male and female by
raising bottacks with one part of hand and other hand holding bed pan. The nurse then should
inspect the perineal parts if there are any lesions, redness, mucus and other possible condition
to assess. After such, will wash and dry upper and inner thighs as the procedure should go “from
cleanest to dirtiest”. For the washing perineal proper for female, we should pick the cotton ball
soaked in soap solution and clean vulva part using the “figure seven strokes”. It should be noted
that every single strokes done should discard the cotton ball soaked in soap solution. First F7
stroke will involve right lateral side of mons pubis, down to the labia majora then down to the
rectum. Second F7 stroke involve, nearer mons pubis, down to labia minora and down to the
rectum. Third stroke involve mons pubis, vaginal canal down to rectum. Other stroke specifically
the top to bottom straight stroke involve the labia minora near vaginal canal. Then the rectum
part should be in circular motion single.

For male, wash and dry penis using firm strokes that is from inner to outer down to the shaft as
doing top to bottom direction. Retract the prepuce/foreskin if the client is uncircumcised then
do the same stroke that is from inner to outer down to the shaft as doing top to bottom
direction. Single stroke is done for scrotum while still following cleanest to dirtiest procedure.
Since posterior scrotum is included in cleaning buttocks, then assist client in turning other side
to clean the posterior by single stroke on posterior scrotum and circular motion in rectum. After
such the nurse then record the time and procedure administer and take note of those
abnormalities observed.
4. What are the special considerations in giving perineal care.
The procedure should involve practicing of medical aseptic techniques and method of “from
cleanest to dirtiest”. As stated, the nurse should always consider hand hygiene prior, during and
after perineal care to maintain sterility, prevent cross contamination and infection. Also, when
lacerations and episiotomy observed, should clean the said area. Rationale behind it is undue
pressure on wounds is always avoided to prevent pain, discomfort and gapping of the wound.
Applying gentle friction should be also considered to remove lochia and bacteria lodged in
perineum. Placing sterile perineal pad after drying with dry and sterile cotton balls. Proper
disposal of used pads and other waste in yellow trash as it indicates infectious wastes. If
indicated should apply perineal heat before applying ointment or antiseptic soulution to aids in
prevention of transmission of diseases.