DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City

Nursing Program
PROGRESS REPORT FOR RELATED RETURN
DEMONSTRATION NRG 203 LEVEL 2 (CMO # 15)
PERINEAL FLUSHING
NAME :
GRP NO. Year & Sec. Final Grade :

CI's Rating
5 4 3 2 1
1. Prepares all the needed materials. Washes hands.
2. Explains the treatment to the patient.
3. Screens the patient or locks the door of patient's room.

4. Positions the patient on a dorsal recumbent. Puts patient on bedpan.

5. Drapes the patient, exposing only the parts to be cleansed.

6. Flush the perineal area with water.

7. Gets cotton balls soaked in a cleansing solution using pick up forceps.

8. Cleanses external genitalia starting from midline of symphisis pubis down to

the anus. Never retrace a stroke.
9. With the second cotton ball cleans starting from mons pubis in figure of 7 by way
of external labium towards the anus. Discard.
10. Do likewise on the opposite side with the next cotton ball.
11. With the fourth cotton ball cleans starting from mons pubis in figure of 7 by way of
external labium towards the anus. Discard.
12. Do likewise on the opposite side with the next cotton ball.
13. With another cotton ball, cleans groin starting from groin going up the thigh.
Use other side of the same cotton ball for near groin. TOTAL

1 OF 2
 CI's Rating
5 4 3 2 1
14. Flush the perineum thoroughly with sterile warm water.
15. Using dry cotton ball, dries the perineum with the same stroke as above.

16. Remove the bedpan gently and turn the patient to side.

17. If necessary, takes one cotton ball and cleans one side of the buttocks. Then cleans
the other side of buttocks and dry both buttocks.
18. Turns patient on her back and make her comfortable.
19. Sprays with antiseptic as needed.
20. Puts the perineal pad with an updown motion,as needed
21. Does after care of the materials used.

22. Records the treatment done to patient and discharges observed.

TOTAL

Student's Comments : CI's Comments:

Student's Signature CI's Signature

LCM RLES/08.03.21 2 OF 2
 DAVAO DOCTORS COLLEGE
Gen. Malvar St., Davao City
COLLEGE OF NURSING

NUMERAL RATING DESCRIPTIVE EQUIVALENT VERBAL INTERPRETATION

5 Outstanding (O) Demonstrates exceptional performance
and mastery of the procedure

4 Very Satisfactory (VS) Exceeds the expected output/

performance of the procedure

Able to state & demonstrate the

step by step procedure but failed
to mention rationale

3 Satisfactory (S) Meets the standards or basic

requirements of the procedure

Misses some steps and rationale

of the procedure

2 Fair (F) Barely meets the requirements

of the performance of the procedure

1 Unsatisfactory (U) Fails to meet the requirements of the

performance of the procedure

Misses most of the steps, without rationale

LGM/Asst.Dean/RLELS/rico6.20.07 2 of 2