Please watch:

https://www.youtube.com/watch?v=6eGGq4fz8SE

COLLEGE OF NURSING
CLINICAL PERFORMANCE CHECKLIST
RETURN DEMONSTRATION
PERENIAL CARE FOR FEMALE

NAME:________________________________________ DATE: ______________

YEAR & SECTION: ____________ GROUP # ______________ RATING: ____________

REMARKS

1. Perform hand hygiene.

2. Knock on the door, introduce your name and purpose of the visit.
3. Identify patient using at least 2 identifiers: by checking the wrist band
and asking her name. Greet the patient at the time of the day, state
that you will be doing perennial care for her and ask if she is
amenable.
4. Inform patient that you will leave her for a while, to assemble supplies
and equipment to be used. Leave the call light to her, in case she
needs help while you are outside her room and assure her that you
will come back.
5. Wash hands and leave the room to prepare supplies needed.
6. Knock the door again. Inform patient that you already came back and
about to start.
7. To start with, prepare the following supplies to be needed in the
bedside table:
a. 2 protective barriers( 1 for bedside table/1 to be placed under the
buttocks)
b. Bath blanket
c. 6 washcloths
d. Soap
e. 2 pairs of gloves
f. Basin for lukewarm water
8. Provide privacy, make sure that the wheels are locked for safety, raise
the bed for the working level (waist level of nurse) and lower side rail
of the right side of the bed.
9. Put on your gloves.
10. Spread the bath blanket on top of the top sheet.
11. Instruct patient to hold the bath blanket so you can move/pull the top
sheet towards the foot of the bed.
12. If possible, instruct the patient that you will be needing her help
because you will be moving her towards you in 3 sections:
a. lift her torso towards you at the count of three
b. lift midsection at the count of three
c. move her legs at the count of three.

13. Raise the side rails up on the left side .Assist patient in assuming left
side lying position. Cross patient’s arms and legs. Inform the patient
that you will turn her over the left side at the count of 3. Patient can
hold on the left side rails for support
14. Place the bedside table near the patient’s bed at the right side.
15. Apply the protective pad 12-18 inches from the head part of the bed,
roll it up and tuck it under patients middle back to the thigh.
16. Return the patient’s position comfortably to lying position then arrange
the protective pad by pulling it on the left side of the bed
17. Get the basin with lukewarm water and let the patient to check the
temperature by soaking her hand in the basin for a while.
18. Bend the patient’s leg. Drape patient appropriately with bath blanket.
Fold outer corners of the blanket around patient’s thighs, lift lower tip
of blanket to expose perineum.
19. Expose the perineal area of the patient by also raising the patient’s
gown on the waist level
20. Get the first three wash cloths for the vagina area.
21. Fold the first wash cloth, fold it into four square method. Dip it in the
water add soap lather. You'll be using each different corner for a
different portion.
For the wash: Wash/wipe( top to bottom /down ward stroke) the left
side of the vagina, right side of the vagina, ,middle and retract the
labia majora with non dominant hand and wipe top to bottom . Soiled
wash cloth should be discard in the hamper.
22. For the rinse: Fold the second wash cloth, double dip it in the basin
with water (you can re-use the water in the basin) and fold it into four
square method. You'll be using each different corner for a different
portion: Lift the bath towel up. Rinse (top to bottom /down ward
stroke) the left side of the vagina and right side of the vagina ,middle.
Retract the labia majora with non- dominant hand and wipe top to
bottom . Soiled second wash cloth should be discard in the hamper.
23. Use the third wash cloth, by pat drying, start from the left side, to the
middle and right side of vagina.

24. Arrange patient’s leg back to a flat position. Raise side rail. Inform
patient that you will get fresh new luke warm water because you will
wash her buttocks region. Change the water. Remove gloves and
washed hands and wear new gloves.
25. After getting new fresh luke warm water, let the patient check the
temperature of the water.
26. Raise the side rails up on the left side .Assist patient in assuming left
side lying position and cross patients arms and legs. Inform the patient
that you will turn her over the left side at the count of 3. Patient can
hold on the side rails on the left side for support.
26. Drape the patient properly. Expose the buttocks area of the patient by
raising the patient’s gown on the middle back of the patient.
27. Get the next 3 washcloths
28. Fold the first wash cloth, fold it into four square method. Dip it in the
water add soap lather. You'll be using each different corner for a
different portion.
For the wash: Wash/wipe 9in a front to back style) the right side
/upper buttock, the left side/lower buttock ,middle and retract the
buttocks with non -dominant hand and wipe . Soiled wash cloth should
be discard in the hamper.
29. Fold the second wash cloth, fold it into four square method, double
dip it in the basin with water (you can re-use the water in the basin).
You'll be using each different corner for a different portion.
For the rinse: Wipe (in a front to back style) right side /upper buttock,
the left side/lower buttock ,middle and retract the buttocks with non-
dominant hand and wipe . Soiled wash cloth should be discarded in
the hamper
30. Use the third wash cloth, by pat drying starting from the right
side/upper, left side/lower and to the middle vagina.
31. Remove the protective barrier by instructing the patient to lift her
buttocks a little bit at the count of 3. Discard the disposable soiled
protective barrier in a trash.
32. Clean up all the supplies on the bedside table. Discard the soiled
disposable barrier from the bedside table.
33. Remove gloves and inform patient that you will wash your hands.
34. Assist patient to go back to lying position comfortably at the count of 3.
35. Return the patient’s top sheet/blanket by pulling it from the foot of the
bed up to the patient’s chest and instruct the patient to hold the top
sheet so that you can remove the bath blanket side wards.
36. Perform hand hygiene.
37. Ask patient’s level of comfort.
38. Place the call light within patient’s reach.
39. Raise side rail.
40. Adjust the level of the bed at its lowest level and lock the wheels.
41. Go to the foot of the bed, check the alignment of the bed and make
sure that the bedside table is within reach.
42. Inform patient that the procedure is done
43. Open the curtain
44. Wash your hands
45. Make a documentation.
REMARKS:

Correctly done ✓

NOT DONE- X

Incorrectly done-INC

SCORING:

Correctly done procedures = 100

1-2 Incorrectly done/ Not done step/s = 95
3-5 Incorrectly done/ Not done steps = 90
6-10 Incorrectly done/ Not done steps = 85
>10 Incorrectly done/ Not done steps = 75

COMMENTS/RECOMMENDATIONS:____________________________________________________
_____________________________________________________________________________________
____

_________________________________ _______________________________
Signature over Printed Name Signature over Printed Name
Clinical instructor Student

Ctto: https://www.youtube.com/watch?v=6eGGq4fz8SE