Definition
Genital care involves thorough cleansing of external genitalia and surrounding skin.
Purposes
- To promote patient’s comfort and cleanliness.
- To prevent infection in high-risk patients.
Indications
- Patients who are unable to do self-care.
- Patients with indwelling catheter.
- Patients with incontinence of urine or stool.
- Patients having excessive vaginal discharge.
- Patients recovering from rectal or genital surgery
- Following childbirth (postnatal care).
Articles
- Soap dish with soap
- Wash cloths (2 nos.)
- Bath towel
- Bath blanket/bed sheet
- Bedpan
- Disposable gloves
- Cotton swabs
- Kidney tray
- Toilet tissues or diaper wipes.
Procedure
| NURSING ACTION | RATIONALE | |
| 1. | Before procedure Explain the procedure and its purpose to patient. | Helps to minimize anxiety and embarrassment during procedure. |
| 2. | During procedure Wash hands and don clean gloves. | Prevents cross-infection. |
| 3. | Position patient with legs spread apart. | |
| 4. | Assess genitalia for signs of inflammation, skin breakdown, infection, or contamination with fecal matter. | Determines the extent of perineal care required by patient. |
| 5. | If fecal material is present, enclose in a fold of pad or toilet tissue and remove. With disposable wipes or tissue, cleanse buttocks and anus, washing from front to back. Cleanse, rinse, and dry area thoroughly. Remove and discard under pad and replace with a clean one. | Cleansing reduces transmission of microorganisms from anus to urethra or genitalia. |
| 6. | Change gloves, if they are soiled. | |
| 7. | Help patient to flex knees and spread legs apart. | Provides full exposure of genitalia. |
| 8. | Fold top linen down toward foot of bed and fold patient’s gown above genital area. | Draping prevents unnecessary exposure of body parts and maintains patient’s warmth and comfort during procedure. |
| 9. | Diamond drape patient by placing bath blanket/top sheet with one corner between patient’s legs, and another corner over patient’s chest. The two side comers should hang over sides of bed. Tuck side corner around patient’s legs and under hips. | |
| 10. | Raise side rails. Fill basin with warm water. | Prevents patient from falling. Use of warm water promotes comfort. |
| 11. | Place wash basin and toilet tissue on over-bed table and place wash clothes in basin. | Articles placed within reach of nurse prevents accidental spills. |
| 12. | A.Female genital care: Lower side rails and instruct patient to maintain dorsal recumbent position with knees flexed and legs apart. Note any restriction or limitation in positioning patient. | Provides full exposure of female genitalia. Minimize degree of abduction if position causes pain because of arthritis or reduced joint mobility. |
| Fold lower corner of bath blanket/sheet up between patient’s legs onto abdomen. Wash and dry the patient’s upper thighs. | Minimizes transmission of microbes. Keeping patient draped until procedure begins to minimize anxiety. Accumulated perineal secretions can soil surrounding skin surface. | |
| Wash labia majora while using nondominant hand to retract labia from thigh. With dominant hand, wash carefully in skin folds and wipe in direction from perineum to rectum. Repeat on opposite side using separate section of wash cloth. Rinse and dry area thoroughly. | Skin folds may contain body secretions which harbor microorganisms. Wiping from perineum to rectum reduces chances of transmitting fecal organisms to urinary meatus. | |
| Separate labia with nondominant hand to expose urethral meatus and vaginal orifice. With dominant hand, wash downward from pubic area toward rectum using separate quarters of wash cloth for each stroke. Clean the vulva and labia minora on both sides and inside of labia majora on both sides. | Cleansing method reduces transfer of microorganisms to urinary meatus (for menstruating women and patients with indwelling urinary catheter, cleanse with cotton balls). | |
| If patient can use bedpan, place bedpan and pour water over perineal area. Dry perineal area thoroughly with bath towel from front to back. | Rinsing removes soap and microorganisms more effectively than wiping. Retained moisture harbors microorganisms. | |
| Fold lower corner of bath blanket back between patient’s legs and over perineum. Ask patient to lower legs and assume comfortable position. | ||
| B. Male genital care: Lower side rails and assist patient to supine position. Note restriction in mobility, if any. | ||
| Fold top half of bath blanket/sheet down below the penis. Position gown to cover chest. Wash and dry patient’s upper thighs. | Minimizes transmission of microorganisms. Keeping patient draped until procedure begins to minimize anxiety. Accumulation of perineal secretions can soil surrounding skin surface. | |
| Gently raise penis and place bath towel underneath. Firmly Tov grasp shaft of penis, if patient is uncircumcised, retract foreskin. If patient has an erection, defer procedure until later. | Towel prevents moisture from collecting in inguinal area. Gentle but firm handling reduces chance of patient having an erection. Secretions capable of harboring microorganisms collect underneath foreskin. | |
| Wash top of penis at urethral meatus first using circular motion. Cleanse from meatus outward. Discard wash cloth and repeat with clean cloth until penis is clean. Rinse and dry gently. | Direction of cleaning moves from area of least contamination to area of most contamination. This prevents microorganisms from entering urethra. Tightening of foreskin around shaft of penis can cause local edema and discomfort. | |
| Return foreskin to its original position. | Vigorous massage of penis can lead to erection, which can embarrass patient and nurse. Underlying surface of penis may have greater accumulation of secretions. Abduction of legs provides easier access to scrotal tissues. | |
| Wash shaft of penis with gentle but firm downward strokes. Pay special attention to underlying surface of penis. Rinse and dry penis thoroughly. Instruct patient to spread legs apart slightly. | Pressure on scrotal tissues can cause pain. | |
| Gently cleanse scrotum. Lift it and wash underlying skin fold. Rinse and dry. | ||
| 13. | Fold bath blanket over patient’s perineum and assist patient in turning to side-lying position. | Draping promotes comfort and minimizes patient’s anxiety. Side-lying position provides access to anal area |
| 14. | If patient has urinary or bowel incontinence, apply thin layer of skin barrier containing petroleum jelly over skin. | Protects skin from excess moisture and irritants from urine or stool. |
| 15. | Apply under pads, if required. | Reduces risk of bed linen from getting soiled. |
| 16. | Remove gloves and dispose in proper receptacle. | Moisture and body secretions on gloves can harbor microorganisms. |
| 17. | Assist patient to comfortable position and cover him/her with top sheet. | |
| 18. | Remove bath blanket, dispose of all soiled bed linen, and return unused articles to storage area. | Reduces chances of transmitting microorganisms. |
| 19. | After procedure Record procedure and the presence of any abnormal finding, e.g. character and amount of discharge and condition of genitalia. | Provides documented evidence and communication among health team health team members. |
| 20. | Report any abnormality observed to nurse in charge and physician. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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