providing incontinence care

Assessment
Assess the patient's ability to perform perineal care
Assess for the presence of irritation, excoriation, inflammation and swelling

Planning
Perform hand hygiene
Prepare necessary equipments:

• commercially prepared package washcloth/moistened cotton wool pads
• incontinent sheets
• napkin
• clean linens: gown/pyjamas, bath blanket, top and bottom sheets, draw sheet
• clean gloves
• linen hamper
• ZnO cream
• disposable plastic bag or receptacle

Implementation

Gather equipment and bring to client's bedside

Identify the patient

Explain the procedure and gain cooperation

Provide privacy

Perform hand hygiene and adopt other appropriate infection control precautions

One nurse works on one side of the bed and the second nurse on the other side

Prepare the bed, and position the client appropriately

• raise bed to comfortable working height. Lower side rails
• remove top linens. If the linens are reused, place them on the bedside table/chair
• assist client in a dorsal recumbent position (lying down/legs flex)

The other nurse works on the opposite side.

Don gloves

Loosen pants or gown

• keep client covered by bath blanket if desired
• expose perineum

Observe skin condition for any presence of irritation, excoriation, inflammation and swelling. 

Place incontinent sheet under the buttock

Clean the soiled area by cleansing from tip of penis down to shaft. Pay attention to the gluteal folds, scrotal folds.

Cleansed tip of penis at urethral meatus using circular motion. Then cleanse shaft of the penis and scrotum. Cleansed the scrotum and the underlying skinfolds carefully

Use a clean washcloth for each area of the perineum in order to prevent cross contamination

Roll up the front side of the napkin

Pull or roll the client to the lateral position

Thoroughly clean up the fecal elimination with cotton swaps and thoroughly dry the area

Apply protective skin barrier cream if indicated.

Remove and discard the gloves and wash the hands

Change the draw sheet or the linen if soiled

Put the new napkin in correct position

Lie flat the client and adjust the position of the napkin

(Avoid any shearing force, roll the client back and forth if need to adjust the position of the napkin)