Checking perineum during assessments?

camay1221_RN · Mar 12, 2005

I just finsihed my practicum on PP. My questions is that I did not see any of the nurses actually view the perineum when doing their initial assessment. They stated they do not look unless the patient has a 3 or 4th degree or unless the patient is c/o of discomfort on her bottom. I would think you would check regardless to see if there is excessive swelling, bleeding or hematoma. What does everyone else do? Thanks for the help since I will be going into this feild after graduating in April

I only checked the perineum within the first 24 hours unless the pt was c/o a problem. If a pt had a hematoma, she would have let you know just by the amount of pain she was in.

Leda · Mar 12, 2005

I have always checked the perineum of all PP patients during their hospital stay. Over the last 30 years I have discovered many interesting things, such as undiagnosed/undocumented herpes, condyloma, lice, hematomas, significant painful hemorrhoids, etc. In addition to checking the condition of the perineal area it gives you an opportunity to evaluate the lochia, note any signs of infection, and evaluate their self-peri care.

In my experience the extra minute of assessing is well worth it.

Fiona59 · Mar 12, 2005

We checked q shift, with each patient assessment, and trust me our patients let us know if the previous shift hadn't done it.... If the woman refused, we explained why we were doing it and if she still refused we charted it. Better safe than sorry was our units approach...

BETSRN · Mar 13, 2005

I just finsihed my practicum on PP. My questions is that I did not see any of the nurses actually view the perineum when doing their initial assessment. They stated they do not look unless the patient has a 3 or 4th degree or unless the patient is c/o of discomfort on her bottom. I would think you would check regardless to see if there is excessive swelling, bleeding or hematoma. What does everyone else do? Thanks for the help since I will be going into this feild after graduating in April [/QUO
I think each case is different. If the mom has an intact perineum, is dressed and someone has checked her within the last shift, and she has no complaints, I do not check her perineum. A hematoma will be very painful. If there are stitches or excessive swelling, or major complaints, I always check.

imenid37 · Mar 13, 2005

I check at least q shift. In this day of liability, having more info. and clarifying that a pt. in your care was doing well or that her problems were being adressed can only help you out (IMHO). Besides that, it is policy where I work! :)

austin heart, BSN, RN · Mar 13, 2005

I just had a baby a month ago and was very supprised at was not done. I had a 4th degree tear/epesiotomy and some of the nurses did not even know about it much less look at my perineum. I am assuming that they just didn't have a very good shift report. First night there I had to wait almost 2 hours for pain meds! Also, in the 2 days that I was in PP my fundus was not checked once (except by MD) and no one asked about my bleeding, how many pads I was going through or if I was having any pain. I guess that I am just use to working in an ICU/ER setting where shift report and patient changes are very improtant. Let's just say I was VERY unhappy with my PP experiance.

SmilingBluEyes · Mar 13, 2005

wow can't believe people are NOT checking perineums, esp on those who tore. It's part of the overall assessment. Even IF there is no tearing, I do assess for swelling anyhow. I can't say I have discovered LICE (!), suddenly-active herpes or other such things Postpartum we did not already see in delivery, but I have seen late-onset swelling, and yes, couple of horribly infected episiotomies/lacerations. So it is important. To NOT check those who have torn is REALLLLLLLY negligent, if you ask me, esp. FOURTH DEGREE LACERATIONS. Unbelieveable in that case, that no one looked.Shameful.

BETSRN · Mar 13, 2005

I just had a baby a month ago and was very supprised at was not done. I had a 4th degree tear/epesiotomy and some of the nurses did not even know about it much less look at my perineum. I am assuming that they just didn't have a very good shift report. First night there I had to wait almost 2 hours for pain meds! Also, in the 2 days that I was in PP my fundus was not checked once (except by MD) and no one asked about my bleeding, how many pads I was going through or if I was having any pain. I guess that I am just use to working in an ICU/ER setting where shift report and patient changes are very improtant. Let's just say I was VERY unhappy with my PP experiance.

You need to let the hospital and the nurse manager of that PP unit know how you feel. You need to point out that no one checked you, your bleeding, perineum, etc. That is substandard care!

SC RN, RN · Mar 13, 2005

I'm a nurse tech on post partum (graduate in May and move on to L&D) and there are many nurses who do not check the perineum. It is ME who checks them when I do peri care for those still in bed or take the other pts to the bathroom for their first three times. I assess the perineum while I show the moms how to clean the area ... I will pass on this info to the nurse but what about the techs that don't? It surprises me how often this is not done.

My two cents? Not checking the perineum after a vag delivery (and some c-sections) is like not turning a patient over to check the dressing after a back surgery. Just doesn't make sense. :smackingf

BETSRN · Mar 14, 2005

I'm a nurse tech on post partum (graduate in May and move on to L&D) and there are many nurses who do not check the perineum. It is ME who checks them when I do peri care for those still in bed or take the other pts to the bathroom for their first three times. I assess the perineum while I show the moms how to clean the area ... I will pass on this info to the nurse but what about the techs that don't? It surprises me how often this is not done.
My two cents? Not checking the perineum after a vag delivery (and some c-sections) is like not turning a patient over to check the dressing after a back surgery. Just doesn't make sense. :smackingf

Just a question.....why do you take people to the bathroom THREE times? Why are they not getting up by themselves?

SC RN, RN · Mar 14, 2005

Just a question.....why do you take people to the bathroom THREE times? Why are they not getting up by themselves?

For several reasons: (1) moms can be very sleepy and weak the first few times either from exhaustion or from meds, (2) we want to be sure that they can void without problems due to swelling and irritation, (3) we want to see the amount of bleeding (is it too much or too little or just right?) and (4) the amount of bleeding and fluid loss can often lead to hypotension and hypotension can lead to dizziness and dizziness often leads to moms passed out on the floor and a baby crying in the crib. No fun writing up that incident report! Hope that helps explain why. :)