Cleaning urinary catheters

Hi,

I have a story and then some questions. First the story:

I am in my last semester of nursing school, and I work as a nurse aide in a large teaching hospital. A few days ago, I was working with a ICU patient who had been burned. He was doing well--off the ventilator, fairly alert, etc. Still, he wasn't able to use his hands yet. I was instructed to do his bath by one of the nurses. I met with the patient first to make sure he was ok with it, etc. His wife said that she could help roll him over if i needed it, which is good because the other nurses aren't fond of helping with that kind of stuff.

I started the bath and things were going according to routine until I happened to look at his catheter--he still had a blanket over his lap at this point. I saw lots of crusty discharge, so much that his pubic hair was stuck to his member and scrotum. It had been a while since someone cleaned him up. I didn't know what to do--I didn't want his wife to see it. After a few moments of panic, I said "It's been a while since someone cleaned around your catheter." I went ahead and cleaned the area up--his wife just kind of made a face. She wasn't upset, thank God.

Here are my questions: how can you tell if your patient is circumcised? Since I work in ICUs, the patients can't usually tell me. I guess I could ask their wives, but is that appropriate? I can't count how many times uncircumcised male patients have developed edema because their foreskin wasn't pulled back.

Also, since perineal care is not usually a priority here, is it appropriate for me to want to do it well? I mean it sort of violates some sort of unspoken rule in the hospital's culture.

My third question is going to make me sound crazy. How common is it for male patients to respond to being touched in the perineal area? I don't mean arousal, but sometimes their member will move or change sizes even if they are sedated. It can take a fair amount of handling to retract foreskin. Am I doing something wrong?

Lastly, when cleaning up female patients, it isn't uncommon for the contents of a bowel movement to get inside their lady partsl canal. I'm pretty sure leaving it there will cause an infection, but how detailed should I be in cleaning that area?

I apologize for the length of this. I just don't want to seem like a pervert, but I want to do a good job. Thanks