Perineal anxiety

[caliber]

I don't mind giving bed baths, wound care, dressing,etc at all.. But when it comes to male perineal care, I hestitate. And I dont mean just washing around the member, its the pulling back of the foreskin and cleaning I can't allways do.:imbar Any one know to overcome this anxiety?

caliber

[leslie :-D]

you know, let this be a gentle reminder that there are pts who are perfectly capable of washing themselves, and should be encouraged.

the only exception is reserved for those w/foleys.

i can't tell you how often i see foley care ignored.

meticulous pericare, esp w/females, is crucial in preventing uti.

*shaking head* about how many times i've noted dried feces on catheter near meatus.

no reason for that.

and then, when you do the actual cleansing, your washcloth has mod amts of feces on it!

ticks me off to no end.

comparable to mike's "choke it" theory, i'm going to remind newbies (and all nurses) to "just do it".

it's important and we need to push aside our anxieties.

leslie

[mcknis]

comparable to mike's "choke it" theory, i'm going to remind newbies (and all nurses) to "just do it".

it's important and we need to push aside our anxieties.

leslie

You said it best, I think. I know for me, it was hard to overcome, but once the fear is over with, anything can be done. Say a quick prayer, go in, and git er dun...

[nursemike, ASN, RN]

I believe I read somewhere that the most common organism responsible for UTI's is E. coli. Kinda puts it in perspective. Those little rascals don't walk there on their own.

But I should probably admit that it's a bit easier to be brave since the aides I work with do most of the peri care. Fortunately, most are pretty darned conscientious about it, too. So, usually, all I have to do is verify that it was done as I do my assessments. God bless good aides!

My first ever bed bath, in school, I did head-to-toe, peri care and all, then the sweet old gentleman got up to his chair so I could change the bed. He let me do a total bath because he "didn't want me to get in trouble." Well, I didn't want to get in trouble, either. But it did make a pretty pointed lesson that the first step of any nursing process is assessment.

[leslie :-D]

i believe i read somewhere that the most common organism responsible for uti's is e. coli. kinda puts it in perspective. those little rascals don't walk there on their own.

undoubtedly, e coli is the culprit and washing, the most preventable means of uti in the hospital.

but i should probably admit that it's a bit easier to be brave since the aides i work with do most of the peri care. fortunately, most are pretty darned conscientious about it, too. so, usually, all i have to do is verify that it was done as i do my assessments. god bless good aides!

you are lucky.

our aides do the foley care as well.

until one time i had to change a cath and accidentally found pt's peri area to be smeared w/feces.

when i brought it to the aide's attn, she said something about it being against her culture to touch 'it' like that.

from that day on, i've done all the care myself.

again, you're very lucky to have such diligent aides.

leslie

[nursemike, ASN, RN]

again, you're very lucky to have such diligent aides.

leslie

ya got that right.

[MassED, BSN, RN]

I'm pretty confident my friend wasn't suggesting sexual contact, lone or otherwise. Can't really say what the fellow who told him had in mind. We took it to mean, put on your gloves, get over yourself, and do what needs to be done--within reason, of course.

nope, interpreted it as grab it at the base, pull up to the sky and insert past that difficult prostate. Of course there's always the normal meaning of "choke the chicken" but I didn't take it that way, in this case.

[leslie :-D]

nope, interpreted it as grab it at the base, pull up to the sky and insert past that difficult prostate. Of course there's always the normal meaning of "choke the chicken" but I didn't take it that way, in this case.

i interpreted it that way also.

that's why i asked for clarification.

the only times i 'choke' it, is when catheterizing.

leslie

[shelly304]

I worked as a CNA (LTC) during nursing school. We had a huge problem w/ UTIs on one floor. There seemed to be an epidemic of aides who didn't want to do perineal care on males or females and gloves were a waste of time!! The DON finally made a chart of all the UTIs that were and had been treated in the last 90 days.

Oh how the finger-pointing started! :uhoh21:!

[Batman24]

Our CNAs do most of it but of course there are plenty of times the nurses do it as well. I find cleaning the peri area and inserting foleys in men a million times easier than doing these for women. Everything is out in the open for the men but for the women you have folds to clean and the opening can be harder to find. Peri care on the whole isn't the most pleasant for us or the patients but for anyone who has had a UTI you know just how important it is to avoid them. Ouch. You also feel so much better when you are fresh and clean.

[Roy Fokker, BSN, RN]

Personally,

I don't think it makes a difference if you're working the ED or ICU or the Floor. CNAs/Aides assisting or not - the procedure is still the same.

I make sure I do a thorough clean up of the glans after I pull back the foreskin of uncircumcised males before inserting a catheter.

Just the same way I do a thorough clean up of the glans before I insert the catheter in circumcised males.

Just the same way I do a thorough clean up of female labia and meatus before inserting a catheter.

The only difference being that in uncircumcised males, I remember to return the foreskin back after retracting it (to insert the foley). I've seen a hideous case where the nurse that put in the foley didn't think to restore the foreskin and the pt. ended up having a stricture so bad he had to undergo emergency surgery.

cheers,

[MassED, BSN, RN]

I worked as a CNA (LTC) during nursing school. We had a huge problem w/ UTIs on one floor. There seemed to be an epidemic of aides who didn't want to do perineal care on males or females and gloves were a waste of time!! The DON finally made a chart of all the UTIs that were and had been treated in the last 90 days.

Oh how the finger-pointing started! :uhoh21:!

gloves were a waste of time? I don't understand what you mean... sorry.

[SuesquatchRN, BSN, RN]

It's funny, but after discovering that most people who are in distress are either grateful for or oblivious to what is being done my anxiety vanished.

You have to get the schmutz out from under the foreskin. That area is ripe for infection, teeming as it is with various organisms, and for skin breakdown from maceration from moisture. I will not be responsible for giving a guy an owie on his uh-oh.

And up here, where a lot of the patient population is composed of old farmers who were born at home, the circumsized member is the rarity.

If you have a dyspneic diabetic with CHF battling for every breath he does not even notice that you've retracted his foreskin to clean the glans.

It's a body part. Simple flesh. It needs to be cleansed.