ST.

PAUL UNIVERSITY DUMAGUETE

ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

URINARY ELIMINATION SDL

Submitted by: Cezanne Danabelle A. Hutalla

Submitted to: Mrs. Sharry Mae G. Awayan, RN, MAN

BSN 2-A
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

Guide Questions:

a. Provide Pictures and label the anatomical structure of a male and female
reproductive organ.

b. Indicate the important information about perineal care like concepts,

principles, guidelines, assessment, purposes, contraindications and
procedures.

Concepts
• involves bathing the external genitalia with water and soap, water
alone, or any commercially available peri wash.
• includes thoroughly washing the client's anal region, external
genitalia, and surrounding skin.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

Principles
Patients who require special attention to perineal area.
1. Patient who are unable to do self-care.
2. Patient with genitor-urinary tract infection.
3. Patient with incontinence of urine and stool.
4. Patient with indwelling catheters.
5. Postpartum patients.
6. Patients after surgery on the genitor-urinary system.

Contraindication
• Perineal malformation
• Inflammatory bowel disease

Assessment
1. Assess the condition of perineal skin-any itching, irritation, ulcers,
oedema, drainage etc.
2. Assess the need and frequency of perineal care.
3. Assess whether perennial care should be done under an aseptic
technique or a clean technique.
4. Check the physician’s order for any specific instructions.
5. assess the patient ability for self-care.
6. assess the patient mental state to follow instructions.
7. check the articles available in patient’s unit.

Purposes
• To stop or inhibit healing, odor, and infection.
• Consolation and secretions removal.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

Procedures
1. Hand washing
2. Over the perineum, pour water.
3. Utilize the moist swabs to clean the perineum.
4. Use forceps to hold the swabs as you clean from above.
5. One swab should be used per swab.
6. From the middle of the perineum outward, clean it as follows:
a. vulva
b. labia
c. both sides of the labia interior.
d. both sides of the labia outside.
7. Thoroughly clean the perineum and anus.
8. By supporting the lips as previously, remove the bed pan. Turn the patient on one side
and use a dry cloth to pat the buttocks dry.

c. Enumerate and indicate all the equipment and its usage. Provide pictures of each.
(Perineal Care)

Kidney tray- for the collection of waste

Gloves- for the prevention of infection

ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

Soap with soap disc- used for hand washing

Sponge holder- To hold swabs and cotton for perineal

care

Antiseptic solution- for cleaning of the genital area

Betadine- for disinfection of the genital area

Bedpan- for the specimen, stool and urine

 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

Towel- for cleaning and drying of the skin

Razor- for the hair removal

Cotton swab- for disinfecting, treating, and cleaning purposes

d. Provide and enumerate the steps/procedures on how to perform perineal

care with rationale. Provide pictures for the steps.
1. Handwashing
Rationale: To prevent cross-contamination and infection.
2. Pour warm water over perineum.
Rationale: To wash off the discharge and specimens from the perineal area
3. Clean the perineum using the wet swabs.
Rationale: To prevent bacterial growth
4. Hold the swabs with forceps and clean from above.
Rationale: To keep the swabs sterile
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

5. Use one swab for one swabbing.

Rationale: To prevent the spread of microorganisms

i. From the middle of the perineum outward, clean it as follows:

a. The vulva
b. The labia
c. Inside of the labia on both sides.
d. Outside of labia on both sides.
ii. Clean the perineal region anus thoroughly.
iii. Remove the bed pan by supporting the lips as before. Turn the
patient to one side and dry the buttocks with dry rag piece.

e. Draw or provide picture for the appropriate/correct stroke during perineal

care.

f. Enumerate and indicate all the equipment and its usage. Provide pictures
of each. (Urinary Catheterization)
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

1. Sterile gloves- shield from infection both the wearer

and the patient.
2. Single-use lubricant and anesthetic gel-
antiseptics to lessen the possibility of infection and to
prevent pain.

3. Catheter- used to perform specific tests and to help the

bladder empty before or after surgery.

4. Urine bag- collection of urine

5. Waterproof pad- protects against fluids, urine, and

perspiration.

g. Enumerate the steps/procedures for the insertion of Urinary Catheter and

the removal. Provide pictures
Insertion
1. Examine the physician's order for catheter insertion. Assess
bladder fullness and pain with palpation or a bladder scanner.

2. Position the patient prone to semi-upright with the knees raised;

put on gloves; and inspect the perineum for erythema, drainage,
and odor. Examine the perineal anatomy as well.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

3. Remove your gloves and clean your hands.

4. Gather supplies:
• Sterile gloves
• Catheterization kit
• Cleaning solution
• Lubricant (if not in kit)
• Prefilled syringe for balloon inflation as per catheter size
• Urinary bag
• Foley catheter

5. Check the size and type of catheter and use the smallest size
possible.

6. Place a waterproof pad beneath the patient.

7. Patient positioning is determined by gender

• Female patient: Lie on her back, knees flexed and thighs

relaxed, hips rotating to expose the perineal area. If the
patient is unable to abduct the leg at the hip, he or she can be
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

side-lying with the upper leg flexed at the knee and hip and
supported by pillows.
• Male patient: Supine with legs extended and slightly apart.

8. Cover the patient with a blanket or sheet, exposing only the

necessary anatomical areas.

9. Apply clean gloves and wash the perineal area with warm water
and soap or perineal cleanser, as directed by the agency.

10. Make sure there's enough light.

11. Hand hygiene should be practiced.
12. Fill the catheterization kit with supplies and cleaning solution, as
directed by agency policy.
13. If using indwelling catheter and closed drainage system, attach
urinary bag to the bed and ensure that the clamp is closed.
14. Use sterile technique to apply sterile gloves
15. Drape the patient with the drape from the catheterization kit, using
either sterile gloves or ungloved hands and only touching the outer
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

edges of the drape. Make sure that any sterile supplies only touch
the middle of the sterile drape and not the edges, and that sterile
gloves do not encounter non-sterile surfaces. Drape the patient to
reveal the perineum or penis.
16. Lubricate the catheter tip with the sterile lubricant provided in the
tray or add lubricant using a sterile technique.

17. Using a sterile syringe, check balloon inflation.

18. Place a sterile tray containing a catheter between the patient's
legs.
19. Clean the perineum as follows.
• Female patient: Use the fingers of the non-dominant hand to
separate the labia (now contaminated and no longer sterile).
Clean the labia and urethral meatus from clitoris to anus, and
from outside labia to inner labial folds and urethral meatus,
using a sterile technique and dominant hand. With each
cleansing stroke, use sterile forceps and a fresh cotton swab.
• Male patient: Using the non-dominant hand, gently grasp the
penis at the shaft and hold it at a right angle to the body
throughout the procedure (now contaminated and no longer
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

sterile). Clean the urethral meatus in a circular motion with

your dominant hand, working outward from the meatus. With
each cleansing stroke, use sterile forceps and a fresh cotton
swab
20. . Pick up the catheter with your sterile dominant hand 7.5 to 10 cm
below the tip.

21. Insert the catheter as shown below.

Female patient:

• Instruct the patient to bear down gently (as if to urinate) to help

expose the urethral meatus.

• Advance catheter 5 to 7.5 cm until urine flows from catheter, then

5 cm more.

Male patient:

• Hold the penis perpendicular to the body and gently pull up on the
shaft.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

• Instruct the patient to bear down gently (as if to urinate) and slowly
insert the catheter through the urethral meatus.

• Move the catheter 17 to 22.5 cm or until urine flows from it.

22. If necessary, place catheter in sterile tray and collect urine

specimen.
23. Using a prefilled syringe, slowly inflate the balloon for indwelling
catheters according to catheter size.
24. After the balloon has been inflated, gently pull on the catheter until
resistance is felt, then advance the catheter again.
25. Connect the urinary bag to the catheter in a sterile manner.

26. Use a securement device to secure the catheter to the patient's

leg just above the catheter bifurcation.
• Female patient: Attach catheter to inner thigh, leaving enough
slack to avoid tension.
• Male patient: Secure catheter to upper thigh (penis
downward) or abdomen (penis toward chest), allowing
enough slack to prevent tension. Check that the foreskin is not
retracted.
27. Dispose of supplies in accordance with agency policy.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

28. Hand hygiene: remove gloves and perform hand hygiene.

29. Document the procedure in accordance with agency policy,
including the patient's tolerance of the procedure, any unexpected
outcomes, and urine output.

Removal

1. Recognize the "Balloon Port" on the catheter's tip (see the diagram).
It has a colorful valve on the end, and the colored valve has multiple
numbers printed on it. This area of the catheter is where the retention
balloon at the tip, which is inside your bladder, keeps the water.

2. Close the "Balloon Port" valve. To accomplish this, cut the tube's
neck slightly behind the valve. Water will trickle out of the tube as the
valve opens. Clean water was present inside the balloon at the
catheter's tip.

3. Watch for the water to eventually seep out. Your bladder's internal
balloon will have deflated by the time it ends.
 ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERISTY SYSTEM
COLLEGE OF NURSING
ISO 9001

4. With a steady pull, remove the entire catheter. Avoid pulling or jerking
it out because doing so will just make it worse.

5. Discard the collection bag and all the tubing.

References
Alatchi, A. (2022, february 1). Retrieved from
https://www.slideshare.net/anjalatchi/perineal-care-for-bsc-iv-year
Bano, S. (2022, january 26). Retrieved from
https://www.slideshare.net/anjalatchi/perineal-care-251056472
Villiran, K. (2019, august 26). Retrieved from
https://www.slideshare.net/kayeconstantino/perineal-care