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Performance Checklist for Perineal Care: Male

Preparation for Procedure:

___ Organize appropriate equipment

___ Place protective pad or towel under the patient

___ Position patient comfortably (bedpan is optional)

___ Drape the patient correctly

Clean the Perineum:

___ Retract foresin of penis if uncircumcised

___ !ash around the urinary meatus in a circular motion" using clean surface of

washcloth for each stroe

___ !ash rest of head of penis in same fashion

___ !ash down shaft of penis toward the thighs

___ !ash scrotum

___ !ash inner thighs___ Rinse with clean wash cloth or peri#bottle using warm water in same sequence

as the wash

___ Dry with clean towel in the same sequence

___ Replace foresin" as appropriate

___ $urn patient on side to wash anus from front to bac and dry

Conclusion of procedure:

___ Remove equipment

___ Removes gloves

___ Redress the patient in clean clothes and cover

___ Reposition to comfortable position

___ !ash hands

___ Document procedure appropriately

Outcome% Pass ___ &ail ___

'omments%

tudent signature% nstructor signature%

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