5.2 Oral Care, Perineal Care, and Catheter Care

Oral Care, Perineal Care, and Catheter Care

Oral care, perineal care, and catheter care are personal tasks, but they are also infection-control tasks. They involve body fluids, mucous membranes, and skin that can break down quickly. They can feel embarrassing for residents, so the nurse aide must combine technical steps with calm communication, privacy, and respect.

Oral care should be offered at routine times and whenever the mouth is dry, food remains after meals, dentures need cleaning, or the resident has bad taste or odor. A resident who is NPO still needs oral care unless the nurse gives different instructions. NPO means nothing by mouth for eating or drinking; it does not mean ignore the mouth. Dry mouth can crack, bleed, collect bacteria, and make the resident less comfortable.

Structured Aid: Clean Care Rules for Sensitive Areas

• Before care: verify the resident, explain the task, provide privacy, gather supplies, raise the bed if needed, and apply gloves when contact with body fluids is likely.
• During care: work from cleaner areas toward dirtier areas, use a clean part of the washcloth for each stroke when needed, avoid tugging tubes, and keep the resident covered.
• After care: remove gloves correctly, perform hand hygiene, place supplies away, position the resident safely, document according to facility policy, and report abnormal findings.

For teeth, brush gently along gums, teeth, and tongue if tolerated. If the resident can brush independently, set up the toothbrush, toothpaste, basin, towel, and water if allowed. For unconscious or high aspiration-risk residents, follow nurse instructions carefully, turn the head to the side if directed, use only small amounts of fluid, and never pour water into the mouth. Suction may be used only if you are trained and assigned under facility policy.

Dentures need careful handling. Line the sink with a towel or fill it partly with water so dentures are less likely to break if dropped. Brush dentures with approved cleaner, rinse as directed, and store them in a labeled denture cup when not in use. Do not wrap dentures in tissue or place them on a meal tray because they can be thrown away. Check the mouth for sores, redness, pressure spots, bleeding gums, loose teeth, pain, or white patches and report concerns.

Perineal care is provided during bathing, after toileting, after incontinence, and when the care plan requires it. Explain what you are doing before touching the resident. Wear gloves. For female perineal care, separate the labia and wipe front to back using a clean area of the cloth for each stroke. Clean the urinary opening area first, then farther back, then the rectal area last. Front-to-back cleaning reduces movement of bowel bacteria toward the urinary tract.

For male perineal care, clean the tip of the penis in a circular motion from the urinary opening outward, then clean the shaft and scrotum. If the resident is uncircumcised and the care plan allows foreskin care, gently retract the foreskin, clean, rinse, dry, and return the foreskin to its normal position. Failing to return it can cause swelling and circulation problems. Clean the rectal area last for any resident.

Catheter care is perineal care plus tube safety. An indwelling urinary catheter enters the bladder through the urethra and drains urine into a bag. Wash around the catheter insertion site gently, moving away from the body along the tubing for the first few inches. Hold the catheter near the insertion site to avoid tugging. Keep the drainage bag below the level of the bladder, but not on the floor. Keep the tubing free of kinks and loops that block drainage.

Do not disconnect the tubing from the bag, open a closed system unnecessarily, irrigate the catheter, remove the catheter, or push it back in if it comes out. Report pain, burning, feverish behavior, new confusion, blood, cloudy urine, foul odor, leaking, no urine in the tubing, tubing pulled tight, or a bag that fills rapidly or not at all. Catheter care is a place where small details prevent infection and injury.