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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Nursing Assistant (CNA) › Patient Care Fundamentals for Nursing Assistants › Lesson 2
HLT-CNA36-02 · Lesson 2 · 5 clock hours · demo

Dressing, Undressing, and Perineal Care

Objective. The student will demonstrate dressing and undressing a mannequin with a simulated weak-side extremity and will perform perineal care for both male and female mannequins using correct technique and appropriate privacy measures

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Why Dressing and Perineal Care Matter

Helping a patient dress and maintaining perineal hygiene are among the most personal skills a nursing assistant performs. Done well, these tasks protect skin integrity, prevent infection, preserve the patient's dignity, and support independence. Done poorly, they can cause injury, embarrassment, or hospital-acquired infection. Because these skills appear on the state CNA competency evaluation, mastering the correct sequence and communication approach is essential before you enter clinical practice.

The Affected-Side-First Rule for Dressing

Whenever a patient has a weak, paralyzed, or injured extremity—commonly called the affected side or weak side—follow this rule:

A helpful memory phrase is "weak first on, strong first off."

Rationale

The affected limb has limited range of motion. Dressing the weaker arm or leg first requires less bending and manipulation of the joint, reducing pain and the risk of injury. When undressing, the unaffected side comes out of the sleeve or pant leg first because it moves more freely, leaving the limited limb last and making removal easier.

Step-by-Step: Putting on a Shirt or Hospital Gown

1. Gather the sleeve of the garment so it is bunched, not dangling.

2. Slide the sleeve over the affected arm first, pulling it up past the elbow.

3. Guide the garment behind the patient's back or over the head.

4. Slide the opposite sleeve over the unaffected arm.

5. Fasten buttons, snaps, or ties without pulling the patient's limbs into uncomfortable positions.

Step-by-Step: Removing a Shirt or Hospital Gown

1. Unfasten all closures.

2. Remove the sleeve from the unaffected arm first.

3. Bring the garment across the back.

4. Gently slide it off the affected arm last.

Always explain each step to the patient before and during the procedure. Ask about pain or discomfort throughout.

Privacy and Communication During Dressing

Before beginning, knock and announce yourself even if a curtain is already closed: "Mr. Rivera, I'm going to help you get dressed now. Is it okay to come in?" Pull the curtain or close the door. Expose only the body area being dressed at that moment. These steps respect dignity and are evaluated on the state skill checklist.

For cognitively alert patients, narrate each action: "I'm going to slide your left sleeve on first because that side is a little weaker." This reduces anxiety and supports cooperation.

Perineal Care: Purpose and Infection Prevention

Perineal care (sometimes called "peri-care") is the cleaning of the genitalia and surrounding area. Its primary goals are to:

Standard Perineal Care Technique

Before You Begin

Female Perineal Care

1. Position the patient supine with knees bent and legs slightly apart (frog-leg or dorsal recumbent position).

2. Use a clean wipe or corner of a washcloth for each stroke.

3. Separate the labia and clean from the urethral meatus toward the anus (front to back). Never wipe back to front.

4. Wipe each labial fold from front to back, using a fresh surface each time.

5. Clean the rectal area last, again front to back.

6. Pat dry if using water and a washcloth.

The front-to-back direction prevents fecal bacteria from entering the urethra, which is the leading cause of UTIs in female patients.

Male Perineal Care

1. Position the patient supine.

2. Retract the foreskin gently if the patient is uncircumcised.

3. Clean the tip of the penis using a circular motion moving outward from the urethral meatus.

4. Clean the shaft moving downward.

5. Return the foreskin to its natural position immediately after cleaning—failure to do so can cause paraphimosis, a painful and dangerous condition.

6. Clean the scrotum and rectal area last.

Catheter Care Considerations

When a patient has an indwelling urinary catheter:

After the Procedure

Safety Points

Key terms10

Affected sideThe weaker or injured extremity; clothing is applied to this side first and removed from it last.
Unaffected sideThe stronger, uninjured extremity; clothing is removed from this side first during undressing.
Perineal care (peri-care)Hygienic cleaning of the genitalia and surrounding perineal area to prevent infection and skin breakdown.
Front-to-back directionThe correct wiping direction for female perineal care—from the urethral meatus toward the anus—to avoid introducing fecal bacteria into the urethra.
Indwelling urinary catheterA tube inserted through the urethra into the bladder to continuously drain urine; requires special catheter care during peri-care.
ParaphimosisA medical emergency in which a retracted foreskin is not returned to its normal position, constricting the penis and impairing circulation.
Waterproof padAn absorbent, fluid-resistant pad placed under the patient to protect bed linens during perineal care.
Knock-and-announceThe privacy protocol of knocking and verbally identifying yourself before entering a patient's space, required before any personal care procedure.
Urinary tract infection (UTI)An infection of the bladder, urethra, or kidneys; a common complication in catheterized patients that correct perineal care helps prevent.
Scope of practiceThe specific tasks a CNA is legally permitted to perform; observing and reporting skin problems is within scope, but diagnosing or treating them is not.
In class: Instructor demonstrates affected-side-first / unaffected-side-first dressing rule using a mannequin with one arm restrained in a sling, explaining the rationale; students replicate the sequence three times until smooth · Perineal care demonstration with female and male mannequins: instructor performs front-to-back wipe pattern, catheter-care considerations, and proper glove use; students then practice and self-score on a skill checklist · Role-play exercise in which one student acts as a cognitively alert patient and the other practices explaining each step of dressing and perineal care before and during the procedure, practicing therapeutic communication and knock-and-announce privacy protocols
Materials: Adult simulation mannequins (male and female), hospital gown, patient clothing with buttons and zippers, arm sling, disposable perineal wipes, waterproof pad, gloves, privacy curtain or screen, state CNA skill-evaluation checklist
Check: Student correctly sequences affected-side dressing on two consecutive attempts; achieves 80% or higher on perineal care skill checklist; instructor observes privacy knock-and-announce performed on every practice repetition

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Activities of Daily Living / Patient Care Skills
1. A patient had a stroke and has weakness in her right arm. You are helping her put on a button-front shirt. Which arm should you dress first?
Activities of Daily Living / Patient Care Skills
2. You are removing a hospital gown from a patient who has a left-sided weakness following a hip fracture. Which side do you undress first?
Infection Control / Patient Care Skills
3. When performing perineal care on a female patient, what is the correct direction for each wipe?
Patient Safety / Patient Care Skills
4. After cleaning the penis of an uncircumcised male patient, you must immediately:
Infection Control / Patient Care Skills
5. While performing catheter care, which action is correct?
Patient Rights / Communication
6. Before entering a patient's room to assist with dressing, the nursing assistant should:
Scope of Practice / Safety
7. While performing perineal care, you notice that the patient's skin around the catheter insertion site is red and has an unusual discharge. You should:
Patient Safety / Scope of Practice
8. A nursing assistant is helping dress a patient who has right-side paralysis. When the assistant attempts to guide the right sleeve onto the arm, the patient winces and says 'That hurts.' What is the correct action?
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