Preventing skin breakdown

Suggestions on Preventing Skin Breakdown

Preventing Skin Breakdown Must Be Priority

Preventing skin breakdown must be a priority for anyone who is mobility challenged. Having a pressure ulcer can “put you on the bench” for months and change your life forever.  The fact is that anyone with limited mobility, general weakness, a condition that affects their circulation, decreased sensory perception, or mental awareness is at risk for developing a pressure ulcer. Even someone who has recently had surgery or received sedation can develop a pressure ulcer if left unattended in the same position for an extended period. Therefore, checking daily for signs of pressure ulcer development is essential for early detection and treatment.  Preventing skin breakdown before a problem develops is the best treatment for pressure ulcers.

anyone restricted to bedrest is at risk for skin breakdown 

Anyone with restricted bed rest for an extended period is at risk for developing skin breakdown

 
 
Lack of Circulation Makes Skin Breakdown Common

Unfortunately, due to a lack of circulation to tissue when someone is limited in their movements, skin breakdown is common.  What is easy to develop is difficult to cure. I’ve seen a small dime-size wound develop into a ¼ inch recessed wound with drainage in a week. Within another week, it can double in size again if it becomes infected and not treated. Infected wounds can cause permanent damage to nerves and bone leading to amputations.  Those are horror stories, but they do occur. Complications from heart disease and diabetes or kidney disease sometimes make healing more difficult.  Therefore, again, preventing skin breakdown is essential because skin repair may not occur once a pressure ulcer starts.

Stay Hydrated
  • Drink plenty of water and other non-caffeinated liquids frequently. If you wait until you are thirsty, then you are already becoming dehydrated.
  • Use lotions with moisturizers if your skin becomes scaly or ashen due to dryness.
  • Wear gloves when using chemical products or needing to keep your hands in water for extended periods.
  • Avoid using soaps that contain perfumes or other drying ingredients.
  • Use a skin barrier to protect the skin from moisture or other irritants such as waste or sweat.
Eat a Well Balanced Diet
  • Eat protein every day. Protein builds cells and replaces tissue when it becomes damaged.
  • Add fat, fiber, and carbohydrates to round out your calories. Eat a variety of foods to get a balance of vitamins and minerals, and then you won’t need supplements.
  • However, if you have difficulty getting a balanced diet, try consulting a dietician regarding adding supplements to your diet to help with tissue repair.
Rotate Pressure Areas
  • Lift and turn your family member away from areas where boney areas press the skin against the bed or other hard surfaces previously receiving all the pressure based on how they were sitting. When helping them move, do not slide them because sliding causes friction, and friction may tear the skin. Try to help them change positions at least every two hours, if possible. (Think about how stiff you get if you don’t move after sitting in the same position for a long time)
  • Use foam wedges or pillows doubled over and tucked under a person’s back to help gradually reposition someone further over onto their side.
  • Pillows placed under elbows, between knees, ankles, and under wrists/hands, help keep the bones in those locations from rubbing together and becoming painful. Padded wash-clothes, cushions, and wedges may also help.
  • Use pillows, wedges, washcloths, anything soft, and flexible to help you reposition. The better padded the bony areas are to keep them from rubbing, the less likely they are to develop pressure ulcers; however, don’t put so many objects in the bed that the person gets over-heated, either!
  • To help with sweating, you can put a little corn starch in the creases to help with the friction rubs. Corn starch is better than talcum powder because it has fewer chemical additives.
Protect Skin from Sun Exposure
  • Many medications have “May cause sensitivity to the sun” as a possible side-affect. Use a sunscreen, sunblock, and protective clothing when exposed to sunlight for extended periods.
  • Remember sunblock on cloudy days as well or when riding in cars.
Keep Skin Clean
  • Bladder or bowel incontinence (accidents) are a significant irritant to the skin. If urine or stool stays on the surface for an extended period, it creates skin damage and begins the pressure ulcer formation. Urine and stool also contaminated the wounds and led to infection.
  • White vinegar is a good agent for cleaning a non-irritated skin surface to restore the ph balance and kill bacteria.  It helps eliminate odor and prevents irritation from developing. I use it a lot to stop fungus from growing. 

Incontinence (Accidents)

  • If bowel or bladder accidents happen throughout the day, clean the skin with a no-rinse cleanser with a neutral pH to keep the skin from becoming irritated from the high extremes in pH levels associated with urine and feces.
  • Use absorbent underpads or undergarments that wick moisture away from the skin if leakage is a problem.
  • A bowel or bladder retraining problem may be useful to help with managing accidents. For severe cases, it may be possible to use a bowel or fecal containment or pouching system or an indwelling catheter.

What Contributes to the Formation of a Bedsore?

In addition to the prolonged pressure from being in one position, excess moisture is often present in sweating or urine/stool incontinence (accidents). However, poor diet intake (unusually low in meats and water) and general poor health, also contribute.

YouTube Video Resources

Pressure Ulcer Prevention: A Guide for Patients and Carers

 

Published on Jul 2, 2015, Nottingham City Care Partnership provides specialist wound care advice and therapies for patients with healing problems and advice to any careers, patients and healthcare professionals with the aim to promote wound healing and prevent deterioration or recurrence. Pressure ulcer prevention is a key objective of the service. This video contains valuable guidance on how to prevent pressure ulcers.

Positioning

  • Use air, gel, or (4 inches) foam mattresses to relieve pressure against patient skin. Beds that raise and lower the head or feet are also nice to have for helping to change positions.
  • Smooth out wrinkles under the patient as much as possible.
  • Don’t let heels or elbows lie directly against the bed. Have them hang over the edge of a cushion or pillow or apply elbow or heel protectors.
  • Perform range of motion exercises to all joints regularly to prevent contractures and improve circulation to body tissues.
  • Reposition in bed at least every two hours using wedges and pillows.
  • Prevent bony body parts from lying directly on the bed.
  • Keep the body in proper alignment.
  • When sitting in a wheelchair, assist the person in shifting positions every 15 minutes.

 

Areas of the body where pressure points development and may lead to skin breakdown

Bath Time

During bath time, use warm water, not hot, because hot dries out the skin.

  • Use mild soaps that are pH balanced with normal skin and non-irritating (no fragrances or alcohol to dry out skin).
  • Check around tubes or devices for any irritation and clean those devices thoroughly as well. Clean starting from the body outward so that you do not bring germs in toward the body.
  • Gently apply skin moisturizer to all skin surfaces after the bath to keep it moist but don’t massage it in, gently rub it on so that you don’t damage delicate blood capillaries.
  • Apply a barrier cream or ointment to the skin along with a protective dressing after cleaning the area.

Diet

  • Encourage a diet that has an adequate amount of protein and vitamins. Ask for a dietary consultation if the calorie intake is not sufficient.
  • Drink water throughout the day to keep the skin moist.

 

Caregiver Marketplace Check out links to products recommended to help caregivers cope with the challenges of caregiving at home. Ideas are available on everything from positioning to self-help booksmobility devices, to skincare.