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Preventing skin breakdown

Suggestions on How to Keep Skin Healthy

Anyone who has limited mobility, general weakness, a condition that affects their circulation, or decreased sensory perception or mental awareness is at risk for developing a pressure ulcer. Even someone who has recently had surgery or been sedated could 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.  The sooner you find it; the quicker you fix it. Early detection is the best prevention for skin breakdown issues.

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 individuals away from areas where boney prominences press the skin against the bed or other hard surfaces previously receiving all the pressure based on how they were sitting. When helping them to move, do not slide them because sliding causes friction, and friction may tear the skin. It’s best to do this at least every two hours, if possible.
  • 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 to keep the bones in those locations from rubbing together and becoming painful. Padded wash-clothes, cushions, and wedges may also be used.
  • 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!
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 damages and begins the process of pressure ulcer formation. Urine and stool also contaminated the wounds and led to infection.

Incontinence (Accidents)

  • If bowel or bladder accidents happen throughout the day, clean the skin with a no-rinse cleanser that has a neutral pH to keep the skin from becoming irritated from the high extremes in pH levels associated with urine and feces.
  • Use absorbent under pads or undergarments that wick moisture away from the skin if leakage is a problem throughout the day.
  • 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, often excess moisture is present related to 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 inch) foam mattresses to help 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 keep circulation going to all tissues of the body and to help prevent contracture to joints.
  • Reposition in bed at least every two hours using wedges and pillows to prevent bony body parts from lying directly on the bed and to help keep the body in proper alignment.
  • When sitting in a wheelchair, assist the person to shift positions every 15 minutes.
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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 most but don’t massage it in, just 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.