Skin_Care

he4/19/2012 Care of the Skin Care of the Skin and Prevention of Pressure Sores Leading Healthcare Providers Skillnet • Maintaining the skin’s integrity is essential to the prevention of infection and the promotion of health. The skin has several functions: • Maintenance of temperature • Protection • Excretion • Sensation Leading Healthcare Providers Skillnet Anatomy and Physiology • It is made up of three layers: – the epidermis, – dermis and – the subcutaneous layer. Anatomy and Physiology • Changes occur due to : – temperature – texture – elasticity – ability to change to environment & stimuli – INTEGRITY, CONTINUITY AND CLEANLINESS ARE ESSENTIAL FOR PHYSIOLOGICAL FUNCTION Leading Healthcare Providers Skillnet Leading Healthcare Providers Skillnet Assessment • Initial assessment is necessary • Several factors may influence the • appearance of the tissue. • • • • • Hydration Age, health, mobility, presence of pressure ulcers Treatment therapies Any concurrent skin conditions. Leading Healthcare Providers Skillnet Assessment • Individualised assessments • Noting privacy, personal preferences and options available for cleansing of the skin e.g. Bath, shower or bed bath • A history is necessary. It may include: • 1 Any previous skin disorders • 2 Any known allergies or drug • reactions • 3 Dietary habits • 4 Recreational customs or hobbies • 5 Family history • 6 Emotional stress Leading Healthcare Providers Skillnet 1 4/19/2012 Observe for: Assessment • Consideration when doing an assessment – Privacy – Skin should be clean – Bathing can provide an opportunity for assessment Leading Healthcare Providers Skillnet • Colour- redness, pallor, cyanosis, yellow or brown discolouration. • Evidence of bruising or bleeding. • Moisture, dryness, sweating, oiliness. • Temperature. Leading Healthcare Providers Skillnet Care of the Skin Assessment • Extra care is needed if damage to the skin noted – note skin folds and crevices – intravenous lines – other invasive devices – breaks in skin • When an abnormality is observed it is • important to ascertain: – When it was first observed (if problem present) – Whether the lesion(s) persist or come & go, or change in appearance – The extent to which it has spread – If it itches, hurts, is dry, moist or discharging Leading Healthcare Providers Skillnet Leading Healthcare Providers Skillnet Care of the Skin • Choice of cleansing agents: – Respect the choices of the patient – May be prescribed cleansing agents – Use non abrasive solutions – Use non-drying agents – Perineal and perianal areas use warm water as it is less irritating to the area Leading Healthcare Providers Skillnet • Texture: rough or smooth • Turgor: when pinched how quickly does the skin return to its normal place • Size, shape, colour and dryness of any lesions and their distribution • Odour Care of the Skin • Prevention of the spread of infection: – Do not share equipment – Patient to have own supplies – Use gloves for washing perineum – Clean equipment after use e.g. bath or shower – Ensure towels, facecloths sponges and basins are cleaned after each use Leading Healthcare Providers Skillnet 2 4/19/2012 Care of the Skin • Nails and Feet – need to avoid pain and infection – Chronic disease – trimming of nails • Ears and nose – impairment of senses • Eye care – communication – cleansing of eyes Leading Healthcare Providers Skillnet • A pressure sore is an area of damaged skin an flesh • it is usually caused by sitting or lying in one position for too long without moving. • A pressure sore can develop in only a few hours • skin colour change (redder or darker) if not treated open blister (few days) – deep hole in flesh Leading Healthcare Providers Skillnet Where do you get pressure sores' – – – – – – – – What is a pressure sore' Risk Factors for Pressure Sores • Immobility/ difficulty moving Heels Ankles Knees Elbows Shoulders Hips Bottom Base of spine – on bed rest – in a wheelchair – who spend long periods in a chair • Age • Systemic illness – – – – Diabetes Stroke Impaired circulation Confusion/dementia • • • • • • Constipation Smoking Some medication Pain Surgical patients Extrinsic factors – surface the patient is on – handling techniques – external influences on the skin e.g. urine, faeces, sweat • Poor nutrition (fluids & food) Leading Healthcare Providers Skillnet Leading Healthcare Providers Skillnet Prevention • Nurse Assesses the risk using tool i.e. – Norton scale – Waterlow scale • • • • Encourage mobility Encourage adequate fluid and food intake Avoid friction Check skin for signs of damaged reddened areas Leading Healthcare Providers Skillnet Prevention • Keep skin clean & dry • Avoid rubbing or massaging your skin • Avoid talcum powder (causes drying of skin) • For those who are incontinent clean as soon as possible • Assistive devices where needed Leading Healthcare Providers Skillnet 3 4/19/2012 For those in bed • Change position every 2hrs (min) alternating between back and sides • Use pillows to help positioning can protect knees and ankles • Use protectors (elbows and heel protectors) • Bed cradle or duvet Avoid sheets made of synthetic material • Avoid creases or crumbs • When sitting in bed prevent sliding as this can friction • Special mattresses Leading Healthcare Providers Skillnet For those in a wheelchair/chair • Alleviate pressure every 15 minutes by getting the person to lean forward or pushing up on the arms of the chair • Can also roll from cheek to cheek for a short while • Pressure relieving cushions • Avoid dragging legs and arms Leading Healthcare Providers Skillnet 4