SECTION 14 Skin care and hygiene

Skin care and hygiene What the skin does How stroke affects skin Effective skin care Cleaning the contracted hand Hygiene and incontinence

Skin The skin is the largest organ in the body. Intact skin keeps us safe from infection. Skin maintains body temperature and hydration.

How stroke affects skin Skin breaks down because of: Decreased activity and mobility Decreased or absent sensation Increased moisture from incontinence or perspiration Poor nutrition, dehydration, and dry skin Inability to communicate pain and discomfort Improper positioning, causing friction.

Key point Correct skin care is very important for survivors who have trouble moving. You play a key role in maintaining the health of the survivor’s skin.

Effective skin care Inspect and report Check the survivor’s skin carefully every day. Pay special attention to bony prominences. Search for redness and cuts. Report concerns or signs of skin irritation to the right person

Effective skin care Clean - This removes irritants and maintains the skin’s natural barrier. Gently wash (do not scrub) skin regularly, using mild cleansers. Rinse thoroughly. Cleanse soiled skin promptly. Moisturize Treat dry skin with moisturizers. Dry, flaky or scaling skin can bring about pressure ulcers, infection and irritation. Do not massage bony prominences or reddened areas.

Effective skin care Protect from too much moisture Sources of moisture on the skin that can cause it to break down include: Urine or stool from incontinence Perspiration Fluids from a draining wound

Protect bony and compromised areas

Reduce friction forces Friction injury occurs when the skin moves over a coarse surface. A friction injury can happen when you move the survivor in bed or they move themselves. These injuries happen often on the heels and elbows. How you can help: Use dressings and padding as needed Use linens to lift the survivor Do not pull or drag the survivor.

Reduce shear forces When the body moves without the skin moving, the person can get shear injury. For example, raising the head allows the survivor’s body to slide down, while the skin remains pressed against the sheets. How you can help: Lift the head of the bed no more than 30º Limit the amount of time in this position.

Move often Having a person sit or lay in the same position for a long time reduces circulation to their skin. This increases the risk of skin damage and ulcers. Risk of damage is greatest among survivors who cannot move themselves without help. How you can help: Work with the team to write up a plan for moving the survivor at least once every 2 hours and follow it.

Provide nutritional support Poor nutrition is linked to skin problems and poor healing. How you can help: Help the survivor eat meals and snacks and drink enough.

Use pressure reduction devices Devices that help to prevent skin breakdown include: pressure-reducing mattresses alternating air mattresses elbow pads pressure-reducing seat cushions for wheelchairs The nurse or therapist may recommend one of these devices, based on the survivor’s needs.

Use pressure reduction devices

Cleaning the contracted hand Survivors with spasticity may have a contracted hand with a closed fist. This hand often sweats. Poor air circulation may cause skin damage, resulting in odour and infection. Good hygiene can prevent skin damage. How you can help: Gently open the hand and fingers to clean and trim the nails. Those who have a painful hand may want to clean it themselves.

Hygiene and incontinence Stroke survivors, especially those with urinary incontinence, have an increased risk of developing perineal skin problems (problems on the skin of their genitals) and urinary tract infections.

Hygiene and incontinence How you can help: Use the right hygiene and skin care to avoid these problems: Wipe from front to back after voiding Change underwear daily or more often if soiled Always provide thorough peri-care (care of the perineum or genital area) after urinary or fecal incontinence. Remember to: wear gloves for peri-care, remove the gloves and wash your hands, wash the hands of the stroke survivor

Hygiene and incontinence How you can help (cont’d): : Do not use deodorant sprays, powder, or perfumes on perineal skin Continence products Use the right continence products. Do not use menstrual products. Follow the directions on the package. Watch for leaking, tightness, skin irritation, or rash. Report redness, irritation, or skin breakdown to the nurse.

Upon reflection Did you learn anything new about skin care today? What did you learn? How will it change the way that you provide care? Think of a stroke client you have cared for who had skin breakdown. Why do you think this breakdown occurred? How might it have been prevented?