1. Skin Care w/ Observations
Presented by: Moyette Graham RN, B.S.N
Chapter 18 pg

2. Objectives
Identify conditions in which the patient is at risk for skin breakdown, decubitus formation
Identify, list signs of impaired circulation which may lead to skin breakdown
List nursing measures employed in prevention of skin breakdown and formation of decubitus

3. S & S of decubitus formation
Reddened area on people with light skin that does not lighted briefly when touched (blanching).
Darker skin people- maybe not change in skin color, no blanching; or skin appear ashen, bluish or purple
Complaints of pain, burning, tingling in general area
May be soft, firm or cooler than surrounding area.

4. Contributing factors…
Elderly, paralyzed, obese, very thin, malnourished patients are at risk for decubiti
Tissue can breakdown anywhere on the body where tissue lies between a bony prominence and a hard surface
Breaks in skin, poor circulation to area, moisture, dry skin, irritation by feces/urine

5. Prevention of decubitus ulcers
Reposition patient q 2 hours; use blankets, pillows as supports
Provide skin care; keep skin clean, dry
Apply lotion to dry areas
Massage back and bony areas when repositioning
Keep linens clean, dry, free of wrinkles

6. Sites of decubiti … over bony areas at pressure points
Ears- behind ears (nasal cannula)
Scapula
Elbows
Heels
Coccyx
Hips
Back of head

7. Prevention… 6. Apply powder where skin touches skin
7. Avoid vigorous scrubbing or rubbing when bathing, drying patient
8. Report S & S of breakdown, decubiti immediately
9. Treatment is individualized and directed by physician

8. Equipment for prevention…
1. Heel, elbow protectors
2. Bed cradle to keep linen off of affected areas
3. Various types of specialized beds
a. Clinitron beds
b. Alternating pressure mattress

9. Risk Factors… Major Factors Contributing Factors Bed/chair confinement
Inability to move
Loss of bowel/bladder control
Poor nutrition
Lowered mental awareness
Contributing Factors
Dehydration
Obesity
Excessive diaphoresis
Edema

10. Prevention… Observe color of skin carefully, frequently
Look for skin that is red, blue, mottled
May indicate impaired circulation
Change position frequently (at least q 2 h)
Keep heels off of bed; use positioning devices as indicated
Avoid positioning patient directly on trochanter
Use trapeze bar, lift sheet to move patient (do not drag across linen)

11. Prevention …
Use pressure-reducing devices (foam pads, pressure-reducing mattress, alternating-pressure pad)
Pressure-reducing devices when sitting in chair
Shift weight q 15 min. or at least q hr.
If patient is unable to comply, return to bed after 1 hr.
Restore circulation to “deprived” area by massaging around reddened area, using circular motion

12. Prevention …
Do Not massage reddened skin! Skin has suffered temporary damage
Do Not massage over bony prominences
Wash/dry incontinent patients ASAP! Urine/feces is extremely irritating to fragile skin

13. Prevention …
Avoid mechanical injury from improperly fitting splints, braces, casts, prostheses
Avoid burns caused by excessively hot/cold applications (hot-water bottles, ice bags, heating pads, heating lamps)
Minimize skin injury caused by friction/shear by using proper positioning, transferring, turning techniques

14. Prevention …
Utilize cornstarch, creams, protective films, dressings, padding to reduce friction
Encourage/provide adequate nutrition and fluid intake