1. Skin Care for the Caregiver
Philadelphia 2011
Association for the Advancement of Wound Care

2. Why Are We Here? To better understand human skin
Learn what factors effect skin
Learn how to identify skin damage
Learn how to care for & protect skin

3. Our Targets

4. Skin is essential
Forms a barrier - prevents harmful substances and microorganisms from entering the body.
Protects body tissues against injury.
Controls the loss of life-sustaining fluids like blood and water.
Helps regulate body temperature through perspiration.
Protects from the sun's damaging ultraviolet rays.

5. Skin Largest organ of the body
Every square inch of skin contains thousands of cells and hundreds of sweat glands, oil glands, nerve endings, and blood vessels.
Skin is made up of three layers: the epidermis, dermis, and the subcutaneous tissue.

7. Epidermis Layer

8. Epidermis Epidermis is the tough, protective outer layer
It's about as thick as a sheet of paper over most parts of the body
It has layers of cells that are constantly flaking off and being renewed
Cells are completely replaced about every 28 days
Minor cuts and scrapes heal quickly

9. Dermis

10. Dermis Dermis – 2nd layer of skin. It contains:
blood vessels, nerve endings, and connective tissue
connective tissue comprised of collagen and elastin
helps skin stretch when we bend & reposition when we straighten up
in older people, elastin degenerate - one reason why the skin looks wrinkled
sebaceous glands - produce the oil sebum that lubricates the skin and hair
sebum producion slow w/ age - contributes to dry skin

11. Subcutaneous Layer

12. Subcutaneous Tissue
Subcutaneous tissue, is made up of connective tissue, sweat glands, blood vessels, and cells that store fat.
Layer helps protect the body from blows and other injuries and helps it hold in body heat

13. What Are the Risks to Skin
Elderly skin changes – gets dryer, fat layer thin out that protects underlying structures
Moisture……. damages skin
Urine/ Feces……erodes skin
Pressure……. decreases blood flow and tissue dies

14. Risk Factors
Incontinence
Urine and/or fecal

15. Pressure Points

16. Pressure Points

17. Pressure Points

18. Tissue Damage
Insufficient amounts of oxygen and nutrients delivered to skin tissue will become damaged
When ‘pressure’ compresses blood vessels in the tissues and decreases oxygen/nutrients – the tissue damage is know as a pressure ulcer

19. Stage I Pressure Ulcer
Stage I - Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

20. Stage I

21. Stage II Pressure Ulcer
Stage II - Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

22. Stage II

23. Stage III Pressure Ulcer
Stage III - Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

24. Stage III

25. Stage IV Pressure Ulcer
Stage IV - Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

26. Stage IV

27. Tissue Damage Progresses

28. Skin Tears

29. Skin Erosion Due to Incontinence

30. Care Issues
Properly position and frequently turn patient off of pressure points
Use pressure relieving devices, as needed
Protect fragile skin w/ protective dressings or protective materials
Keep skin moisturized
Cleans skin w/with non-toxic cleansers
Protect skin exposed to incontinence w/ skin protective barriers and creams

31. Positioning

32. Positioning

33. Pressure Relief

34. Pressure Reduction Overlay

35. Pressure Reduction Overlay

36. Alternating Pressure Mattress

37. Pressure Relief

38. Skin Tear Protection

39. Pressure Relief

40. Wound Care Ensure hands are cleanse before changing dressings
Use only sterile products, as ordered by physician
Use dressing appropraitely to provide a moist healing environment:
Wide variety of dressing types: e.g. hydrocolloids, foams, antimicrobial dressings, hydrogels, specialty absorptive dressings, collagen, etc.

41. Summary You are essential You can identify early
pressure ulcer development and help avoid progression of skin damage
You can be the ‘eyes’ for the clinician and warn them of early changes to skin integrity