Adriene needs continence support and maintaining skin integrity is a priority in her care. She also utilizes a wheelchair to assist with mobility needs at times and ensuring her skin stays healthy in times of immobility is a priority in her care. Check her skin well when she is removed from her wheelchair, her bed, and at diaper changes. A pressure sore (also called pressure ulcer, bedsore, or skin breakdown) is an area of the skin or underlying tissue (muscle, bone) that is damaged due to loss of blood flow to the area. Blood flow to the skin keeps it alive and healthy. If the skin does not get blood, it will die. Normally, sensation acts as a warning system, signaling the person to move or shift their weight to let blood flow return to an area before damage occurs. Because the client may not be able to feel discomfort or pain, they cannot depend on their sensation of pressure to cue the individual to move or shift weight to relieve pressure. Skin breakdown happens when pressure decreases blood flow to the skin. Adriene also needs to be checked regularly for infected hangnails. Check her fingernails and toenails weekly for any infection around her nails. Incontinence Skin Support Ways to Reduce Skin Irritation from Incontinence: Both urine and feces are highly irritating to the skin, making it more susceptible to pressure damage and therefore it is important to maintain continence and actively manage incontinence. Incontinence is not a normal or inevitable part of aging and has many different causes. Always check whether your resident has a urinary tract infection (UTI) as this can be a cause of incontinence in the elderly or make incontinence worse. Where continence problems are identified, refer to the community nurse for a full continence assessment to identify the cause and develop a management plan. There are a few easy ways to promote continence and reduce the risk of moisture sitting on the skin: Take the ‘Toilet First’ approach, ensuring clients can access toilet facilities, wear clothing that is easy to remove and are regularly offered support to visit the toilet (every two to four hours). For clients who are regularly incontinent, it may be helpful to develop a timetable that offers a reminder for going to the toilet. Gently clean and dry the skin when continence pads are changed, or accidents happen. Wash gently, do not rub. Avoid using traditional soaps as they can irritate the skin. Skin cleansing products can be used to clean the skin without rinsing or use a low pH soap which is less irritating. Apply a barrier cream or spray (if prescribed), following medication instructions on how to apply. Prevent the client becoming too hot and sweaty. Ensuring clients drink enough fluids to prevent them becoming dehydrated. If using pads, use 1 pad only, folding length-ways to form a channel. Continence pads should be changed as often as is necessary. Do not use thick creams, ointments or talcum powder as these can reduce the absorbency of the continence pad. If the resident has a catheter, ensure the bag is emptied regularly to prevent it becoming too heavy. Catheter tubing should be secured safely and any problems with the catheter addressed quickly. Continence aids: Using continence aids can help to keep the client comfortable and protect skin when used appropriately. Incontinence pads and pull-up pants can be worn day and night, or during the night only, to draw fluids away from the skin. It is important to find the right type and absorbency for the individual. They should be comfortable without chafing the skin or leaking. They should be changed as often as necessary. Male clients may benefit from using a male continence sheath. This is a silicone condom which drains into a bag attached to the leg and may be particularly helpful when worn at night. Immobility Skin Support Preventing problems with skin: Look at skin at least once a day for changes in color or temperature (warmth or coolness), rashes, sores, breaks, odor or pain. Use mild soap, avoiding those with antimicrobial or antibacterial properties; use warm (not hot) water; rinse thoroughly and pat dry well (don’t rub). Lubricate dry skin with moisturizing creams or ointments, avoiding scented substances. Use cushion or towel on shower chair to prevent bare skin from pulling or tearing or shearing. Protect bare skin during all transfers and position changes. Report these changes to Physician: The person gets worse in his or her ability to shift weight, turn, reposition. You feel using special equipment might help to transfer more safely and easily. There are new or worsening changes in skin such as discoloration, swelling, a break in the skin, heat or pain over a pressure point. You are unaware how to provide care, or if equipment might be beneficial. Repositioning: When in bed, repositioning needs to be done at least every 2 hours When in chair, repositioning needs to be done at least every 1 hour; plus weight shifts for 15 seconds every 15 minutes Purpose: To keep skin clean, dry and intact To prevent pain and infection from broken skin Supplies you’ll need: Washcloth and towel Mild PH-balanced cleanser Moisturizing lotion Barrier cream, if prescribed Absorbent pad What to do: Explain to the client what you are going to do even if you are unsure whether they can hear Inspect skin daily especially the ears, elbows, back, hips and heels Cleanse the skin with warm water and a mild PH-balanced cleanser Pat dry and apply moisturizer and/or barrier cream Keep linens clean, dry and as wrinkle free as possible Help individual change position at least every 2 hours or as recommended by the physician Special instructions: Pad the bed rails Use a turning sheet when changing the clients’ position Lift, don’t drag the client who is unable to help during transfers or position changes Avoid massaging reddened skin or skin that may easily tear Avoid powders as they tend to accumulate in skin folds Report any areas of redness, discoloration or blistering to the physician Do not use doughnut-type devices as they may cause more pressure rather than relieving pressure Use pillows to keep bony areas like knees and ankles from touching each other Contact primary care physician for reddened skin that does not improve, opens skin, bruising, or drainage.