By Marygrace Lomboy –
Working as a nurse practitioner specializing in wound care, everyday I come across many skin issues ranging from skin tears to pressure ulcers to cancerous lesions that are very painful, odorous and draining. There are many reasons why the skin fails as your loved one’s disease progresses. Pressure ulcers, also known as decubitus ulcers or bed sores, are a result of continued pressure on the skin, usually found over a bony prominence. Increased pressure over the area causes a decrease in blood flow resulting in ulceration.
As your loved one gets weaker, more time may be spent in bed or longer periods in a chair or recliner. Also, as your loved one becomes less active and takes in less food and fluids, there is a greater risk for skin breakdown and bed sores. Keeping the skin clean and dry is one way to help to prevent skin breakdown. Another way to care for the skin is to help change position as often as comfortable. (rule of thumb is every 2 hours if they are unable to do so themselves). You can alternate between laying them on their back and turning to the right and left sides. Keep a lot of pillows handy. You can place one at your loved one’s back, one between their knees, and perhaps one under their arm when they are on their side. Use a lift sheet to turn your loved one from side to side and moving up in bed. Check the skin often, especially at the base of the spine (tailbone area), heels, elbows and hips. Look for any areas that appear pink or red. You may elevate the heels off the bed with pillow by placing a pillow under the ankle and “float” the heels up. If your loved one has redness or ulceration, be sure to alert your health car provider to develop a place of care for the skin. An air mattress or cushion may be recommended to relieve pressure.
Often times, skin will breakdown regardless of meticulous care. Please don’t feel like it is your fault…the skin is the largest organ in the body and it fails as other organs in the body will shut down as a disease progresses.
Tips on Skin Care:
- Moisturize the skin – the best way to prevent cracking and skin tears is to keep the skin lubed up. Use non alcohol based moisturizers. Healthy skin needs to be clean and well hydrated.
- Use mild soaps only to prevent irritation.
- Do not rub skin too hard or scrub hard with wash cloth, which may damage fragile skin.
- Look for areas of redness or discoloration, especially around bony areas. Reposition at as tolerated every 2 hours and place pillows in bony areas to relieve pressure.
- Remember to wash your hands frequently to prevent the spread of infection.
- If your loved one is wearing adult diapers, check the brief at least every two hours while you’re awake and change it if it becomes soiled
- Do not use a donut cushion to relieve pressure. It is likely to cause more damage to the skin.
- Make sure the bedding is without wrinkles or folds underneath your loved one. Change linens when wet or soiled.