Our skin is far more than just the outer covering of our bodies; it is an organ just like the heart, lung, or liver. Besides providing a layer of protection from germs, injuries and radiation from the sun, the nerve endings in our skin makes us aware of the sensation of touch, pain and heat. Our skin helps our bodies to metabolize the Vitamin D we get from sunlight that helps our bones stay strong. Our skin helps regulate our body temperature when we shiver and sweat. Perspiration also helps excrete body waste (salts).
When an individual is confined to a bed, recliner or wheelchair for long periods every day, concerns arise about the condition of their skin. Special care must be taken to keep their skin good shape. The best action is prevention: keeping the individual out of the bed or the chair as much as possible and for as long a duration as possible. It is much easier to keep skin intact than to heal open areas that may occur. Skin breakdown is often referred to as bed sores, pressure sores/ulcers or decubiti (Dee-cube-it-eye)
Beds should be as comfortable as possible, but not too hard or too soft. Creases that form in mattresses or bed linens can cause skin irritation and breakdown. Mattress covers are good choices to protect the underlying fabric from damage caused by excretions. Air mattresses, egg-crate or foam pads may be added to increase comfort. It is important to keep the sheets clean, dry and smooth. Fabric pads or synthetic pads often are used under buttocks, wounds or heads to prolong the use of sheets; they can be purchased through durable medical equipment (DME) suppliers, drugstores or large retail stores. These pads and sheets need to be changed when they become wet or soiled.
Positioning and repositioning an individual in a bed or chair is another key to keeping skin healthy skin. Turn from side to side to back, or assist the individual to reposition himself every 2-4 hours. Every time this is done it is important to look at the pressure areas: heels, hips, tailbones, elbows, ears, and backs of heads. Gentle massage of these areas helps to promote circulation to the region. Keeping an individual on their side is sometimes a challenge; use pillows or wedges to support their back, place a pillow between their knees and raise their heels off the bed by placing the pillow under their lower legs but leaving the heels off of the pillow. Avoid donut cushions because they can compromise circulation (blood flow) to areas. Special cushions for chairs and wheelchairs can be obtained at your local DME company, but you usually need a physician’s order for insurance coverage. Heels and elbows can be protected with foam or shearling protectors which can be purchased at drug stores or medical supply stores.
If your loved one uses oxygen, the backs of his ears need to be checked daily for skin breakdown. The oxygen company can supply special ear protectors.
If you are assisting your loved one with bathing or hygiene, use this opportunity to look for potential problems. What appears as just a red area today can be a pressure ulcer in a few days for a bed- or chair-ridden individual. Also check skin creases (under breasts, in abdominal folds) and feet (including between toes) for red areas or foul odors which can also indicate skin breakdown or infections. It is important to respect your loved one’s dignity and modesty as much as possible during this process. Cover areas with a thin blanket or sheet to allow for privacy and prevent chilling as much as possible; if you are bathing the upper body cover the lower body. Using a mild soap with moisturizer is a good choice, many deodorant soaps are too drying. Rinse the soap off the skin and dry well without aggressive rubbing. Applying lotion helps to moisturize the skin too but do not mix powder and lotion. Clean off urine and stool as soon as possible; both can be caustic to skin.
If your loved one has an intact blister or scab, do not open these areas as that could increase the risk of infection. If you are applying antibiotic ointment to an area of skin, use a thin coat only as thick applications encourage bacteria growth.
If you see an open area that is not healing or shows signs of infection (redness, purulent [pus-producing] drainage, or foul odor); call the physician or your home care/hospice nurse. Early detection and treatment can prevent further complications.
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