Skin care (elderly patient)

SN educated patient/caregiver on skin care for elderly patient; these are; bathing regularly, using warm water and mild soap, it is necessary to use a moisturizing lotion after bath due to loss of the natural oils in the skin. Choose loose clothing especially to Pt who are prone to excessive sweating, be observant of any changes to your skin. Any changes should be reported immediately.

Skin Hygiene

SN educated patient/caregiver in the importance of bathing to preserve personal hygiene and skin integrity. Patient instructed to keep skin clean and dry and to report any changes in the skin as soon as it is observed.

Skin healthy

SN educated patient/caregiver how to keep the skin healthy: Dry, fragile skin should be rehydrated using a simple, unperfumed moisturizer (direction of the body hair). Skin cleansers can be used to clean the skin without rinsing (traditional soaps should be avoided as they can irritate the skin) and be dried gently. Eating well and drinking enough water can also keep skin healthy and is vital for wound healing. It is important to protect the skin from contact with urine and feces and the harmful irritants in them.

Pressure ulcer prevention

SN instructed patient/caregiver how prevent pressure ulcers: Provide appropriate support surface, reposition every two hours in bed, off-load heels (use pillows or positioning boot), reposition every hour when in chair, use pillow between legs for side lying, do not position directly on trochanter, do not use doughnut-type devices.

Reduce friction and shear

SN educated patient/caregiver how reduce friction and shear: Use draw sheets for repositioning, encourage use of trapeze if possible, keep head of bed elevated 30 degrees if tolerated, elevate foot of bed slightly, if condition permits; use pillow or wedge to support hip for 30? side-lying, lateral position, utilize lifts and transfer devices, rehabilitation or Restorative care if indicated.

Manage Incontinence

SN educated patient/caregiver how manage incontinence: Timely cleansing, apply barrier ointment to intact skin, if skin is red or denuded use a paste, use appropriate incontinence disposables, apply fecal incontinence pouch if needed.

Skin Tear Prevention

SN educated patient/caregiver how prevent skin tear: Wash with gentle cleansing products, use emollients on skin, ensure adequate hydration/nutrition, transfer techniques to avoid friction/shear, support dangling extremities, avoid use of adhesive products on skin.

Venous Ulcer Prevention

SN instructed patient/caregiver how prevent venous ulcer: Use of compression stockings (contraindicated if ABI < 0.5), elevation of effected leg above level of the heart at rest, avoid use of products likely to be sensitizers (lanolin, fragrances), avoid trauma to legs, calf muscle strengthening, regular follow up to monitor ABI.

Prevention of Limb loss in Lower extremity arterial disease

SN instructed patient/caregiver how prevent of limb loss in lower extremity arterial disease: Consistent use of protective footwear, avoid friction, shear or trauma to feet/legs, apply emollients to keep skin pliable, avoid cold, caffeine, nicotine and constrictive garments, planned graduated walking program, no use of thermal devices, routine professional foot care.

Prevention of neuropathic ulcers

SN instructed patient/caregiver how prevent neuropathic ulcers: Control diabetes, daily care and inspection of feet, wear well-fitting protective footwear, avoid application of external heat, avoid use of OTC meds for corns/callous, avoid cold, caffeine, nicotine and constrictive garments, routine professional foot care.

Bony prominences

SN instructed the patient/caregiver to place a foam pad or soft pillow under all bony prominences to reduce pressure and injuries.

Change position Q 2 hrs.

SN educated patient/caregiver on importance of avoiding pressure to wound site: to promote healing Pt should shift /change position often; at least every two hours.

Dressing CDI (Clean/Dry/Intact)

SN educated patient/caregiver that the purpose of a wound dressing is to be an impermeable barrier to bacteria to keep the wound free from particles and toxic contaminants. To work effectively it is important to keeping the dressings clean, dry and intact.

Float heel

SN instructed the patient/caregiver to float Pt’s heels by elevating the Patient’s calves with a pillow. This elevation of the heels will eliminate pressure off of the heels.

Friction shear

SN instructed the patient/caregiver on methods to reduce friction and shear while repositioning Patient every two hours by placing a soft blank, pad or pillow under the Patient to avoid dragging the Patient across the mattress causing friction, shear or injury to the patient’s skin.

How scab works

SN educated patient/caregiver as to how a scab works: When your skin gets cut, your body springs into action to heal the wound. First, the body works to limit blood loss by reducing the amount of blood flowing to the wounded area. Proteins in blood, such as fibrin, work with the blood platelets already in place and plasma to form a protective covering called a scab. While your skin regenerates underneath the protective layer, the scab protects the wound from outside infection.

How we heal

SN educated patient/caregiver that a wound is gradually healed as new granular skin tissue begins to generate. Starting at the edges of the wound, the new tissue forms and works its way toward the center until it has covered the entirety of the lesion. Once the wound underneath has sealed itself with another skin layer, the scab will slough off on its own.

New skin is fragile

SN educated patient/caregiver that newly healed skin tissue isn’t like normal skin tissue it is very fragile and care must be taken not to re-injure the site.

Protein Diet

SN educated patient/caregiver that a diet to promote wound healing should include increased amounts of protein like from: meats, eggs and legumes.

Why wounds itch

SN educated patient/caregiver that wounds are sometimes itchy because of the new skin growth however, over time this will subside.

Wound care

SN educated patient/caregiver that purpose of wound care is to remove excess exudate & toxic compounds from the wound, thereby enhancing the healing process.

Diet/Vitamins

SN educated patient/caregiver that a diet to promote wound healing should include increased amounts of Vit “A”, Vit “C” and Vit “E”.

Vac/Problems

SN instructed patient/caregiver on trouble shooting wound vac. If there’s any abnormal sound you should read the display on face of vac and follow instructions accordingly. Ensure the vac is on suction at all times call SN for any problems. All drainage can be seen in the reservoir.

Vac/Purpose

SN instructed patient/caregiver on the use of wound vac: A wound vac will remove unwanted fluids and infectious material, reduce swelling and promote tissue formation and provide a moist environment.

Vac/How works

SN instructed patient/caregiver how wound vac works with negative pressure by drawing wound edges together by evenly distributing negative pressure across the edges of the wound. It provides direct and complete contact to the wound bed.