Concordia Home Care and Nursing Services LLC Concordia Health Mobile Lab
Skin Care: Guidelines for Ensuring Skin Integrity-delete
Participants will be able to:
• Understand the structure and functions of the skin
• Understand what happens to the skin as people age
• Understand how to care for elderly patients’ skin and how to prevent skin problems
• Be able to recognize and report skin problems
Dermis: The thicker layer underneath the surface. The dermis contains:
• Blood vessels: Tubes that carry blood through the body, with oxygen and food
• Nerves: Fibers that carry sensations to and from the brain
• Oil glands: Organs that secrete an oily lubricating fluid
• Sweat glands: Organs that separate waste products from the blood and secrete them as sweat
• Hair follicles: Organs that create hair
Fatty tissue: Layer of fat under the skin. While not part of the skin, the fatty tissue provides a protective layer of padding (to prevent injury to underlying bones and muscles) and insulation (to keep heat in).
Functions of Skin: What Skin Does
1. Controls body temperature:
• Releases heat through sweat
• Constricts and expands surface blood vessels to insulate or cool the body
2. Protects against injury and disease:
• Covers and pads muscles and bones, preventing damage
• Forms a barrier against harmful organisms and infection
3. Provides sensations:
• Nerve endings sense danger
• Sensitive to pressure, pleasure, pain, and temperature
4. Creates vitamin D:
• Skin is the primary source of Vitamin D, which is activated through sunshine
5. Cares for itself:
• Self-lubricating with oil glands
6. Warns of disease:
• Changes in color, temperature, or moistness may signal illness
The Aging of Skin: What Happens
• The skin and fatty tissue layer get thinner
• The skin becomes less elastic due to changes in connective tissue
• Oil glands produce less oil, so skin is dry
• Blood vessel walls get thinner and more delicate, so they break easily
• Circulation of the blood slows down, so the skin is not getting as much oxygen and nutrition from the blood, causing the skin to become poorly nourished and fragile
Because of these changes in the skin, older people:
• Tend to feel cold due to thinning of fatty tissue layer
• Suffer from skin tears due to thinning of the epidermis and fatty tissue layer
• Heal slowly due to blood vessel changes and other disease processes common in the elderly (diabetes, poor immunity, heart disease)
• Become wrinkled due to loss of elasticity of connective tissue
• Develop pressure sores due to loss of fatty tissue padding and decrease in circulation
Caring for Older Skin: What to Do
Keep skin clean:
• Pat skin, don’t rub when washing or drying
• Use powder sparingly—excess powder can cause irritation
Keep skin lubricated:
• Use lotions liberally and avoid heavily perfumed soaps/lotions
• Frequent bathing with soap will dry the skin—use lotion cleansers
• Consider bathing two to three times per week
• Keep skin creases and folds dry
• Keep clothes and bedding dry
• Eat nutritious food and drink lots of water
• Change position often to improve circulation and prevent pressure sores
• Don’t disturb moles, skin tags, or dark spots on the skin
• Massage the skin, but avoid bony projections and irritated areas: Massage around but not directly on them
• Use chair or bed cushions
• Observe skin daily for changes and report any of the following changes to the nurse
–– Redness in the skin, especially over bony projections or high-risk areas such as coccyx, sacrum, hips, heels, elbows, ears, back skull
–– In darker-skin patients, observe skin for areas that are either darker or dark bluish-purple tint or a lighter skin color compared to surrounding areas
–– Rashes or patient itching/scratching
–– Open skin areas such as skin tears with or without bleeding
–– New bruising or red areas
–– Changes in skin temperature (warm or cool)
–– Complaints of pain or burning
–– Weeping of the skin or increase drainage from wounds
Decubitus ulcers (bed sores or pressure sores)
• Sustained pressure on the skin compresses the blood vessels and prevents nutrition and oxygen from getting to the skin cells. Over time, the skin tissue dies and decubitus ulcers develop.
• The skin is under pressure where the bones press against the skin tissue, especially when the weight of the body or a body part is pushing down on a pressure point. In patients with chronic illness or the elderly, the loss of the fatty tissue layer makes the patient more susceptible to pressure.
• Body fluids such as urine and feces contain damaging chemicals. When they remain on the skin, they cause moist areas that become irritated and develop sores.
• Friction from clothing or bedding can injure the skin and lead to skin breakdown.
What to report to the nurse, doctor, or supervisor
• A red pressure area that does not become normal after 20 minutes without pressure
• A reddened area of the skin that does not turn white when you push on it
• In darker-skin patients, observe skin for areas that are either darker or dark bluish-purple tint or a lighter skin color compared to surrounding areas
• Skin warm or cold to touch
• Any opening in the skin, tears in skin, blisters, craters, rashes
Be especially alert when you are caring for patients that are frail, have limited ability to move, or have poor nutrition.
Patients with little or no feeling in parts of the body, such as stroke victims, must be watched because they don’t feel pressure spots and may not change position as often as they should.
Preventing skin problems
Encourage or assist patients to:
• Change position, walk or exercise every 1 to 2 hours
• Keep their skin clean, dry, and moisturized
• Keep their bedding free of wrinkles
• Encourage good nutrition and fluid intake.
For patients that are in chairs/wheelchairs for long periods of time:
• Encourage or assist them to stand, walk, or shift their weight every 15 to 30 minutes.
• Teach them how to do chair push-ups with their arms.
• Teach them to sit with their knees at the same level as their hips, with their thighs horizontal to the chair. This will distribute their weight along their thighs and away from pressure points.
For patients that use special chair cushions, check to be sure that the pads are thick enough to do the job. Place your hand under the pad while the patient is on top of it—if you can feel the patient’s body through the cushion, the pad is too thin.
If a patient cannot do these things, he or she should return to bed after an hour in a chair.
For patients that are in bed most of the time:
• Teach them how to use side rails and the trapeze to change position frequently, at least every one to two hours. Be available to assist them if necessary. Even small shifts in body weight are helpful.
• When you are assisting a patient to change position, move him or her carefully so you do not create friction and shearing between the skin and the bedding or clothes.
• The head of the bed should be raised as little as possible, no more than 30 degrees, to prevent sliding and pressure on the bony areas. If it must be raised higher for eating, it should be lowered an hour later.
• Massage the skin when possible, but avoid massaging pressure points or irritated areas.
• For patients that use mattress overlay pads, check to be sure that the pads are thick enough to do the job. Place your hand under the pad while the patient is on top of it—if you can feel the patient’s body through the cushion, the pad is too thin.
• Use comfortable pillows to protect bony projections and reduce pressure between legs.
• Elevate heels off the mattress using a pillow under the calves.
For patients with pressure sores:
• Keep weight and pressure off any reddened areas and wounds If the patient has wound care dressing on pressure sores, notify the nurse if any of the following:
• Changes in skin color surrounding dressing
• Drainage soaked through dressing or leaking around the dressing
• Dressing not intact to skin
• Increase drainage or change in the odor of drainage
• Swelling in area
• Increase pain or discomfort verbalized by the patient