Skin Care and the Individual with Alzheimer's Disease
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- 1. SKIN CARE and the INDIVIDUAL WITH ALZHEIMERS DISEASE Panelists: Judy Nelson,Gale Davis,Dana Raborg September 28, 2007
2. Skin Care
- Skin is our lifelong protection from heat and cold, sun, undue exposure to germs or harsh chemicals, and injuries of all kinds.
- Skin care refers simply to the ways we protect our skin on an everyday basis by:
- applying lotion
- cleaning a cut with soap and water
- using sunscreen outdoors
- eating a balanced diet
- preventing injuries such as burns, and
- seeing a dermatologist when necessary.
3. IDENTIFYING RISK FACTORS RiskFactors IMMOBILITY DECREASED LEVEL OF AWARENESS OR DECREASED SENSATION INCONTINENCE POOR NUTRITION/LOW WEIGHT ANEMIA, DIABETES OR OBESITY DEHYDRATION Aging in general causes skin to be fragile as the layers thin and lose their elasticity. Other risk factors are: 4. IDENTIFYING RISK FACTORS Most skin wounds begin in facilities, both in hospitals and in nursing homes . It is estimated that over 70,000 people in America die each year from wound infections that begin with skin breakdown or pressure sores. Other names for this injury are pressure ulcers, bed sores ordecubitusulcers. There are four stages of skin ulcers, from Stage I, the most superficial, to Stage IV, the deepest, extending into the muscles. These sores are slow to heal and easily infected, so prevention is paramount. STAGE I(most superficial) STAGE IV(deepest) 5. IDENTIFYING RISK FACTORS
- MEDICATIONS can affect the skin by:
- Increasing sensitivity to sunlight . Examples: doxycycline, amiodarone, hydrochlorothiazide.
- Causing dehydration . Dehydration can result in dry skin and other changes in the skin. Examples: furosemide.
- Increasing risk of bruising . Examples: warfarin, clopidogrel, aspirin, gingko.
- Impairing wound healing . Steroids (topic and oral) can cause wounds to heal more slowly. Examples: hydrocortisone, prednisone.
- Causing nutritional deficiencies . Medications can worsen nutritional status by impairing vitamin absorption, causing dry mouth and loss of appetite, or impairing swallowing. Poor nutrition can affect the skin.
- Check for warnings on the prescription vial or patient leaflet regarding risk of bruising or sun sensitivity.
- Discuss possible skin-related medication effects with your pharmacist or prescriber.
6. SKIN ULCER TYPES, CAUSES AND CARE 1 PRESSURE SORES 2 3 SHEARING INJURIES FRICTION INJURIES 7. SKIN ULCER TYPES, CAUSES AND CARE
- Pressure sores are most frequently caused by prolonged pressure on a vulnerable area a bony prominence like the hip, heel, tail bone, or ankle. When skin is squeezed between bone and the mattress or a chair, the pressure limits blood flow to the area. Within hours, this can lead to tissue death.
- Always roll a person from side to side and gently remove soiled linen without pulling against the skins surface.A person who cant move in bed can develop a pressure sore in as little as two hours . Damp skin presents the greatest risk, so wet or soiled clothing and bedding must be changed quickly.
8. SKIN ULCER TYPES, CAUSES AND CARE
- Friction injuries usually occur when skin rubs against a resistive surface like a sheet . When linen is pulled forcefully out from under a person, such an injury can easily occur.Always roll a person from side to side and gently remove (rolling up) soiled linen without pulling against the skins surface!
- Shearing injuries occur when a persons skin tends to stick to the bed or chair and pulls away from the underlying tissue as they slide down or are pulled or turned . The outer layer of skin can become separated from its blood supply just below the surface. These shearing forces frequently result indecubitus ulcers .
- Inspect skin every day several times for people confined to bed or chair. Pay special attention to pressure points or moist areas, and report any sign of redness or injury to a professional to check the area right away.
- Reducing friction by making sure aperson is LIFTED and NOT DRAGGEDduring repositioning, and that linen is rolled, not yanked or pulled out from under him or her will prevent many injuries.
- Clean soiled or wet skin quickly . Ideally, skin should be cleaned as soon as it is soiled. When that is not possible, use pads or briefs that absorb moisture and keep it away from the skin. Stool needs to be removed immediately.
- Daily bathingis necessary for comfort and cleanliness.
- Use lotions, creams or oils to prevent dryness and cracking . Powder and lotion are both fine but together they can make a paste. Use one or the other for any one part of the body. Cornstarch can soothe like powder.
- Change positions at least every two hoursin chair or bed to limit pressure over boney parts.
- Lift, dont drag a person during repositioning, and roll linen, dont yank or pull out from under the person . This will reduce friction and prevent many injuries.
- Avoid donut-shaped rings or cushionsas they can cause pressure on the skin over the sacrum.
- In Bed:
- Keep heels off the bed at all times propped on pillows or person lying on side.
- Use pillows for support or protection , such as for heels, elbows, or between legs.
- Keep the head of the bed low(30 degrees at the most) to prevent shearing injuries.
- Use cornstarch-like powder to smooth over rough surfacesin bed.
12. RESOURCES and DISCUSSION
- Discuss solutions atwww.alzpossible.org(click on forum)
- Resources and references will continue to be posted on the newsletter (www.alzpossible.org/newsletter/jul07.html)
13. TODAYS PANELISTS Judy Nelson, BS, RNis the Adult Care Services Manager for Senior Connections, The Capital Area Agency on Aging in Richmond, Virginia. As such, she manages grants for respite and short term home care and assists families in assessing their care needs and finding resources in the community. For the past three years she has helped to organize and co-teach a week long seminar for family caregivers with Dr. Ayn Welleford and the VCU Department of Gerontology.Ms. Nelson is a graduate of theUniversity of Vermont with a Bachelor of Science in Nursing, and has worked at New York University Hospital in pediatrics, at Virginia Commonwealth University Medical Center as a consultant and in public health nursing for the past 12 years. Gale Davis, MSjoined the VCU Department of Gerontology staff in Fall, 2006.She is a Masters Degree in Gerontology from VCU and undergraduate in Social Work from JMU.She is a Professional Geriatric Care Manager and member of the National Association of Professional Geriatric Care Managers. She teaches the courseThe Business of Geriatric Care Managementfor the Department of Gerontology.In addition Gale is the clinical site coordinator for GCM students at Senior Solutions of Richmond, a home care provider agency with a GCM practice.Gales work as Geriatric Care Manager started at Jewish Family Services of Richmond where she started their GCM Program and practiced there for 5 years.Dana RaBorg, RNhas worked with Hill-Roms home care division for over 5 years providing the appropriate products to patients at risk for and with active decubitus ulcers. Dana provides inservicing to the staff of Home Care Agencies and Assisted Living Facilities in the Richmond and surrounding areas. She has received extensive training in pressure ulcer prevention and management of pressure ulcers through Hill-Rom. She also gained much knowledge of preventing and managing pressure ulcers while working as a Home Health nurse and also as being the Director of Nursing for Long Term Care facilities in the Richmond area.