#skin breakdown

[yvonnerknight]

Breakdowns are literally a pain in the butt

Duoderm and Neosporin with pain relief really said my skin. My wheelchair cushion is causing major damage my skin. At first I was a little timidated to use duoderm because most of the skin was gone. Only after a day the skin is completely healed. I also took time to lay on my side during the day to get out of the chair.

[internationalnursesassociat-blog]

Patients with Skin Breakdown

With skin being the largest organ, covering and protecting the entire outside of the body, it has to be very durable. The skin is tough and provides protection from heat, light, chemical and physical conditions.  Skin receives one third of the body's blood circulation, and plays an important role within the immune system.  

The layers of Skin

Epidermis- this is the outermost layer of the skin.  This layer contains mainly dead skin cells, which are continuously being shed and regenerated.  

Dermis- this is the second layer of the skin, which consist of sweat glands, oil glands, nerve endings, and small blood vessels. These are all held together by a protein known as collagen. Collagen plays a major factor in keeping skin looking young, pliable and protected.  Collagen also helps prevent injuries to an extent, however, any wound to the epidermis or dermis can leave the body susceptible to infection.

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Bedridden patients

For patient’s lying in bed 24/7 skin is always susceptible to breakdown. When this occurs, the skin may have been under pressure for quite some time, and not received enough air and is very vulnerable. It’s at this point skin may break down and tear almost as if it’s paper thin. This can create sores and if the patient continues to lay on them they can become infected. Because the patient is lying in bed at all times, conditions may not be adequate for skin to not be under constant pressure. Patients must be turned repeatedly throughout the day to ensure against skin breakdown. The patient’s temperature should be monitored to ensure they’re not too warm, and bed linens should be kept clean at all times.  For patients suffering from paralysis, such as a  stroke patient, they may not have full sensation in their body, and skin breakdown may happen without causing them pain, it’s important that checks on skin be conducted multiple times, every day.  Paralysis   affects the skin and underlying tissue. When there is a lack of collagen, it results in weakening the skin, making it less elastic that combined with the lack of muscle function around the bony areas of the body can result in less padding which in turn adds to the risk of skin breakdown.    Most patients with paralysis have great difficulty in shifting their body or repositioning them, which makes them at even higher risk for skin breakdown.    Paralysis patients also lack the sensation of feeling so they may not be aware when the sores begin developing or skin breakdown starts to occur.

Levels of skin breakdown

Skin breakdown can vary widely. It can be minor and consist of scrapes or minor tears, and small blisters. More severe cases consist can of gaping cuts, severe blisters. Burns or the more serious ulcers called pressure ulcers. Pressure ulcers can be very serious and could even require surgery, reaching very deep down to the bone, causing the patient to have a lengthy hospitalization.

Keeping the patient’s skin healthy

Prevention of skin breakdown should be key in caring for a patient. Patients at risk for skin breakdown should be turned multiple times daily, and should have their skin checked daily. The skin should be kept clean and dry at all times. Bed linens should be changed regularly and any sign of skin breakdown should be reported to the patient’s physician and should also be monitored very closely. For obese patients that are unable to move on their own a lift may be used to help turn them on their side, giving their back side a rest. Many patients may resist being turned and moved however, it is imperative that this is done to prevent skin breakdown.

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Skin breakdown for hospitalized patients can cost in the billions. It is estimated that one in seven patients over age 70 that are hospitalized for more than five days will suffer some form of skin breakdown. With elderly patients, the risk of his death increases as the skin breakdown can cause infections that may be resistant to antibiotic treatments. There are cushions made of  dry moisture wicking material that may be beneficial for bedridden patients, however, it is still important to see the patient is moved several times per day. Patients confined to bed should have regular exercise and physical therapy, which in itself should help prevent skin breakdown. Muscles need to be kept active in the patient should continue to receive physical therapy regardless of age or medical conditions, unless the physician directs otherwise. Keep in mind that if skin breaks down what may appear to be a small bedsore could actually be going under the skin and could be quite severe, so be sure to alert physicians to any possible bedsores or skin breakdown areas.

All skin breakdown cannot be prevented, but keeping patients dry, clean, and repositioning them multiple times a day can help significantly in lowering the risk of skin breakdown.

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