Caregivers can help prevent skin breakdown for people in hospice
By Lauri Weiss, CRNP
Hospice-palliative care nurse practitioner Lauri Weiss presents a three part series on skin care for hospice patients. In her last post, Lauri talked about how physical changes from advanced illness can alter skin function at end of life.
Skin can become fragile for hospice patients. As a caregiver, there are things you can do to prevent skin breakdown for people with advanced illness. Pressure, moisture, and trauma can all cause skin breakdown, so setting goals of reducing or minimizing undue pressure, assisting with mobility and keeping skin clean and moisturized can make a big difference.
The most common cause of skin breakdown is pressure. Pressure ulcers are areas of local tissue damage, usually developing where soft tissue is compressed between a bone and any external surface. The following interventions help to reduce/minimize pressure and prevent pressure ulcers:
- Use specialty support surfaces for bed and chair (gel overlays, air overlays and air mattresses)
- Encourage activity, as tolerated
- Assist with range of motion activity to all extremities
- Turn and reposition every 2 hours while in bed and encourage minor shifts in body position while sitting every 30 minutes
- Use lift sheets when repositioning
- Support lower extremities so heels are suspended off the bed
Another common cause of skin breakdown at end of life is incontinence. Moisture and enzymes from urine and/or stool cause skin damage that is characterized by inflammation of the surface of the skin with redness, weeping, and in more severe cases, blistering or erosion. Here’s what you can do to help prevent and treat skin damage caused by incontinence:
- Gently cleanse skin from front to back with a pH balanced product after each incontinence episode
- Pat skin dry – do not rub
- Apply a moisture barrier cream liberally after each incontinence episode to help prevent and treat irritation
- If an incontinence pad or brief is necessary, use a product that wicks fluid away from the body and is not too tight or constrictive
Traumatic wounds cause skin tears. The majority of skin tears are caused by falls; routine activities, such as dressing and bathing; repositioning people or bumping extremities against wheelchairs, bedrails or other hard objects. Try these solutions to help prevent traumatic wounds:
- Use protective skin sleeves and leggings
- Remove objects that are potential causes of trauma
- Pad bed rails and hard edges of wheel chairs or furniture
- Use gentle pH balanced skin cleansers and daily application of lotion to moisturize skin
- Take care with transfers and provide “gentle” personal care
- Keep fingernails and toenails short—for both the caregiver and the patient
Even though it is not possible to prevent all cases of skin breakdown at end of life, these tips are effective ways to reduce the risk of developing a wound. My next post will discuss treatments that promote comfort and dignity when, in spite of our best preventative efforts, skin breakdown does occur.