Skin Care for the Caregiver

Philadelphia 2011Association for the Advancement of

Wound Care

Why Are We Here?

To better understand human skin Learn what factors effect skinLearn how to identify skin damageLearn how to care for & protect skin

Our Targets

Skin is essential• Forms a barrier - prevents harmful substances

and microorganisms from entering the body. • Protects body tissues against injury. • Controls the loss of life-sustaining fluids like

blood and water. • Helps regulate body temperature through

perspiration.• Protects from the sun's damaging ultraviolet rays.

Skin

• Largest organ of the body

• Every square inch of skin contains thousands of cells and hundreds of sweat glands, oil glands, nerve endings, and blood vessels.

• Skin is made up of three layers: the epidermis, dermis, and the subcutaneous tissue.

Epidermis Layer

Epidermis• Epidermis is the tough, protective outer layer

– It's about as thick as a sheet of paper over most parts of the body

• It has layers of cells that are constantly flaking off and being renewed

• Cells are completely replaced about every 28 days

• Minor cuts and scrapes heal quickly

Dermis

Dermis• Dermis – 2nd layer of skin. It contains:

– blood vessels, nerve endings, and connective tissue• connective tissue comprised of collagen and elastin

– helps skin stretch when we bend & reposition when we straighten up

– in older people, elastin degenerate - one reason why the skin looks wrinkled

– sebaceous glands - produce the oil sebum that lubricates the skin and hair

• sebum producion slow w/ age - contributes to dry skin

Subcutaneous Layer

Subcutaneous Tissue

• Subcutaneous tissue, is made up of connective tissue, sweat glands, blood vessels, and cells that store fat.

• Layer helps protect the body from blows and other injuries and helps it hold in body heat

What Are the Risks to Skin

• Elderly skin changes – gets dryer, fat layer thin out that protects underlying structures

• Moisture……. damages skin• Urine/ Feces……erodes skin• Pressure……. decreases blood flow and tissue dies

Risk Factors

IncontinenceUrine and/or fecal

Pressure Points

Pressure Points

Pressure Points

Tissue Damage

• Insufficient amounts of oxygen and nutrients delivered to skin tissue will become damaged

• When ‘pressure’ compresses blood vessels in the tissues and decreases oxygen/nutrients – the tissue damage is know as a pressure ulcer

Stage I Pressure Ulcer

Stage I - Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Stage I

Stage II Pressure Ulcer

Stage II - Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Stage II

Stage III Pressure Ulcer

Stage III - Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Stage III

Stage IV Pressure Ulcer

Stage IV - Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Stage IV

Tissue Damage Progresses

Skin Tears

Skin Erosion Due to Incontinence

Care Issues

• Properly position and frequently turn patient off of pressure points

• Use pressure relieving devices, as needed• Protect fragile skin w/ protective dressings or

protective materials• Keep skin moisturized • Cleans skin w/with non-toxic cleansers• Protect skin exposed to incontinence w/ skin

protective barriers and creams

Positioning

Positioning

Pressure Relief

Pressure Reduction Overlay

Pressure Reduction Overlay

Alternating Pressure Mattress

Pressure Relief

Skin Tear Protection

Pressure Relief

Wound Care• Ensure hands are cleanse before changing

dressings• Use only sterile products, as ordered by

physician• Use dressing appropraitely to provide a moist

healing environment:– Wide variety of dressing types: e.g. hydrocolloids,

foams, antimicrobial dressings, hydrogels, specialty absorptive dressings, collagen, etc.

Summary• You are essential

• You can identify early pressure ulcer development and help avoid

progression of skin damage

• You can be the ‘eyes’ for the clinician and warn them of early changes to skin integrity