Page 11 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

are 22 times more likely to develop pressure ulcers than patients who are not incontinent of
5
stool. If moisture or moisture source cannot be controlled, protective barriers and moisture‐
absorbing products are recommended. See Topical Medicated Agents chart on page 46 for
more information.

If the patient is incontinent of urine and stool, fecal enzymes convert urea to ammonia, raising
the skin pH and making it more permeable to other irritants. Containment devices, such as
3
external pouches (e.g., rectal, ostomy, perianal), indwelling catheters, incontinence pads and
6,7
briefs to wick moisture away from the skin, are additional methods to protect patient skin.

3
Steps in a Skin Maintenance Regimen:
1. Cleanse skin with a pH balanced cleanser as soon as it is soiled
 Cleansing of the skin after each fecal incontinence episode is important because briefs
can trap stool against the skin.
2. Moisturize and lubricate skin. Moisturizers may be incorporated into commercially prepared
skin cleansers.
3. Apply a skin protectant (sealant, ointment and paste) depending on need:
 Skin sealants protect the skin from maceration, but have limited effectiveness at
protecting the skin from enzymes.
 Moisture barrier ointments protect the skin from enzymes, but may be inadequate if
excessive moisture is present.
 Pastes are appropriate with high‐volume output or diarrhea.

Shear injury:
Occurs when the skin remains stationary and the underlying tissue shifts. Most shear injuries
can be eliminated by proper positioning technique. Shear is exerted on the body when the head
of the bed is elevated; the skin is fixed against the linens, and the deep fascia and skeleton slide
down toward the foot of the bed. Shear also occurs when the individual sitting in a chair slides
8
down in the chair.

Friction injury:
Occurs when the skin moves across a coarse surface, such as bed linens. Voluntary and
involuntary movement by patients can lead to friction injuries, especially on elbows and heels.
Most friction injuries can be avoided by using proper positioning and transfer techniques. Do
not transfer patients by dragging them across the linens. Friction is common in individuals who
8
cannot lift sufficiently during a position change or transfer.

7