Lesson 4 - Skin and Body Care
What you will learn in this lesson:
1. A caregiver’s role in client skin care, including:
- Promoting healthy skin;
- Routinely observing a client’s skin;
- Knowing the types of skin problems to look for;
- Documenting and reporting skin problems immediately.
Definition
Nurse Delegation : When an RN delegates nursing tasks to qualified NACs or NARs
Pressure ulcers or Pressure sores : Skin breakdown or injury caused by pressure that damages the skin and underlying muscle
Pressure points : Places on the body where the bone causes the greatest pressure on the muscles and skin
Self-Directed Care : When an in-home client directs an Individual Provider to help him/her with health related tasks
Skin breakdown : Any break in the skin, creating a risk for infection and further injury
Sterile dressing : A protective, bacteria-free, covering put on an injury
Pressure ulcers or Pressure sores : Skin breakdown or injury caused by pressure that damages the skin and underlying muscle
Pressure points : Places on the body where the bone causes the greatest pressure on the muscles and skin
Self-Directed Care : When an in-home client directs an Individual Provider to help him/her with health related tasks
Skin breakdown : Any break in the skin, creating a risk for infection and further injury
Sterile dressing : A protective, bacteria-free, covering put on an injury
1- Skin Care
The four important caregiving roles in client skin care include:
1. Promoting healthy skin.
2. Routinely observing a client’s skin.
3. Knowing the types of skin problems to look for.
4. Documenting and reporting problems immediately.
Skin is the first line of defense a client has to heat, cold, and infection. Skin changes as we age and sometimes because of a chronic illness. These changes can lead to the:
1. Promoting healthy skin.
2. Routinely observing a client’s skin.
3. Knowing the types of skin problems to look for.
4. Documenting and reporting problems immediately.
Skin is the first line of defense a client has to heat, cold, and infection. Skin changes as we age and sometimes because of a chronic illness. These changes can lead to the:
- Skin becoming thinner and dryer - tearing easier and not healing as easily;
- Loss of the layer of fat just below the skin, decreasing the ability to stay warm;
- Sweat glands losing the ability to cool in heat;
- Loss of the ability to feel pain, heat, or light touch.
Promoting Healthy Skin Care
There are five ways to help a client keep his/her skin healthy.
1. Keep skin clean.
2. Keep the skin dry.
3. Use moisturizing creams and lotions.
A caregiver can apply:
4. Encourage good nutrition.
1. Keep skin clean.
- Keep skin, nails, hair, and beards clean.
- Set up a routine bathing schedule.
- When bathing, use warm, not hot, water, and mild soaps. Monitor water temperature to avoid burns for any client who has lost the ability to feel heat.
- Take extra care to make sure skin folds are clean and dry for clients who are obese. Skin folds hold bacteria, dirt, and old skin cells.
- In-between baths, clean the skin as soon as you see something on it.
2. Keep the skin dry.
- Use pads or briefs that absorb urine and keep moisture away from the skin for clients with incontinence. Use a cream or ointment as further protection for the skin.
- Avoid using “blue pads” or disposable waterproof under pads that can hold moisture on the skin. A waterproof cloth pad that can be laundered and reused is a good alternative.
3. Use moisturizing creams and lotions.
- Gently apply lotion to dry skin regularly.
A caregiver can apply:
- Non-prescribed ointments or lotions (e.g. dandruff shampoo or body lotion to prevent drying of skin);
- Or change a band-aid in response to a first-aid situation.
- Change sterile dressings;
- Apply a prescribed lotion or ointment used to treat a condition (unless under Nurse Delegation or Self-Directed Care).
4. Encourage good nutrition.
- Diet contributes a great deal to healthy skin. Encourage a client to eat a healthy, well-balanced diet and to drink plenty of fluids (unless on a fluid restriction).
- Encourage a client to stay as mobile as possible.
- Encourage activities or exercise that help increase circulation.
Skin Problems a Caregiver May See
Pressure Ulcers (or Bed Sore) : Skin breakdown or injury caused by pressure and/or weakened skin that damages the skin and underlying muscle.
Stasis/Venous Ulcers : A chronically open area, caused by poor circulation of the blood in the veins. Early symptoms are a rash or a scaly, red area and itching.The skin around the ulcer becomes a discolored reddish-brown. This occurs most often on the lower legs and feet.
Arterial Ulcers: Round open areas on the feet and lower leg due to lack of blood flow to the legs.
Rashes and Infections: Most rashes are raised, red, bumpy areas on the skin that are often itchy. Skin infections are a break in the skin, like a scratch, where bacteria have spread and caused an infection.
Burns: Skin that is damaged by fire, sun, chemicals, hot objects or liquids, or electricity. Burns are classified according to how deeply the skin is damaged. 1st degree burns are when the skin is reddened and maybe swollen and tender. 2nd degree burns usually have blisters, intense redness, pain and swelling. 3rd degree burns are the most serious and involve all layers of the skin.
Skin Cancer/Lesions: Abnormal growth on the skin that usually doesn’t spread and is treatable. A more dangerous kind of skin cancer is melanoma. Melanomas are irregularly shaped and may be described as a “strange mole” or a mole that is changing. If a client has a strange mole, encourage him/her to contact his/her doctor.
Observe a client’s skin whenever you are doing personal care. Look at the client’s skin at least once a day.
What to Look For
Observe:
Reporting : Observing any of these signs could be an indication of a skin problem and should be reported to the appropriate person in your care setting.
Stasis/Venous Ulcers : A chronically open area, caused by poor circulation of the blood in the veins. Early symptoms are a rash or a scaly, red area and itching.The skin around the ulcer becomes a discolored reddish-brown. This occurs most often on the lower legs and feet.
Arterial Ulcers: Round open areas on the feet and lower leg due to lack of blood flow to the legs.
Rashes and Infections: Most rashes are raised, red, bumpy areas on the skin that are often itchy. Skin infections are a break in the skin, like a scratch, where bacteria have spread and caused an infection.
Burns: Skin that is damaged by fire, sun, chemicals, hot objects or liquids, or electricity. Burns are classified according to how deeply the skin is damaged. 1st degree burns are when the skin is reddened and maybe swollen and tender. 2nd degree burns usually have blisters, intense redness, pain and swelling. 3rd degree burns are the most serious and involve all layers of the skin.
Skin Cancer/Lesions: Abnormal growth on the skin that usually doesn’t spread and is treatable. A more dangerous kind of skin cancer is melanoma. Melanomas are irregularly shaped and may be described as a “strange mole” or a mole that is changing. If a client has a strange mole, encourage him/her to contact his/her doctor.
Observe a client’s skin whenever you are doing personal care. Look at the client’s skin at least once a day.
What to Look For
Observe:
- Redness or other changes in coloring
- Swelling
- Changes in temperature (warm or cold)
- A break in skin
- Rashes, sores, or a gray or black scab over a pressure point
- Odor
- Pain
Reporting : Observing any of these signs could be an indication of a skin problem and should be reported to the appropriate person in your care setting.
Pressure Ulcers
What causes pressure ulcers
Immobility is the number one cause of pressure ulcers. When a person sits or lies in a position too long without moving, the weight of his/her body puts pressure on the skin and muscle. The pressure can be from a bone pressing against another part of the body or from a mattress or chair. This unrelieved pressure cuts off blood supply to the skin. Without a blood supply, the skin - and eventually the muscle under it - dies and a pressure ulcer forms.
The amount of pressure needed to cause a pressure ulcer ranges from a small amount of pressure for a long time to high pressure for a short time.
Pressure ulcers can also be caused when the skin is weakened by:
- Friction;
- Too much moisture on the skin;
- Dryness and cracking;
- Age;
- Irritation by urine or feces;
- Lack of good nutrition and/or drinking enough fluids;
- Certain chronic conditions or diseases - especially those that limit circulation.
High risk for pressure ulcers
Clients who are fully or partially immobile or with weakened skin are at high risk for getting a pressure ulcer. This includes clients:
In wheelchairs or who spend a lot of time in a chair or bed;
- Who have had a pressure ulcer in the past;
- Who are paralyzed;
- Who have unmanaged incontinence;
- With poor nutrition or dehydration;
- With a chronic illness, like diabetes, that decreases circulation;
- With cognitive impairments that make him/her forget to move;
- Who have a decreased ability to feel sensation;
- Who are obese or too thin.
What pressure ulcers look like
What a pressure ulcer looks like depends on how severe it is. The first signs of a pressure ulcer include:
- Redness on unbroken skin lasting 15-30 minutes or more in people with light skin tones. For people with darker skin tones, the ulcer may appear red, blue, or purple. If in doubt, compare the area to the other side of the client’s body.
- Any open area - it may be as thin as a dime and no wider than a Q-tip.
- An abrasion/scrape, blister, or shallow crater.
- Texture changes - the skin feels “mushy” rather than firm to the touch
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Pressure points
Pressure points are likely areas for pressure ulcers.
Pressure points are likely areas for pressure ulcers.
What to do if you see a problem
Anytime you see redness on unbroken skin or feel heat in the area lasting 15-30 minutes or more - especially at a pressure point:
Do not:
Anytime you see redness on unbroken skin or feel heat in the area lasting 15-30 minutes or more - especially at a pressure point:
- Reposition the client off of the red area immediately to remove pressure from the area.
- Report it to the appropriate person where you work. Make sure you know ahead of time who to report to about this kind of situation. Document your concerns.
Do not:
- Massage the area or the skin around it.
- Use a heat lamp, hair dryer, or “potions” that could dry out the skin more.
Changing a Client’s Position
A client needs to change position frequently to protect his/her skin. A pressure ulcer can start in as little as one to two hours for clients in bed and unable to move. Clients who sit in chairs and can’t move can get pressure ulcers in even less time because the pressure on the skin is greater.
Caution
A client confined to bed should change position at least every 2 hours. A person confined in a chair or wheelchair should shift his/
her weight in the chair at least every 15 minutes for 15 seconds and change position at least every hour.
Preventing friction to the skin
Friction is caused when skin is rubbed against or dragged over a surface. Even slight rubbing or friction on the skin may cause a pressure ulcer - especially for those clients with weakened skin.
Special care by a caregiver must be made when transferring and positioning a client. A client must always be:
Skill: Turn and Reposition a Client in Bed
1. S.W.I.P.E.S.
2. Bend client’s knees.
3. Before turning client, move client’s body towards self.
4. Place your hands on the client’s hip and shoulder and gently roll the client over on his/her side away from you.
5. Position client in proper body alignment:
7. Remove gloves (if used) and wash hands as final step.
The following are general tips to remember when repositioning a client.
Skin care tips for positioning a client confined to a bed or chair
Caution
A client confined to bed should change position at least every 2 hours. A person confined in a chair or wheelchair should shift his/
her weight in the chair at least every 15 minutes for 15 seconds and change position at least every hour.
Preventing friction to the skin
Friction is caused when skin is rubbed against or dragged over a surface. Even slight rubbing or friction on the skin may cause a pressure ulcer - especially for those clients with weakened skin.
Special care by a caregiver must be made when transferring and positioning a client. A client must always be:
- Lifted - not dragged when transferring;
- Positioned in a chair or bed correctly so he/she cannot slide down;
- Positioned on smooth linen or clothing.
Skill: Turn and Reposition a Client in Bed
1. S.W.I.P.E.S.
2. Bend client’s knees.
3. Before turning client, move client’s body towards self.
4. Place your hands on the client’s hip and shoulder and gently roll the client over on his/her side away from you.
5. Position client in proper body alignment:
- Head supported by pillow;
- Shoulder adjusted so client is not lying on arm and top arm is supported;
- Back supported by supportive device;
- Top knee flexed, top leg supported by supportive device with hip in proper alignment.
7. Remove gloves (if used) and wash hands as final step.
The following are general tips to remember when repositioning a client.
- Make sure there is room to roll the client.
- Tell the client to look in the direction they are being rolled.
- Do not roll the client by pulling or pushing on his/her arm.
Skin care tips for positioning a client confined to a bed or chair
- A special mattress that contains foam, air, gel, or water may be used. A doctor or the case manager can help the client get special equipment. Check the mattress daily to make sure it is working properly.
- Do not use donut-shape cushions. They reduce blood flow and cause tissue to swell. This increases the risk of a client getting a pressure ulcer.
- Choose a position that spreads weight and pressure most evenly.
- Use pillows or wedges to keep knees or ankles from touching each other.
- Place pillows under the client’s legs from mid-calf to ankle to keep a client’s heels off the bed if a client can’t move at all.
- Never place pillows directly behind the knee. It can affect blood circulation and/or increase the risk of blood clots.
- Be cautious about raising the head of a bed. This puts more pressure on the tailbone and allows the client to slide, possibly causing a pressure ulcer.
- Lying flat can be a problem for clients who have difficulty breathing. If this is the case, the head of the bed should not be raised at more than a 30° angle, unless necessary for breathing.
- Avoid positioning a client directly on the hipbone when he/she is lying on their side. Tuck pillows behind a client’s back when in this position.
Module Scenario
Mr. Bernard is a 44-year-old client who had a stroke (CVA) six months ago. The results from the stroke have left Mr. Bernard depressed. He has weakness on his left side and needs help with many care tasks including positioning himself in bed. Since this morning, Mr. Bernard has refused to get out of bed and has stayed in the same position for several hours.
RESEARCH:
Review Common Diseases and Conditions. stroke (CVA) and depression.
PROBLEM SOLVE:
1. Identify what problem(s) a caregiver needs to address in this situation.
2. Pick one problem and brainstorm ways to solve it. Pick a solution.
3. How does this impact how a caregiver provides care?
DEMONSTRATE
One group will demonstrate for the class repositioning Mr. Bernard in his bed, making sure to avoid pressure on areas at risk for skin break down.
RESEARCH:
Review Common Diseases and Conditions. stroke (CVA) and depression.
PROBLEM SOLVE:
1. Identify what problem(s) a caregiver needs to address in this situation.
2. Pick one problem and brainstorm ways to solve it. Pick a solution.
3. How does this impact how a caregiver provides care?
DEMONSTRATE
One group will demonstrate for the class repositioning Mr. Bernard in his bed, making sure to avoid pressure on areas at risk for skin break down.
2- Personal Hygiene
What you will learn in this lesson:
Your role in helping a client perform personal hygiene, bathing, body care, and getting dressed.
Definition
Body care : Helping the client with exercises, skin care, and changing dry bandages
Personal hygiene: Cleaning and grooming of a person, including care of hair, teeth, dentures, shaving, and filing of nails
Range of motion : How much a joint can move
Personal hygiene
Personal hygiene is a very important part of helping to keep a client’s skin and body healthy. Being well-groomed is also an important psychological and physical boost for most people. This lesson covers the personal hygiene tasks you may be asked to help a client do.
Mouth care
Proper care of the mouth and teeth supports a client’s overall health and helps prevent mouth pain, eating difficulties, speech problems, digestive problems, tooth decay, and gum disease.
To help prevent decay and gum disease, teeth should be brushed twice a day with fluoride toothpaste (if available). It is even better to
brush after every meal. Teeth should be flossed at least once a day to clean between the teeth where the brush misses.
Watch for, document, and report any sore areas in the mouth, changes in tissue, complaints a client may have in eating comfortably,
or anything unusual inside the client’s mouth.
See the Resource Directory for more information on gum disease, dry mouth, and oral cancer.
Your role in helping a client perform personal hygiene, bathing, body care, and getting dressed.
Definition
Body care : Helping the client with exercises, skin care, and changing dry bandages
Personal hygiene: Cleaning and grooming of a person, including care of hair, teeth, dentures, shaving, and filing of nails
Range of motion : How much a joint can move
Personal hygiene
Personal hygiene is a very important part of helping to keep a client’s skin and body healthy. Being well-groomed is also an important psychological and physical boost for most people. This lesson covers the personal hygiene tasks you may be asked to help a client do.
Mouth care
Proper care of the mouth and teeth supports a client’s overall health and helps prevent mouth pain, eating difficulties, speech problems, digestive problems, tooth decay, and gum disease.
To help prevent decay and gum disease, teeth should be brushed twice a day with fluoride toothpaste (if available). It is even better to
brush after every meal. Teeth should be flossed at least once a day to clean between the teeth where the brush misses.
Watch for, document, and report any sore areas in the mouth, changes in tissue, complaints a client may have in eating comfortably,
or anything unusual inside the client’s mouth.
See the Resource Directory for more information on gum disease, dry mouth, and oral cancer.
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