Nurses responsibilities in manintaining skin care

Nurses Responsibilities in Manintaining Skin Care

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ANATOMY AND PHYSIOLOGY

STRUCTURE OF THE SKINThe skin layers are divided into three:-1)Epidermis2)Dermis3)Subcutaneous layer

Epidermis

CELL TYPES 1)KERATINOCYTESThey become filled with a tough,fibreous

protien called keratin.2)MELANOCYTESThese contribute colour to the skin &serve to

decrease ultraviolet that can penetrate into deeper layers of the skin.

Cell layers

1)STRATUM CORNEUM It is called the barrier area of the skin becbecause it functions as a barrier to

water loss,although it may absorb surrounding water & to many environmental threats.

2)STRATUM LUCIDUM The keratinocytes here are loosely packed & clear.These cells are filled with a soft

gel like substance called eledin.This layer is seen in thick skin like soles of feet or palms of hands.

3)STRATUM GRANULOSUM The process of keratinization begins here.Cells are arranged in a sheet two to

four layers deep & are filled with granules called keratohyaline.

4)STRATUM SPINOSUM It is formed from 8-10 layers of irregularly shaped cells with desmosomes.Cells

here are rich in RNA,are well equiped to initiate protien synthesis.

5)STRATUM BASALE It is a single layer of columnar cells.Deeper cell layers have regenerative capacity.

DIAGRAM OF THE SKIN

DERMIS

The mechanical strength of the skin is the dermis.This layer provides reservoir storage area for water & electrolytes.It is composed of thin papillary layer & thick recticular layer.

SUBCUTANEOUS LAYER

Beneath the dermis this layer lies.It is rich in fat and areolar tissues.

DEFINITION

Bed bath is defined as cleansing the body of a dependent patient in bed

TYPES OF BED BATH

COMPLETE BATHIt is required for patients who are totally

dependent and require total hygeine.PARTIAL BED BATHInvolves bathing only body parts that would

cause discomfort or odor if left untreated.

PURPOSES OF BED BATH

To remove microbes,body secretions & dead skin cells.

To promote circulationTo promote a sense of well being.To prevent or eliminate body odor.To induce sleep.To regulate body’s temperature.To prevent bed sores.To provide active and passive exercises.

DECUBITUS ULCER/PRESSURE SORE/BED SORE-

DEFINITIONDecubitus ulcers also known as pressure

score or decubitii are ulcerated or sloughed area of tissue subjected to pressure from lying on matters or sitting on chair for a prolonged period of time resulting in the slowing of circulation and finally death of tissues

COMMON SITES

The pressure point in the supine position are back of the head,scapula,sacral region,elbow and heels in a slide lying position the pressure points are the ears acromion process of the shoulder,ribs greater trochanter of the hip medical and lateral condyles of the knee and malleolus of the ankle joint. In a prone position the pressure points are ears,check,acromion process,breasts,genitalia,knee and toes.

CAUSES

PRESSURE

Is considered to be the primary causes of the pressure sore. In a sick person,the area of tissue resting against the hatters are vulnerable areas The pressure in these area causes depletion of blood supply with the fallure of circulation to the weight bearing area resulting in the tissue damage The pressure over this areas are increased in the following conditions

(a)When there is lumps are creases on the bed (b)Incorrect positioning of the body (c)Infrequent change of position.

FRICTION Function of the skin with a rough or hard surface can cause tissue damage contact with

the rough surface of the bed wrinkles on the bed clothes hard surfaces of the plaster casts and splints presence of foreign bodies on the bed careless handling of bed pan pulling sheets under the patients etc are frequent cause of friction which cause tissue damage friction is also cause due to the rough sponge clothes and prolonged massage without lubricant

MOISTURE The skin contact with moisture for a period of time can lead to maceration of the skin

patients who are sweating profusely with incontinence of urine and stool are liable to pressure sores.

PREVENTION

Identification of patients who are particularly prone to the development of decubitus ulcer

2: Daily examination of the decubitus-prone patients for redness discoloration or blister on the pressure points and they should be reported and treated immediately.

3:Keep the patients clean and dry. 4:Change the position of the patient every two hours so that another body surface bears the weight. 5:use a bed cradle to take off the weight of the bed linen of the patient so as to enable him to move in bed

with case 6:Keep the patient’s skin well lubricated to prevent cracking by using powder 7:protect the damaged skin. Damaged skin can be further irritated and macerated by urine faces sweat

etc. 8:Provide the patient with adequate fluids and with a nourishing diet that is high in protein and vitamins 9:attend to the pressure points as often as necessary to stimulate circulation the patients who are liable to

bed sores must circulation the patients who liable to bed sores must have their back treated two hourly or more often the back is washed with soap and warm water dried and massaged with powder avoid using excess alcohol for back rub because it dries the skin and cause tissue damage.

10:Call assistace and lift the patient before giving and taking bed pans if the bed pan is chipped care should be taken to pad the bed pan to avoid friction.

11:Provide a smooth firm and wrinkle free bed on which the patient can take rest 12:use special mattresses and beds to decrease the pressure on body parts 13:Cut short the finger nails of the patient to avoid scratching on the skin 14:Use adequate amount of cotton under splints and plaster casts to prevent friction 15:Use the comfort devices to take off the pressure from the pressure points avoid using rubber rings

since they compress the area of the skin beneath them decreasing blood supply around the pressure point 16:Encourage the patient to move in bed as far it is allowed 17:Change the linen as soon as they become wet.The back and buttock also must be washed dried and

rubbed with powder after each urination and defection the back must be attended 18:Teach the patients and their relatives the hygienic care of the skin

TREATMENT

1:Report to the sister incharge and physician the early symptoms of a bed sore so that steps may be taken as early as possible to prevent further damage

2:whenever possible take off the pressure from the decubitus by placing the patient on pillows or form cushion or change the position of the patient

3:Prevent the ulcerated area from becoming infected. Infection will retard healing of an ulcer. Follow strict aseptic technique.

4: a cleaning agent is used to clean the ulcerated area. 5: Apply all the possible measures for the healing of the

wound .Heat is applied by an electric bulb. This is placed from 45 to 60 cm away from the wound and is left in place for 10 minutes.Application of a few drops of insulin dropped from a syringe has a healing effect on the wound. The wound is the exposed to air to dry.

GENERAL INSTRUCTIONS Maintain privacy of the patient. Explain the procedure to the patient. Wash hands before and after the procedure. Articles used should be clean. Prior all the articles must be set. Conserve the energy of the patient Remove the soap completely to avoid the drying effect of the soap

residue left on the patient’s skin. only a small area of the body should be exposed and bathed at a

time the wash clothes should be held with the corners tuck securely in

the palms of the hand to avoid dragging its cold and wet ends over the skin

Each stroke should be smooth and long rather than short and jerky. Support should be given to the joints in lifting the arms and legs

while washing and drying these areas.

Provide active and passive exercises whenever possible unless contraindicated.

Wash the hands and feet by placing them in the basin because it promotes thorough cleaning of the finger nails and toe nails.

cut short the nails ,if they are long Thorough inspection of the skin especially at the back should be done

to find out the early signs of bed sore. Redness in the skin, an excoriation of the skin etc.., should be reported immediately and treated adequately to prevent development of bed sores.

The skin surfaces should be included in bathing processes with special care in cleaning and drying the creases and folds the bony prominences etc. Since these parts are most likely to be excoriated by moisture, pressure, friction, dirt etc.

Special attention to axilla and groin should be given to prevent body odors.

Cleansing is done from cleanest to the less clean area .e.g. upper part of the body will be bathed before the lower parts.

Avoid bathing the patients immediately after the meal as it depletes the blood supply to the digestive organs and interfere with digestion.

The temperature of the water should be 110-115 degree fahrenheit for sponge bath.

Use only small amount of spirit in back care as evaporation of the spirit causes excessive cooling of the body.

The nurse should maintain good posture and balance of the body during bed bath. Keep the patient near to the edge of the bed to prevent over reaching and strain on the lower back.

Preliminary assessment includes the following:-

1) Check the physician’s orders to see the specific precautions if any regarding positioning and movement of the patient.

2) Assess the patient’s need for bathing.3) Assess the patient’s ability for self-care.4) Assess the vital signs5) Check the patient’s mental status to follow

instructions.Check the patient’s preference for soap, powder

6) Check the linen and equipment available in the patients unit.

EYE CAREDEFINITION

The process of cleansing one or both the eyes using prescribed solution for removing secretion and for preventing infection.

PURPOSES

1)to prevent discomfort and pain2)to prevent infection3) To prevent any further injury to the eye.4) To provide instillation of an eye drop or

application of an eye ointment.

BACK MASSAGEDEFINITION

It is the scientific form of the massaging the back using different massaging strokes to provide cutaneous stimulation to promote comfort.

PURPOSES

To relieve muscle spasm.To promote physical and mental relaxation.To stimulate circulation.To relieve insomniaTo assess the condition of the skin.

NAIL &FOOT CARE

It is defined as maintaining of hygiene to feet and hands by providing care to them.

PURPOSES

The purposes are listed below:-1) To keep the feet clean and dry.2) To teach the patient proper way to

inspect all the surfaces of feet and hands for lesions, dryness or signs of infection.

3) To trim the nails and keep they short to prevent injury.

4) To prevent accumulation of dirt and microbes underneath the nails.

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