Skin care and hygiene

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SECTION 14
Skin care and hygiene
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Skin care and hygiene

• What the skin does
• How stroke affects skin
• Effective skin care
• Cleaning the contracted hand
• Hygiene and incontinence

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Skin

• The skin is the largest organ in the body.
• Intact skin keeps us safe from infection.
• Skin maintains body temperature and hydration.

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How stroke affects skin

• Skin breaks down because of
• Decreased activity and mobility
• Decreased or absent sensation
• Increased moisture from incontinence or
  perspiration
• Poor nutrition, dehydration, and dry skin
• Inability to communicate pain and discomfort
• Improper positioning, causing friction.

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Key point

• Correct skin care is very important for survivors
  who have trouble moving.
• You play a key role in maintaining the health of
  the survivors skin.

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Effective skin care

• Inspect and report
• Check the survivors skin carefully every day.
  Pay special attention to bony prominences. Search
  for redness and cuts.
• Report concerns or signs of skin irritation to
  the right person

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Effective skin care

• Clean - This removes irritants and maintains the
  skins natural barrier.
• Gently wash (do not scrub) skin regularly, using
  mild cleansers. Rinse thoroughly. Cleanse soiled
  skin promptly.
• Moisturize
• Treat dry skin with moisturizers. Dry, flaky or
  scaling skin can bring about pressure ulcers,
  infection and irritation.
• Do not massage bony prominences or reddened
  areas.

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Effective skin care

• Protect from too much moisture
• Sources of moisture on the skin that can cause it
  to break down include
• Urine or stool from incontinence
• Perspiration
• Fluids from a draining wound

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Protect bony and compromised areas
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Reduce friction forces

• Friction injury occurs when the skin moves over a
  coarse surface. A friction injury can happen when
  you move the survivor in bed or they move
  themselves.
• These injuries happen often on the heels and
  elbows.
• How you can help
• Use dressings and padding as needed
• Use linens to lift the survivor
• Do not pull or drag the survivor.

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Reduce shear forces

• When the body moves without the skin moving, the
  person can get shear injury. For example, raising
  the head allows the survivors body to slide
  down, while the skin remains pressed against the
  sheets.
• How you can help
• Lift the head of the bed no more than 30º
• Limit the amount of time in this position.

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Move often

• Having a person sit or lay in the same position
  for a long time reduces circulation to their
  skin. This increases the risk of skin damage and
  ulcers.
• Risk of damage is greatest among survivors who
  cannot move themselves without help.
• How you can help
• Work with the team to write up a plan for moving
  the survivor at least once every 2 hours and
  follow it.

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Provide nutritional support

• Poor nutrition is linked to skin problems and
  poor healing.
• How you can help
• Help the survivor eat meals and snacks and drink
  enough.

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Use pressure reduction devices

• Devices that help to prevent skin breakdown
  include
• pressure-reducing mattresses
• alternating air mattresses
• elbow pads
• pressure-reducing seat cushions for wheelchairs
• The nurse or therapist may recommend one of these
  devices, based on the survivors needs.

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Use pressure reduction devices
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Cleaning the contracted hand

• Survivors with spasticity may have a contracted
  hand with a closed fist. This hand often sweats.
• Poor air circulation may cause skin damage,
  resulting in odour and infection.
• Good hygiene can prevent skin damage.
• How you can help
• Gently open the hand and fingers to clean and
  trim the nails.
• Those who have a painful hand may want to clean
  it themselves.

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Hygiene and incontinence

• Stroke survivors, especially those with urinary
  incontinence, have an increased risk of
  developing perineal skin problems (problems on
  the skin of their genitals) and urinary tract
  infections.

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Hygiene and incontinence

• How you can help
• Use the right hygiene and skin care to avoid
  these problems
• Wipe from front to back after voiding
• Change underwear daily or more often if soiled
• Always provide thorough peri-care (care of the
  perineum or genital area) after urinary or fecal
  incontinence.
• Remember to wear gloves for peri-care, remove
  the gloves and wash your hands, wash the hands of
  the stroke survivor

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Hygiene and incontinence

• How you can help (contd)
• Do not use deodorant sprays, powder, or perfumes
  on perineal skin
• Continence products
• Use the right continence products. Do not use
  menstrual products. Follow the directions on the
  package.
• Watch for leaking, tightness, skin irritation, or
  rash. Report redness, irritation, or skin
  breakdown to the nurse.

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Upon reflection

• Did you learn anything new about skin care today?
  What did you learn?
• How will it change the way that you provide care?
• Think of a stroke client you have cared for who
  had skin breakdown. Why do you think this
  breakdown occurred?
• How might it have been prevented?

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