Module 30. Assisting with Special Skin Care

Transcription

1 Home Health Aide Training Module 30. Assisting with Special Skin Care Goal The goal of this module is to prepare participants to assist clients with skin care and help prevent the development of pressure ulcers and other skin conditions. Time 3 hours Activities Teaching Methods Time 1. Introduction to Special Skin Care Interactive presentation, smallgroup work and reporting, and large-group discussion 2. The Role of the Home Health Aide in Assisting with Special Skin Care 3. Skills Demonstration and Practice Small-group work and reporting, interactive presentation, smallgroup and large-group discussion, and large-group exercise 1 hour and 5 minutes 1 hour and 10 minutes Demonstration and practice triads 45 minutes Supplies Flip chart, markers, and tape Paper and pencils Index cards Treats or prizes for the matching game (Activity 1) Buttocks model with pressure ulcer (optional) Trainer s Manual Page 30.1

2 Bed for demonstration of skills for positioning clients Supplies for skills demonstration: large and small pillows, sheepskin Learner s Book 1. Review of Routine Skin Care 2. Important Terms for Special Skin Care 3. Stasis Dermatitis 4. Pressure Ulcers 5. Special Skin Care Observe, Record, and Report 6. Special Skin Care Your Approach Makes a Difference! 7. Special Skin Care What You Can and Can NOT Do 6. Special Skin Care Client Case Studies Worksheets Worksheet 1. Matching Game Medical Terms for Special Skin Care Worksheet 2. Special Skin Care Client Case Studies Skills Checklists Skills Checklist 1. Positioning a Client on His/Her Back (DOH Procedure Checklist F-1) Skills Checklist 2. Positioning a Client on Her/His Side (DOH Procedure Checklist F-2) Handouts Handout 1. Key Terms Handout 2. Summary of Key Information Advance Preparation Review all the training instructions and learner s materials for this module. Note that icons are used to remind the trainer of the following: Trainer s Manual Page 30.2

3 When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in the Learner s Book and the handouts, but we use the key icon only when it is covered elsewhere in the learning process.) When it is important to ask a particular question to get participants input. When it is time to refer to the Learner s Book. When it is time to distribute a worksheet. When it is time to distribute a skills checklist. When it is time to distribute and discuss a handout. Copy all worksheets and handouts for participants. Prepare copies of the skills checklists. You will need one copy for each participant, to be collected and reused for subsequent trainings. Laminating the skills checklists will make them more durable and reusable. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS. Activity 1. Introduction to Special Skin Care Prepare the following flip chart pages: Learning Agenda (Step 1) Routine Skin Care; Special Skin Care (Step 2) Special Skin Care: Medical Terms (Step 7) Trainer s Manual Page 30.3

4 Activity 2. The Role of the Home Health Aide in Assisting with Special Skin Care Prepare the following flip chart pages: Special Skin Care: Observations (Step 3) Special Skin Care: Observe, Record, and Report (Step 5) Your Approach Makes a Difference! (Step 9) The Role of the Home Health Aide in Assisting with Special Skin Care: DO and DO NOT (Step 11) Prepare 10 index cards with one of the following tasks written on each card: [for the DO List] Assemble equipment and supplies. Change client s position at least every two hours. Keep skin clean and dry. Apply non-medicated lotions. Encourage nutrition and hydration. Observe, record, and report. Clean reusable equipment. Store reusable supplies. Use a person-centered care approach. [for the DO NOT List] Apply topical medications to unstable skin surface. Activity 3. Skills Demonstration and Practice Set up at least two beds with bedding for skills demonstration and practice. Having one bed for each practice triad is ideal in order to complete the skills practice in 30 minutes. Otherwise, you may need more time. Gather other supplies needed: large and small pillows and a sheepskin. Trainer s Manual Page 30.4

5 Activity 1. Introduction to Special Skin Care 1 hour and 5 minutes Learning Outcomes By the end of this activity, participants will be able to: Define routine skin care and special skin care. Explain the importance of preventing skin care problems. Define medical terms that are important in special skin care. Describe symptoms and stages of stasis dermatitis and pressure ulcers. List steps the home health aide can take to prevent stasis dermatitis and pressure ulcers. Key Content Routine skin care consists of activities normally done on a regular basis to keep the skin healthy. Special skin care consists of activities done when needed to protect a wound, or to prevent skin problems from developing for people at higher risk of skin breakdown. Because the treatment of skin conditions is difficult, it is important to prevent skin problems through routine skin care and special skin care. Important medical terms for special skin care are: drainage, edema, integrity, phlebitis, pressure ulcer, stable skin surface, stasis dermatitis, stasis ulcer, topical medication, turgor, unstable skin surface, and varicose veins. For stasis dermatitis, participants will learn what it looks like, its stages, what causes it, and how to prevent it. For pressure ulcers, participants will learn what they look like, their four stages, common areas where they occur, what causes them, and how to prevent them. Trainer s Manual Page 30.5

6 Activity Steps Interactive Presentation 5 minutes 1. Review Learning Agenda. Welcome participants. Explain the purpose of this module to prepare participants to assist clients with skin care and help prevent the development of pressure ulcers and other skin conditions. Special skin care can be defined as activities performed as needed to protect a wound or to prevent skin problems from occurring. Post the flip chart page with the Learning Agenda and review. Flip Chart LEARNING AGENDA: Assisting with Special Skin Care Review routine skin care Define special skin care and key medical terms Describe stasis dermatitis and pressure ulcers, and steps to prevent them Explain the role of the home health aide in assisting with special skin care Demonstrate skills for repositioning the client 2. Define routine skin care and special skin care. Post the prepared flip chart and review the definitions. Explain that participants will learn later about the difficulties of treating serious skin conditions. Therefore, it is extremely important for home health aides to help prevent skin problems from developing in the first place. This is done partly through routine skin care. Routine skin care was introduced in earlier modules (Supporting Clients Dignity while Providing Personal Care; and ADL: Bathing and Personal Care), but participants will review it now, to reinforce the key information and steps. Trainer s Manual Page 30.6

7 Flip Chart ROUTINE SKIN CARE Activities normally done on a regular basis to keep the skin healthy SPECIAL SKIN CARE Activities done to protect a wound, or to prevent skin problems for people at higher risk Small-Group Work 10 minutes 3. Form small groups and give instructions. Ask participants to close their Learner s Books. Then form groups of three participants each. Explain that you will conduct a review of routine skin care by asking each group to answer one question. They will have 5 minutes to discuss the question together. They can refer to their own notes, but they cannot use their Learner s Books, nor their Handouts. Post the flip chart page with the list of questions and assign one question to each group. Teaching Tip If you do not have six groups, you can assign Questions 1 and 2 to one group. Quickly visit each group to answer any questions they may have about the task. If any groups finish their questions ahead of time, encourage them to continue answering the rest. Trainer s Manual Page 30.7

8 Flip Chart Review of Routine Skin Care 1. What is skin and what are its functions? 2. How can you assist a client with routine skin care? 3. Why are bathing and personal hygiene important? 4. Why are nutrition and hydration (drinking water) important? 5. Why is it important to be gentle when touching the skin of clients who are obese, frail, elderly, or underweight? 6. Why is ORR important for routine skin care? Small-Group Reporting 10 minutes 4. Facilitate small-group reporting. Read Question 1 What is skin and what are it s functions? Ask the group that worked on this question to briefly give you their answer. Correct any misinformation or add information as needed, referring to section 1. Review of Routine Skin Care in the Learner s Book. Teaching Tip Participants should still NOT be looking in their Learner s Books. 5. Continue with the remaining questions. Repeat this process for Questions 2-6. Let the groups answer first, then add points or correct misinformation. Note that participants will get a handout summarizing this information after the discussion, so they can focus on listening for now. Teaching Tip This approach takes slightly longer than an interactive presentation, but the purpose is to emphasize what participants already know and how they can find the answers. Trainer s Manual Page 30.8

9 6. Refer to 1. Review of Routine Skin Care in the Learner s Book. Note that this section contains the information they have been discussing. Thank participants for their work and point out the value of reviewing routine skin care and discussing the questions amongst themselves, since routine skin care is the foundation of special skin care. Small-Group Work: Matching Game 15 minutes 7. Set up the matching game. Ask participants to stay in their groups. Explain that there are a lot of new medical terms that they will need to know when assisting with special skin care. Post the flip chart page and read the list of Medical Terms. Note that you will define these in detail in a few minutes, but you want to introduce them to these terms by playing a matching game, to see how many they can figure out on their own. Flip Chart SPECIAL SKIN CARE: Medical Terms Drainage Edema Phlebitis Pressure ulcer Stable skin surface Stasis dermatitis Stasis ulcer Varicose veins 8. Give instructions. Distribute Worksheet 1. Matching Game Medical Terms for Special Skin Care. Ask each group to work together to figure out which term matches each definition. One person should be the group recorder. When they think they have a match, that person should write the term next to the definition on his or her paper. They will have 10 minutes. Trainer s Manual Page 30.9

10 Teaching Tips You can give them a tip on doing matching games read the whole list of definitions and fill in the easy ones first, crossing them off the list of terms. After that, they can go back and work on the harder ones. You can also encourage them to use their knowledge of other medical terms like ulcer, stable, pressure, veins to figure out what these new terms might mean. Large-Group Discussion 5 minutes 9. Discuss the correct terms for each definition. Read the first definition and ask a group to volunteer their answer. Ask if any group had a different answer. Then read the correct answer. Continue quickly through the list of definitions, calling on different groups to share their answers. Save the detailed corrections for the interactive presentation (next). Teaching Tip Having prizes (e.g. snacks, marker pens) for groups who give a correct answer is a way to make this more fun. Be sure to have enough for everyone, however, so that groups who don t give a correct answer don t feel discouraged. They should be rewarded for trying! Interactive Presentation 20 minutes 10. Review 2. Important Terms for Special Skin Care. Note that this handout has all the definitions in their matching game, plus a few more. Highlight the definitions that were not in the matching game (i.e. integrity, topical medications, turgor, and unstable skin surface). Then discuss the photographs of skin conditions that match some of the definitions. Note that they will get this same list of terms in their handouts. 11. Discuss stasis dermatitis and pressure ulcers. Review 3. Stasis Dermatitis and 4. Pressure Ulcers in the Learner s Book. Trainer s Manual Page 30.10

11 Activity 2. The Role of the Home Health Aide in Assisting with Special Skin Care 1 hour and 10 minutes Learning Outcomes By the end of this activity, participants will be able to: Describe what to observe, record, and report when assisting with special skin care. Explain the importance of having a positive approach to assisting the client with special skin care. Explain what a home health aide can do and can NOT do when assisting with special skin care. Key Content When assisting with special skin care, the home health aide should notice changes in the skin color, drainage, edema, rash, dryness, scratching, pain reported by the client, skin feeling too warm or cold to the touch, and skin integrity. Because of the pain and potential embarrassment of clients who have special skin care needs, it is particularly important for the home health aide to have a positive approach to assisting with special skin care tasks. Clients need encouragement, acceptance, and support. How the worker approaches the tasks may be just as important as the skills they bring to it. Key tasks that the home health aide CAN do to assist with special skin care include repositioning the client every two hours (or as prescribed), keeping the skin clean and dry, applying non-medicated lotions, and observing any signs of skin breakdown. One key task that they can NOT do is to apply any topical medication to an unstable skin surface. Trainer s Manual Page 30.11

12 Activity Steps Small-Group Work 10 minutes 1. Introduce topic of Observe, Record, and Report for special skin care. Explain that observing, recording, and reporting (ORR) are very important functions for home health aides when assisting with special skin care. The purposes of ORR are to monitor the condition of the client s skin and keep the medical staff informed. This activity will give them a chance to practice ORR, using photos of different skin conditions. Each group will have a couple of minutes to examine the pictures and make notes of their observations, as if they were going to report them to the nurse. Teaching Tip A buttocks model with a pressure ulcer can also be used here, in addition to photos. The model can be passed from group to group, while other groups keep working on their photos. 2. Give instructions for group work. Ask participants to stay in the same small groups. Refer to the photographs in 2. Important Terms for Special Skin Care in the Learner s Book. Give the groups a few minutes to examine the photos and make notes about what they observe. Ask them to choose one person to report for the group. Remind them of all the other times they have discussed ORR, and ask them to apply the same principles here. Teaching Tip To save time, you may decide to assign one or two photos to each group. Small-Group Reporting 10 minutes 3. Facilitate group reports on their observations. Starting with the first example, ask one group to begin by sharing ONE of their observations. Then ask another group to share ONE observation. List all the observations on a flip chart page. Continue from group to group until all their observations have been listed. Trainer s Manual Page 30.12

13 Flip Chart SPECIAL SKIN CARE: OBSERVATIONS 4. Repeat with the next example. Start the group reporting with a different group this time. Use the same flip chart page to list the participants observations. Place a checkmark next to any observation that is the same as one already listed from the other example. Continue with the remaining examples. Interactive Presentation 10 minutes 5. Review key elements for ORR in special skin care. Post and review the prepared flip chart pages (below). Also refer to section 5. Special Skin Care Observe, Record, and Report in the Learner s Book. Note how many of the elements they listed in their observations. Flip Chart SPECIAL SKIN CARE: Observe, Record, and Report Changes in the color of the skin Drainage: type of fluid, amount, color, and odor Swelling (edema) Rash Dryness Scratching Pain reported by client Skin feeling too warm or cold to the touch Integrity: are there any new openings in the skin, including skin tears, blisters, or cuts? Trainer s Manual Page 30.13

14 6. Review recording and reporting. Note that the guidelines for recording and reporting their observations will be different, depending on the agency protocol. Such guidelines will be explained during their orientation. But in all cases, any observed changes in skin integrity must be reported, for the health of the client. Small- and Large-Group Discussion 10 minutes 7. Give instructions for small-group discussion. Note that the home health aide s approach to a task consists of their feelings, attitudes, and behaviors. Their approach while assisting with special skin care is just as important as how skilled they are at performing the task. Ask them to take five minutes to share, within their groups, what their reactions were when they first saw the pictures for the ORR group work. Teaching Tip It is quite likely that you heard their reactions! It should not be necessary, but you can refer to that if participants are reluctant to discuss this. 8. Facilitate a large-group discussion. Ask if any of the groups would like to share some of their reactions. Thank participants for their sharing. Note that reactions of shock, disgust, or even fear are very common when it comes to pressure ulcers. Ask participants: How do you think the client will feel if you react that way in front of him or her? 9. Summarize key points. Thank participants for their honest sharing. Post and review the prepared flip chart page. Also, refer to section 6. Special Skin Care Your Approach Makes a Difference! in the Learner s Book. Trainer s Manual Page 30.14

15 Flip Chart YOUR APPROACH MAKES A DIFFERENCE! Your approach toward a client or a task is just as important as your skills at performing the task Show a positive attitude toward the client Provide as much privacy as possible Make the client feel comfortable Speak to the client while you are offering care Large-Group Exercise 10 minutes 10. Introduce the exercise. Explain that there are a lot of things that home health aides can do to assist with special skin care and some very important things that they should NOT do. 11. Give instructions. Ask participants to CLOSE their Learner s Books. Post the prepared flip chart page at the front of the room. Stay in the same groups of three. Explain that each group will get one or more cards with a task written on it (see Advance Preparation). Their job in this exercise is to decide if this task is something they could do ( DO ) or should NOT do ( DO NOT ) for a client with special skin care needs. Once they have decided, one person from the group will tape the group s card in the appropriate place on the flip chart page. Trainer s Manual Page 30.15

16 Flip Chart The Role of the Home Health Aide in Assisting with Special Skin Care: DO DO NOT 12. Distribute cards. Ask the groups to take three minutes to discuss and then tape their card(s) on the flip chart page. Attach strips of masking tape to the side of the flip chart easel for participants to use. 13. Review answers and correct as needed. Refer to section 7. Special Skin Care What You Can and Can NOT Do in the Learner s Book. Check the placement of cards against the list in the Learner s Book, and move cards if necessary. Briefly discuss any cards that were placed in the wrong category. Small-Group Work 10 minutes 14. Give instructions. Ask participants to stay in the same groups of three. Distribute Worksheet 2. Special Skin Care Client Case Studies. Assign Case Study A to half of the groups, and Case Study B to the other half. Ask them to take five minutes to read the case study and answer the questions. Large-Group Discussion 10 minutes 15. Facilitate a discussion about Case Study A. Read Case Study A aloud. Ask the groups that discussed Case Study A to share their answers to the first question. Note the common themes. Briefly discuss any differences. Trainer s Manual Page 30.16

17 16. Facilitate a discussion about Case Study B. Read Case Study B aloud. Ask the groups that discussed Case Study B to share their answers to the first question. Note the common themes. Briefly discuss any differences. 17. Review the role of the home health aide when assisting with special skin care. Briefly summarize the topics covered in this activity: what to observe, record, and report; the importance of having a positive approach to working with clients with special skin care needs; and being clear about what they can and can NOT do as home health aides. Trainer s Manual Page 30.17

18 Activity 3. Skills Demonstration and Practice 45 minutes Learning Outcomes By the end of this activity, participants will be able to: Practice and demonstrate how to position a client on his/her back. Practice and demonstrate how to position a client on her/his side. Key Content Clients who are in bed for long periods of time need to be repositioned at least every two hours or as indicated in the care plan to prevent skin breakdown. In addition, areas that are most likely to develop pressure ulcers ( bony prominences ) should be supported with pillows or sheepskin to help prevent pressure and rubbing that can damage the skin. Being able to position the client on his/her back and on her/his side are important skills for the home health aide. Activity Steps Teaching Tip The classroom space should be set up with at least two hospital-style beds for demonstration and practice. Ideally you will have one bed for each practice triad (see Advance Preparation). Trainer s Manual Page 30.18

19 Demonstration 10 minutes 1. Introduce activity. Explain that changing the client s position at least every two hours or as indicated in the care plan is very important to preventing pressure ulcers. Participants will learn and practice two positioning procedures positioning the client on his or her back, and positioning a client on her or his side. 2. Demonstrate how to position the client onto his/her back. Ask for a participant to volunteer to help you, by playing the role of the client lying on his or her side on the bed. Follow the steps in Skills Checklist 1. Positioning a Client on His/Her Back. Answer questions. 3. Demonstrate how to position the client on her/his side. With the same volunteer still lying on her or his back, demonstrate how to position a client on her or his side. Follow the steps in Skills Checklist 2. Positioning a Client on Her/His Side. Answer questions. 4. Discuss skills checklists. Distribute and review Skills Checklists 1 and 2. Ask participants if they have any questions before they begin practicing. Practice Triads 35 minutes 5. Form triads. Explain to participants that they will again practice in triads. Participants will form teams of three and practice following the steps in Skills Checklists 1 and 2. Ask participants to work in the same triads that they were in for the Do and Do NOT exercise. Each person will have about 10 minutes to practice the skills. 6. Give instructions for practice triads. In their triads, participants will take turns playing different roles. One person will be the home health aide, one person will be the client, and the third person will be the observer. The observer will use the checklist to provide guidance to the home health aide and to give feedback afterwards. This is also a tool to help the observers informally reinforce their knowledge of the steps involved in performing the task. Trainer s Manual Page 30.19

20 After one person completes the task, participants switch roles so that the second person can practice being the home health aide, the third can be the client, and the first can be the observer. After one more switch, all three participants will have performed in all three roles. 7. Review the trainer s role. Remind participants that the trainer(s) will be moving around the room to monitor how participants are doing, to answer questions, and to provide additional instruction as necessary. Teaching Tip Some participants may be ready to do their return demonstration during this practice lab. Have extra performance checklists on hand to record these demonstrations, as this is part of each participant s formal evaluation. Give feedback following the return demonstration. If a participant s performance is not satisfactory, encourage him or her to practice more and do another return demonstration at a later date. 8. Remind participants to switch roles every 10 minutes. 9. Wrap up practice triads and prepare for closing. When participants have rotated through all three roles in their triads, bring participants back to the large group for the closing activity. If there is not enough time for all participants to practice in all three roles, make sure that they have the chance to do so in the next practice lab. 10. Summarize the module. Distribute and briefly review Handout 1. Key Terms and Handout 2. Summary of Key Information. Trainer s Manual Page 30.20

21 Learner s Book Module 30. Assisting with Special Skin Care Activity 1. Introduction to Special Skin Care 1. Review of Routine Skin Care Worksheet 1. Matching Game Medical Terms for Special Skin Care 2. Important Terms for Special Skin Care 3. Stasis Dermatitis 4. Pressure Ulcers Activity 2. The Role of the Home Health Aide in Assisting with Special Skin Care 5. Special Skin Care Observe, Record, and Report 6. Special Skin Care Your Approach Makes a Difference! 7. Special Skin Care What You Can and Can NOT Do Worksheet 2. Special Skin Care Client Case Studies Activity 3. Skills Demonstration and Practice Skills Checklist 1. Positioning a Client on His/Her Back Skills Checklist 2. Positioning a Client on Her/His Side Learner s Book Page 30.1

22 1. Review of Routine Skin Care Page 1 of 2 1) What is the definition of skin? a. The outer covering of the body. The skin is also the body s largest organ. 2) What are the functions of skin? a. Protecting the body from infection and injury b. Eliminating body wastes through perspiration c. Regulating body temperature d. Sensing heat, cold, pain, and pressure 3) How can you assist a client with routine skin care? a. Bath or shower b. Perineal care c. Back rub d. Fingernail care e. Toileting f. Hair care g. Changing positions h. Applying cream/lotion 4) Why is bathing important? a. Bathing removes dirt, bacteria, odor, and substances that cause allergies. b. During bathing, the client and home health aide can observe rashes, infected areas, bruises, cuts, etc. Learner s Book Page 30.2

23 1. Review of Routine Skin Care Page 2 of 2 5) Why are nutrition and hydration important? a. They are beneficial to every part of the body. b. Color, texture, and the ability of skin to heal depend on good, nourishing food and adequate fluids. 6) Why is it important to be particularly gentle when touching the skin of obese, frail, elderly, or underweight clients? a. Obese clients have skin that is less elastic and may have poor circulation. They may have folds of skin, making cleaning difficult and possibly causing irritation. Rapid weight or fluid gain can cause skin to stretch to the point of breaking open. b. Elderly or frail clients have thin skin that tends to be dry and to tear very easily. c. Underweight clients have poor nutrition and thin skin. d. All these characteristics make the skin susceptible to injury. 7) Why is it important to observe, record, and report? a. If danger signs are noted early, it can help prevent breakdown of the skin. Learner s Book Page 30.3

24 2. Important Terms for Special Skin Care Page 1 of 5 Bony prominences: Places where bone comes close to the skin for example, elbow, tailbone, heel, ankle, shoulder blades. These are places where pressure ulcers may form. Drainage: Any fluid or blood that leaks from a wound. Edema: Swelling; a condition in which the body tissue contains too much fluid. Integrity: A description of whether or not the client s skin is intact (or unbroken). Phlebitis: Inflammation of a vein; common to the veins in the legs. Pressure ulcer: An area of skin where pressure has destroyed the surface tissue, sometimes called a pressure sore, decubitus, or bedsore. Stable skin surface: Skin that may have a superficial wound (just on the surface) but it is not open, infected, or draining. (Also called good skin integrity. ) Learner s Book Page 30.4

25 2. Important Terms for Special Skin Care Page 2 of 5 Stasis dermatitis: A skin condition with a rash, or a scaly, red area, or itching. It s usually caused by problems in circulation. Stasis ulcer: An open wound usually found on the lower leg, due to poor blood circulation. It does not affect the surrounding skin. Topical medications: Medications that are absorbed through the skin. Turgor: The normal fullness and elasticity of the skin. We test skin turgor by gently pinching a small piece of skin on the back of the hand and then letting go. If the skin stays in the pinched position, the person has poor skin turgor this is a sign of dehydration. If the person has very tight and shiny skin, this can be a sign of edema. Unstable skin surface: Area of the skin that does have a wound and it is open, infected, or draining. (Also called poor skin integrity. ) Varicose veins: Swollen, distended, and knotted veins, visible especially in the leg. They occur most often in people who stand or sit motionless for long periods of time. Learner s Book Page 30.5

26 2. Important Terms for Special Skin Care Page 3 of 5 Stasis ulcer (above) Stasis dermatitis (above) Varicose veins (right) Learner s Book Page 30.6

27 2. Important Terms for Special Skin Care Page 4 of 5 Edema (below) Learner s Book Page 30.7

28 2. Important Terms for Special Skin Care Page 5 of 5 Stage 4 pressure ulcers (above and below) Learner s Book Page 30.8

29 3. Stasis Dermatitis This condition can occur and continue for many years without affecting the surrounding skin, or can become more severe and cause an open wound called a stasis ulcer. The lower leg is most usually affected. The causes of stasis dermatitis include: Poor circulation Tight stockings, shoes, casts, braces, or splints Injuries Edema Varicose veins Phlebitis Poorly controlled diabetes You can help prevent stasis dermatitis by encouraging your client to: Avoid wearing tight stockings and shoes. Elevate the client s leg(s) when she or he is sitting down. Not cross the client s legs. Limit salty food. Get exercise to encourage circulation. You can also help with gentle handling and proper cleaning of the skin. Learner s Book Page 30.9

30 4. Pressure Ulcers Page 1 of 2 There are four stages in the development of pressure ulcers. Stage 1: Inflamed skin Stage 2: Blisters, tears in skin, or a shallow open area Stage 3: Full skin loss, exposing damaged tissue beneath, and tissue loss Stage 4: Full skin loss and tissue loss, exposing muscle or bone. May also include dead tissue that has turned black. Pressure ulcers usually develop over bony areas (bony prominences) and pressure areas, including: Elbows Heels & ankles Knees Hips Tailbone (coccyx) Backbone Shoulder blades Toes Wrist Ears Learner s Book Page 30.10

31 4. Pressure Ulcers Page 2 of 2 Some causes of pressure ulcers are: Pressure on skin being in one position too long Rubbing against skin (shearing) Lack of fatty tissue Dirty and/or wet skin Person too overweight or too thin Existence of infection Poor nutrition and hydration Lack of activity/movement You can help prevent pressure ulcers! Positioning: o Change the client s position at least every two hours o Encourage the client to move around. Use lotion on dry skin, but DO NOT apply lotion to skin that has tears or is open. Report if client complains of a tingling or burning feeling in the skin. When client is in bed: o Use special pressure-relieving mattresses. o Place cushions between bony prominences such as ankles and knees when client is on his or her side. Small pillows and sheepskin are two common options. o Keep linens from wrinkling. o Keep the client clean and dry. Learner s Book Page 30.11

32 5. Special Skin Care Observe, Record, and Report Observing and reporting changes in the client s skin is your most important role in special skin care. Noticing and reporting changes before they get really bad can make a big difference in the health and comfort of the client. Be sure to report: Changes in the color of the skin Drainage: the type of fluid, amount, color, and odor Swelling (edema) Rash Dryness Scratching Pain reported by client Skin feeling warm or cold to the touch (more than usual) Integrity: are there any new openings in the skin, including tears, blisters, or cuts? Learner s Book Page 30.12

33 6. Special Skin Care Your Approach Makes a Difference! Your approach toward a client or toward a task is just as important as your skills at performing the task. Show a positive approach be encouraging, accepting, and supportive. Provide as much privacy as possible. Make the client feel comfortable. Speak to the client while you are offering care. Learner s Book Page 30.13

34 7. Special Skin Care What You Can and Can NOT Do What You CAN Do Assemble equipment and supplies. Change client s position at least every two hours or as prescribed in their care plan. Keep skin clean and dry. Apply nonmedicated lotions. Observe, record, and report. Clean reusable equipment. Store reusable supplies. Encourage nutrition and hydration. Use a person-centered care approach. What You Can NOT Do Don t apply topical medications to an unstable skin surface. Learner s Book Page 30.14

35 Handout 1. Key Terms Page 1 of 2 Bony prominences [2] Places where bone comes close to the skin for example, the elbow, tailbone, heel, ankle, shoulder blades. These are places where pressure ulcers may form. Drainage [2] Any fluid or blood that leaks from a wound. Edema [2] Swelling; when the body tissue contains too much fluid. Integrity [2] A description of whether or not the client s skin is intact (or unbroken). Phlebitis [2] Inflammation of a vein; common to the veins in the lower limbs. Pressure ulcer [2, 4] An area of skin where pressure has destroyed the surface tissue, sometimes called a pressure sore, decubitus, or bedsore. Routine skin care [Activity 1] What aides do on a regular basis to maintain the skin s integrity; for example, bathing and grooming. Skin [1] The outer covering of the body. The skin is also the body s largest organ. Special skin care [Activity 1] What aides do to protect a wound or to prevent skin problems from developing. Usually provided for clients who are considered at higher risk for skin breakdown. Handouts

36 Handout 1. Key Terms Page 2 of 2 Stable skin surface [2] Skin that may have a superficial wound (just on the surface) but it is not open, infected, or draining. (Also called good skin integrity. ) Stasis dermatitis [2, 3] A skin condition with early symptoms of a rash, or a scaly, red area, or itching. It s usually caused by problems in circulation. Stasis ulcer [2] An open wound usually found on the lower leg, due to poor blood circulation. It does not affect the surrounding skin. Topical medications [2] Medications that are absorbed through the skin. Turgor [2] The normal fullness and elasticity of the skin. We test skin turgor by gently pinching a small piece of skin on the back of the hand and then letting go. Healthy skin should go right back to how it was before. If the skin stays in the pinched position, this is a sign of dehydration. If the person has very tight and shiny skin, this can be a sign of fluid retention (edema). Unstable skin surface [2] Area of the skin that does have a wound and it is open, infected, or draining. (Also called poor skin integrity. ) Varicose veins [2] Swollen, distended, and knotted veins, visible especially in the leg. They occur most often in people who stand or sit motionless for long periods of time. Handouts

37 Handout 2. Summary of Key Information Page 1 of 2 The skin is the largest organ of the body. It has many important functions. It: Protects the body from infection and injury Eliminates body wastes through perspiration Regulates body temperature Senses heat, cold, pain, and pressure It is important to be particularly gentle when touching the skin of obese, frail, elderly, or underweight clients because: Obese clients have skin that is less elastic and may have poor circulation. They may have folds of skin, making cleaning difficult and possibly causing irritation. Rapid weight or fluid gain can cause skin to stretch to the point of breaking open. Elderly or frail clients have thin skin that tends to be dry and to tear very easily. Underweight clients have poor nutrition and thin skin. All these characteristics make the skin susceptible to injury. Observing and reporting changes in the client s skin is your most important role in special skin care. Noticing and reporting changes before they get really bad can make a big difference in the health and comfort of the client. Be sure to report: Changes in the color of the skin Drainage: the type of fluid, amount, color, and odor Swelling (edema) Rash Dryness Scratching Pain reported by client Skin feeling warm or cold to the touch (more than usual) Integrity: are there any new openings in the skin, including tears, blisters, or cuts? Handouts

38 Handout 2. Summary of Key Information Page 2 of 2 Your approach toward a client or toward a task is just as important as your skills at performing the task. Show a positive approach be encouraging, accepting, and supportive. Provide as much privacy as possible. Make the client feel comfortable. Speak to the client while you are offering care. What You CAN Do Assemble equipment and supplies. Change client s position at least every two hours or as prescribed in their care plan. Keep skin clean and dry. Apply non-medicated lotions. Observe, record, and report. Clean reusable equipment. Store reusable supplies. Encourage nutrition and hydration. Use a person-centered care approach. What You Can NOT Do Don t apply topical medications to an unstable skin surface. Handouts

39 Worksheet 1. Matching Game Medical Terms for Special Skin Care Find the definition (below) that matches each of these terms. Then write the term on the line in front of the definition. Drainage Edema Phlebitis Stable skin surface Stasis dermatitis Stasis ulcer Pressure ulcer Varicose vein 1. Swelling, or when there s too much fluid in one part of the body. 2. An open wound usually on the lower leg, but not affecting the surrounding skin. 3. An area of skin where pressure has destroyed the surface tissue; sometimes called a bedsore or decubitus. 4. Swollen and knotted vein, seen especially in the leg. 5. Area of skin that may have a wound but is NOT open, infected, or draining. 6. Inflamed vein; usually in the legs. 7. A skin condition with a rash or scaly, red area, or itching. 8. Any fluid or blood that leaks from a wound. Worksheets

40 Worksheet 2. Special Skin Care Client Case Studies Case Study A Mr. Eduardo Gomez is 75 years old. He lives alone in a small studio apartment in the city. He has been diagnosed with diabetes, high blood pressure, and acid reflux. He does not eat much and drinks even less. He spends much of his day lying in bed because he is lonely and depressed. 1. What factors put him at risk for poor skin integrity? 2. As the home health aide, what can you do to assist this client? Case Study B Ms. Roz Shapiro is 34 years old and single. Last year, she was in a car accident that caused severe damage to her spinal cord. As a result, she is now a quadriplegic and is incontinent of her bowels and bladder. She is at home now, but since the accident she has been very depressed and eats and drinks very little. 1. What factors put her at risk for poor skin integrity? 2. As the home health aide, what can you do to assist this client? Worksheets

41 Skills Checklist 1. Positioning a Client on His/Her Back 1. Talk with client about need to reposition (from lying on her or his side). Explain what the steps will be. Talk with client throughout the procedure. 2. Wash hands. 3. Gather equipment (large and small pillows, sheepskin). 4. Move client either to center of bed or a safe distance from the side. 5. Turn client onto back with head and body in line with each other. 6. Place pillow under client s head and neck. 7. Place pillow under lower legs from knees to ankles with heels hanging free. 8. Position client s arms, slightly bent, at side or folded on top of abdomen. 9. Cover client and make sure bedding is loosened over the feet. 10. Make client comfortable and safe. 11. Wash hands. 12. Record and report unusual observations or problems. Skills Checklists

42 Skills Checklist 2. Positioning a Client on Her/His Side 1. Talk with client about need to reposition (from lying on her or his back). Explain what the steps will be. Talk with client throughout the procedure. 2. Wash hands. 3. Gather equipment (large and small pillows, sheepskin). 4. Move client either to center of bed or a safe distance from the side. 5. Turn client onto side with head and body in line with each other. 6. Place pillow under client s head and neck. 7. Place pillow (lengthwise) at client s back, anchoring in place. 8. Flex hips and knees slightly. 9. Position bottom legs comfortably. 10. Position entire upper leg and foot on top of thin pillow or sheepskin, slightly in front of bottom leg. 11. Pull bottom shoulder slightly forward so weight of body is not resting on bottom arm. 12. Fold bottom arm across chest or place arm flat on bed with elbows bent and palm of hand facing up. 13. Rest top arm on pillow in front of client. 14. Cover client make sure bedding is loosened over feet. 15. Make client comfortable and safe. 16. Wash hands. 17. Record and report any unusual observations or problems. Skills Checklists