Skin protection - Assisting a family member


Assisting a family member

Assisting a family member

Skin protection

Patient hygiene Wound management
  • Hygiene of the patient
    • Cleaning products and powders
    • The bathroom in bed
    • Hand washing
    • Hair washing
    • Facial hygiene
    • Beard hygiene
    • Nail cutting
  • Wound management

The skin of the sick is often treated with unsuitable or too aggressive products; the results are frequently disappointing and those in charge of care are unable to interpret their meaning.

The skin must be respected and it is necessary to understand that age influences certain types of treatments as the skin of the elderly is particularly thin and more subject to external insults.

Characteristic and easy to spot in the elderly is the rhombus-shaped skin, found behind the nape.

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Hygiene of the patient

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Cleaning products and powders

When washing a patient, it is essential to understand which type of soap or detergent to use.

A good product must have some fundamental characteristics:

  • create little foam
  • be easily rinsed
  • do not contain too much perfume
  • have an acceptable cost
  • must return to normal skin after two hours from its use.

The main products can be classified simply into four groups:

  1. soaps
  2. synthetic detergents
  3. shower gel
  4. bath oils.

Soaps are alkaline products with a pH between 8 and 10. Alkalinity affects the coat that covers the skin and the (good) bacteria that protect it, it also dries the skin: the more alkalinity increases, the more it dries up and changes Skin.

The detergents produce foam, have a pH that varies from acid to alkaline (from 3.5 to 7) and have an excellent cleaning action.

The bubble baths dry the skin a lot, are highly concentrated and should therefore be diluted at least 50% with water.

Bath oils are not very foaming and cleanse less than other products but, being emollient and soothing, they respect the skin more.

Many times scratching lesions are found on the skin of the elderly, in particular on the forearms, shoulders, abdomen and also on the tibia. These signs can be caused by too aggressive detergents; before undertaking therapies to quell the itch, it would be advisable to replace the substance and check if they disappear.

A soap widely used, even on wounds, is Marseille soap. Over the years, this type of soap has been attributed an almost "magical" power; today it is still widely used even if it does not find specific indications.

Dusts, like talc, are widely used by older people. They are made up of tiny flakes that scratch the skin and clog pores. Often they are applied in the skin folds (armpits, submammary spaces, groin) to dry them, but they end up forming a sort of dough conducive to the multiplication of bacteria.

Classic talc can be replaced by aspersory powders, which have round granules and do not damage the skin.

Intimate cleaners are substances used for perineal hygiene. It is necessary to use suitable intimate products, which are delicate, unscented and, preferably, purchased in a pharmacy or in any case meeting particular quality requirements. Given the nature of their use, a poor product can modify the population of useful bacteria and allow only harmful ones to multiply, favoring the appearance of infections. Use the intimate cleanser only 1-2 times a day at most; if necessary, use only water.

Hygiene is a particular moment in the person's life. Keeping the skin clean and cared for is essential in many aspects: biological, social and psychological, just to mention the most important.

The skin undergoes a continuous transformation and the cells are replaced regularly. It is possible to verify this process when a limb remains bandaged for a long period, at the time of removal the skin remained covered by the bandages has scales and debris.

Furthermore, the need to relate and to have contact with others requires the absence of bad smells. Not all cultures assign the same value to hygiene: in some countries hygiene is practiced at least once a day, in others only once a week. Local temperature also influences the need to wash: very hot climates require more frequent washing.

When a person is unable to carry out hygiene care on his own, he will have to provide it by helping or replacing his abilities. Privacy must always be guaranteed. The availability of the person providing care is also very important: washing a patient is an act that presupposes either a certain confidence or a rigid professional detachment.

Before proceeding with the hygienic care, it is essential to prepare the material (sleepers, towels, knobs, soap, jugs, hot water), prepare the environment, providing the right temperature, the right light and the right humidity, and arrange the person comfortably safe and use the aids correctly.

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The bathroom in bed

If assistance is provided to people with difficulty walking, it may be necessary to take a full bath in bed. The bath has a very important effect not only for hygienic purposes, but also for relaxing and toning the body.

Before proceeding to the bath, it is necessary to place some disposable sleepers under the patient in order to isolate the mattress and check the room temperature, which must be between 20 and 22 degrees. After that, you have to prepare the person: undress him (so that he is completely naked) in the bed in the dorsal decubitus position, cover him with a sheet and ask him if he has to urinate or defecate so that these needs are fulfilled before the hygiene treatments. If the person feels cold, it is possible to proceed with one body segment at a time.

After preparing a basin with water, it must be checked that the temperature is not excessively hot or cold. Liquid soap and knobs must be prepared before putting on disposable gloves.

At this point you need to take a piece of soap, put it on the previously wet knob and start washing a single part, rinse, pat dry and finally remove the crossbar from under the washed part.

In general, it starts from the face and then goes to the neck, upper limbs, abdomen, legs, genitals, back and perineal area.

The exact procedure is carried out as follows:

  • Wash eyes individually with sterile, soap-free gauze;
  • Clean your face, ears, neck and rinse;
  • Wash the arms starting from the hands up to the armpits;
  • Proceed in the same way with the abdomen, taking particular care of the folds under the breasts in women;
  • Start from the foot and proceed towards the pubis, first one leg and then the other;
  • Place the subject in a lateral position and proceed with cleansing the back;
  • Carry out genital hygiene using a pan (there are several types on the market).

If the person is not cold, the body can also be lathered, leaving the genital area last, and then rinsing. The bath is an excellent time to evaluate the condition of the skin and to detect the presence of any lesions. At the end of the bath remove the wet sleepers and check the skin humidity again, do not leave wet areas, especially between the skin folds; to facilitate drying, the use of a hairdryer (be careful not to burn the patient!) in areas particularly prone to rubbing such as armpits and groin can be a valuable aid. A good moisturizer must be applied all over the body so that the skin remains elastic. If the person is able to go to the bathroom or can be helped, consider purchasing specific aids for the tub and shower (bathroom seats, chairs or shower stretchers) that make hygiene more physiological .

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Hand washing

Hand washing can be carried out with the person in bed whenever the subject requests it and in any case always after evacuation and before and after meals.

Prepare the necessary material:

  • disposable sleepers
  • liquid soap
  • towels
  • basin
  • disposable gloves.

The person seated in the bed must be placed, the crossbar positioned on the abdomen and, if possible, a table on which to rest the basin. After soaping your hands, being careful to wash the nail area thoroughly, rinse thoroughly with running water and dry very well; finally apply a thin layer of cream (emollient) to keep the skin hydrated.

If necessary, use a nail brush to remove any debris.

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Hair washing

The bedridden person must necessarily undergo hair washing if he is unable to do it himself. Hair has a very high social impact, no one leaves the house with tangled hair, therefore, in addition to the purely hygienic aspect, the alteration of the self-image that implies poor care of the hair is not to be underestimated. Women with very long hair should brush it at least once a day. Brushes and combs must have bristles with blunt tips to avoid injuring the scalp and promoting the onset of skin infections. If the patient manages to go to the bathroom, it will not be difficult to carry out hygiene in the shower or with the head tilted backwards into the sink.

The collection container should be able to contain a lot of water, to avoid having to go to the bathroom continuously to empty it.

Prepare the necessary material:

  • basin
  • hot water in a jug
  • shampoo
  • disposable waterproof sleepers
  • disposable gloves
  • towels
  • phon
  • comb or brush
  • shampoo tray in bed.

Correctly arrange the subject so that it is comfortable and does not assume spoiled positions.

Check that the room temperature is comfortable. If washing is done in bed, its surface must be protected to prevent it from getting wet (use waterproof disposable sleepers). Then proceed as follows:

  • moisten the hair with hot water and apply shampoo;
  • lather well by massaging the scalp with your fingers for a few minutes (in this way circulation is stimulated on the skin) and rinse thoroughly;
  • repeat the operation if the hair is very oily or dirty;
  • remove the pan and dry well by dabbing with a towel;
  • gently comb your hair and blow dry; this maneuver should be carried out with the person in a sitting or semi-sitting position;
  • arrange your hair according to your preferences; if the patient is able to move his arms (i.e. in the case of at least partially self-sufficient patients), perhaps provide him with a mirror.

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Facial hygiene

Facial cleansing is a very simple operation that must also be carried out several times a day: on waking up, after meals and whenever necessary.

The procedure varies depending on whether the subject is independent or not.

Prepare the necessary material:

  • basin
  • hot water
  • disposable sleepers.
  • liquid soap
  • towel
  • knobs.

If the patient is able to cooperate, he must be placed in a semi-sitting position, after which he must apply the disposable waterproof crosspieces on his abdomen and place the basin with hot water on the bedside table. Provide the patient with the soap knob and ask him to wash. The eyes must be washed using two gauze wetted with water or physiological solution, proceeding from the inside to the outside; this procedure avoids carrying debris into the lacrimal sac.

After washing, the basin must be supplied with warm, clean water for rinsing and drying by dabbing without excessively rubbing the skin.

In the case of an uncooperative patient, it must be placed in a semi-sitting or dorsal position and then proceed with soaping the face. Use the same precautions already mentioned for the eyes, use gauze wetted with saline and gently clean from the inside out.

If the patient cannot communicate the pain, be very careful not to touch the inside of the eye with gauze as small ulcers on the cornea can occur, which are extremely painful and dangerous. Rinse with a wet but clean knob and pat dry. When performing facial hygiene, remember to also clean your ears. Use a cotton swab only to remove the earwax visible on the outside, never perform maneuvers in depth using the sticks because you push the earwax to the bottom. It is also recommended not to use cotton swabs if the subject is not cooperating: there is a risk of piercing the eardrum if it makes sudden movements! In case of bleeding coming from the bottom of the ear (otorrhagia), notify the doctor immediately.

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Beard hygiene

The mustache and beard must be taken care of very carefully since fragments of food that tend to dry out may remain between the hairs, for this reason it is essential to wash the beard thoroughly after meals, comb it and dry it, perhaps with a hairdryer, always being careful not to burn the patient. In case it is necessary to shave the beard prepare the material:

  • safety razor or electric razor
  • shaving foam
  • basin
  • hot water
  • mirror
  • towel
  • moisturizing cream.

If the subject manages to make movements independently, supply the material and hold the mirror.

When the patient does not have the necessary strength or the general conditions do not allow him to shave, remembering that the best time is in the morning.

Proceed as follows:

  • Apply the foam or shaving gel evenly (without exaggerating) and then start shaving;
  • Keep the skin taut before shaving to facilitate the sliding of the blade and the prevention of cuts;
  • shave in the direction of the hair (remember to never proceed against the hair);
  • rinse the razor thoroughly after every two passes;
  • at the end wash the face with a wet knob and pat it dry.
  • if the subject is agitated use an electric razor.

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Nail cutting

Cutting the nails is an important part of personal care and must be carried out with some precautions that guarantee patient safety, especially if at risk (diabetics, arteriopaths). If the nails are particularly hard (like toenails), the cut should be preceded by a five-minute foot bath that will soften the nail. Do not improvise: if you are not able, contact trained personnel.

Prepare the material:

  • manicure set
  • basin
  • hot water
  • mineral oil (paraffin).

Cutting the nail straight without rounding the edges, this error is often the cause of ingrown nails.

Use cardboard files to shape the nail and, lastly, apply a little oil all around it.

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