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Tuesday, January 11, 2011

Skin Health and Incontinence Part 3

By Kimberly Crews, LPN, BBA

Prevention is key with any medical condition or issue.  Incontinence associated dermatitis (IAD) is no exception.  By preventing IAD we decrease the risk of fungal and bacterial infections.

Nutrition and hydration are key to maintaining health in general; it is a key factor in tissue integrity of the body.  Staying well hydrated is essential for the derma layer of skin to maintain moisture, but moisture is the enemy of the outer layer of the epidermis.

When preventing and treating IAD we need to identify the reason for incontinence.  If possible treat the cause of incontinence and this improves quality of life.  Keep a regular check on skin and its tone in the perineal area.  During incontinent product changes check skin for any reddened areas or inflamed areas.  It is essential to perform proper peri care on any incontinent individual. When performing peri care be sure to follow the How To of  Peri Care listed on the prevail.com page.  While cleansing area be sure not to scrub as friction from scrubbing can cause further skin damage.

It is suggested to use a product with ph level close to the skin. Prevail adult wash cloths are pre moistened wipes and are ideal for peri care.  Soap does not have the same ph and can cause further breakdown.  Apply any needed creams, like zinc oxide as needed.  Be sure to read the directions on the manufacture label as application is different for each manufacture.

Take care of yourself inside and you will see the benefits on the outside.


Monday, November 15, 2010

Skin Health and Incontinence Part 2

By Kimberly Crews, LPN, BBA
Skin Health and Incontinence Part 2:
Once the skin begins to break down you will begin to develop dermatitis in the perianal area.  In infants this is referred to as diaper rash.  With adults it is often referred to as perineal dermatitis, contact dermatitis, heat rash, moisture associated skin damage, irritant dermatitis and incontinence associated dermatitis.
Incontinence Associated Dermatitis (IAD) is constant exposure with urine and fecal matter in the perineal area causing inflammation to the skin. As the skin begins to breakdown you begin to lose the protective barrier your skin provides.  While hydrating our bodies from the inside is essential to life, but when epidermis is in contact with moisture for extended period of time skin damage occurs and the result is IAD.  Often IAD is treated as a pressure ulcer. To better understand IAD below you will find the etiology and characteristics of incontinence associated dermatitis.
The etiology of IAD is based on 3 principals and their determining factors are:
-Tissue Tolerance including your age, health, hydration and nutritional status, oxygenation, perfusion and body temperature
-Perineal Environment including urine/fecal incontinence and volume of output,
Chafing and irritants (creams, ointments etc that are unnecessary)
-Toileting Ability including mobility, sensory perception and cognitive awareness (ability to know when to go and how to get there)
Physical characteristics of IAD related to urine and fecal incontinence are the following:
-Inflammation of surface of skin
-Redness, edema (swelling) areas may appear patchy or consolidated (located in the labia majoria (vaginal area) on women or scrotum of men)
-Erosion and dehydration of superficial layers of skin
People often relate the feeling of IAD to a burn on the skin.  It is often itchy, burning, and/or tingling.  The longer the skin is exposed to the urine/stool the more it affects the area and increases breakdown.  To help prevent IAD a consistent skin care program is necessary.  Use a premoist wash cloth, like Prevail adult washcloths to clean after incontinence episodes.  Avoid scrubbing the area and only gently wash the area.  See the other articles on proper Peri Care listed on the Prevail website.
Once the skin begins to break down you will begin to develop dermatitis in the perianal area.  In infants this is referred to as diaper rash.  With adults it is often referred to as perineal dermatitis, contact dermatitis, heat rash, moisture associated skin damage, irritant dermatitis and incontinence associated dermatitis.
Incontinence Associated Dermatitis (IAD) is constant exposure with urine and fecal matter in the perineal area causing inflammation to the skin. As the skin begins to breakdown you begin to lose the protective barrier your skin provides.  While hydrating our bodies from the inside is essential to life, but when epidermis is in contact with moisture for extended period of time skin damage occurs and the result is IAD.  Often IAD is treated as a pressure ulcer. To better understand IAD below you will find the etiology and characteristics of incontinence associated dermatitis.
The etiology of IAD is based on 3 principals and their determining factors are:
  • Tissue Tolerance including your age, health, hydration and nutritional status, oxygenation, perfusion and body temperature
  • Perineal Environment including urine/fecal incontinence and volume of output, Chafing and irritants (creams, ointments etc that are unnecessary)
  • Toileting Ability including mobility, sensory perception and cognitive awareness (ability to know when to go and how to get there)
Physical characteristics of IAD related to urine and fecal incontinence are the following:
  • Inflammation of surface of skin
  • Redness, edema (swelling) areas may appear patchy or consolidated (located in the labia majoria (vaginal area) on women or scrotum of men)
  • Erosion and dehydration of superficial layers of skin
People often relate the feeling of IAD to a burn on the skin.  It is often itchy, burning, and/or tingling.  The longer the skin is exposed to the urine/stool the more it affects the area and increases breakdown.  To help prevent IAD a consistent skin care program is necessary.  Use a premoist wash cloth, like Prevail adult washcloths to clean after incontinence episodes.  Avoid scrubbing the area and only gently wash the area.  See the other articles on proper Peri Care listed on the Prevail website.

Tuesday, August 3, 2010

Skin Health and Incontinence

By Kimberly Crews, LPN, BBA

This is the first in a three-part series about Skin Health and Incontinence.

The Integumentary system or better known as the skin is the largest organ in the body. The hair, nails, glands (sweat) and specialized nerve receptors for stimuli (touch, cold, heat, pain and pressure) are accessories of the Integumentary system. The skin protects the internal organs from the environment. It also protects our immune system by protecting us from disease. To understand better to protect your skin you must understand how it works.

Subcutaneous, dermis and epidermis make up the 3 layers of the skin. The subcutaneous is the home of blood vessels and nerves, meaning it is the deepest layer. This area regulates the body’s temperature and also is a shock absorber for our bodies.

Dermis is the middle layer of the skin; it’s composed of collagen, elastic tissue, and reticular fibers. The dermis thickness varies on the location of the body, meaning thin on eyelids and thicker on your back. Tiny blood vessels, hair follicles, lymph vessels, and nerve endings that detect pain make up the dermis.

Epidermis is the outer most layer of skin which we see. There are 3 parts to the epidermis: Stratum Corneum, Keratinocytes (squamous cells), Basal layer. The epidermis protects from foreign objects entering into the body. This layer of the skin also
contains keratin which keeps skin elastic and protects underlying from drying out. Maintaining and protecting the Epidermis is important for everyone, but with an incontent person it needs to be a priority. If we neglect to take care of the out part of

the skin it will breakdown, causing damage to the dermis and subcutaneous level of the skin. Completing proper peri care with every incontinence episode maintains healthy skin. Using proper peri cleansers, creams and incontinence products are pertinent to maintaining health skin.

Next month Types of Peri-area Dermitis.


Wednesday, June 30, 2010

1. Myth or Fact: Protective Underwear absorbs as much as a brief and is more dignified.”

By Christine Pruneau, RN, BSN

Myth (usually)!

In general, incontinent briefs absorb more than protective underwear (sometimes known as adult pull-up) and are meant for those whose needs are heavy.

Mobility and amount of incontinence are the 2 factors used to choose the right product at the right time. If a product is chosen that does not absorb enough, leakage will likely occur. Some believe that protective underwear is the most dignified product to use. But if the needs are heavy and leakage appears, there is nothing dignified about choosing the wrong product.

The time of day can also influence a person’s needs. During the day, people are often awake and more active. Protective underwear can be a good choice if they are actively toileting with or without help. At night if needs are heavy, absorbent briefs are an excellent choice. Daytime and night time needs can be very different and it is appropriate to switch products if the needs change.

Prevail protective underwear comes in “extra” and “super” absorbencies. They are highly absorbent products and will be fine for many people. But, keep in mind for those whose needs are heavy, choosing a brief will keep them dry and more comfortable, promoting sleep.