b. Incontinence. If the patient is unable to control the bladder or bowel
functions, skin breakdown is likely to occur due to the presence of moisture and bacteria
on the skin.
c. Emaciation. An emaciated patient may be prone to skin breakdown over
bony prominence (heels, elbows, and coccyx).
d. Obesity. An obese patient may have many skin folds where perspiration and
bacteria may contribute to skin breakdown.
e. Age-Related Skin Changes. An older person's skin is very thin and
inelastic. The sweat and oil glands are less active. Thin, dry skin is more susceptible to
pressure areas and skin breakdown.
f. Any Disease or Condition that Affects Circulation. Any disease or
condition that affects circulation can encourage skin breakdown in a patient who is
confined to bed.
NURSING INTERVENTION TO PREVENT SKIN BREAKDOWN
a. The time of the patient's bath or back massage is the most logical time to
thoroughly observe the patient's skin for pressure areas.
b. At the first sign of redness, the area should be washed with soap and water
and rubbed with lotion; measures should then be taken to keep the patient off the
c. Report any signs of pressure to the charge nurse.
d. Keep sheets under the patient clean, smooth, and tight to help eliminate skin
e. Ensure adequate nutrition and fluid intake, according to physician's orders.
f. Every effort should be made to keep urine and feces off the patient's skin,
washing the skin with soap and water and keeping the buttocks and genital area dry
(lotion or powder may be used depending upon the patient's skin type) when the patient
g. Obese patients may need assistance washing and drying areas under skin
folds (groin, buttocks, under breasts, and so forth.)
h. For the patient with very dry skin, various bath oils may be added to the bath
Soap may be omitted because of its drying effect.