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Skin Care

It is important to try and keep the skin in good condition. Unfortunately, this is one of the most difficult problems in caring for bed-bound patients.

Pressure sores (also called bedsores) often occur on the patients who are confined to a bed for a long time and don't change position in bed often enough. Bedsores occur over bony areas of the body.

Figure 1.

Figure 1 shows areas most likely to develop sores.

Sometimes pressure sores can be prevented if the following steps are taken:

  • Explain to the patient the importance of turning frequently.

  • Provide pain medication as needed so that movement is easier.

  • Use pillows to support the patient in a side lying position.

  • Keep the skin clean and dry.

  • Keep the bed linens dry and wrinkle free.

  • Very gently, massage around the reddened pressure areas.

  • Apply lotion around areas of pressure once or twice each day.

It is a good idea to check the patient's skin for reddened areas each day during the bath. If you see redness over pressure areas, tell your nurse. The nurse will check them during the visit. Your primary nurse may suggest the use of devices, such as air, water, or egg-crate mattresses to help reduce pressure. In addition, sheepskins, heel and elbow protectors can be used to reduce friction as the patient moves about on the bed linens.

Even with the best care, skin breakdown may occur. Your primary nurse and doctor will suggest ways to treat these pressure sores and promote skin healing.


Mouth Care

Cleansing the mouth provides several benefits for the hospice patient. Regular care helps to prevent sores and may improve the patient's appetite and desire to eat.

Things You'll Need:

  • soft toothbrush

  • toothpast

  • small bowl

  • dry cloth

  • cool water

  • mouthwash

How To Do It:

The patient may be able to do this unaided and, if so, will probably prefer to be independent. If the patient needs assistance, raise the head and trunk to a half-sitting position to prevent choking and put a dry cloth under the patient's chin. Give the patient a sip of water to moistent hte inside of the mouth. Brush teh teeth and gums gently with toothpaste. Try to thorougghly remove all food particles and crushed materials. The patietn can then spit into the bowl and rinse with cool water, followed by a mouthwash rinse. Try to clean the patient's mouth twice daily.

Denture patients should continue to follow their usual mouth care routine during illness. After eating, remove and clean the dentures. Gently clean the patient's mouth with a soft toothbrush or cloth. Have the patient rinse with cool water, followed by a mouthwash rinse. As the patient loses weight, they may find their dentures no longer fit properly. This may be caused by a change in the shape of the jaw. A poor denture fit may result in mouth sores. If the refitting by a dentist is not possible, the dentures should be left out. Continue to provide mouth care twice daily.

After completing mouth care, apply a moisturizer to the lips and both corners of the mouth to prevent cracking. Reapply the moisturizer throughout the day.

Things to Remember about Mouth Care:

  • Don't put the toothbrush too near the back of the patient's throat or the patient will gag.

  • Do not give the patient mouth care as explained here if they are lying flat or are unable to swallow. The patient may choke on the liquid.

  • If the patient cannot swish and remove liquid from teh mouth, your primary nurse can give you special instructions for mouth care.

  • If mouth soreness develops, tell your primary nurse. He or she will ask your doctor for medicine to treat the sores.

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