Published Feb 28, 2014
I'm a senior student and my patient this week was a very obese, trached woman with C-diff. Her skin was in very bad shape due to moisture, feces and yeast in her skin folds and peri area. She couldn't tolerate the wiping deep in the folds by the end of my day (pain & rolling would cause her to de-sat) and I left clinical feeling that in trying to keep her clean, we caused her a lot of pain.
We used the ordered nystatin powder, barrier cream and butt paste but with the diarrhea, we were still cleaning her and changing the bed every hour. We repositioned Q2, and used some linen laid between her legs and under her panniculus to help keep her dry. She was red all over and starting to get pressure sores.
Has anyone found any tricks or methods to protect the skin in this situation? Thanks
Sounds like she could use a rectal tube... as long as it's watery and nothing solid. If there's no contraindication, such as thrombocytopenia, see if her MD will consider ordering one?
In the meantime, I would try putting a silicone dressing (Mepilex or Aquacel) over the most irritated area. Those dressings are supposed to be waterproof and you can just wipe over it and they will stay on. If the irritation is all over, it wouldn't work though.
This patient sounds like a candidate for a fecal management system/rectal tube. Keep up with the barrier cream, and call a wound/ostomy nurse for a consult if the patient's skin is still getting worse.
Should advocate for your patient to get a dignicare or whatever brand your hospital uses.
Nurse SMS, MSN, RN
A seemingly contradictory name, but dignicare and flexiseal are two of the main trade names for rectal tubes.
Definitely someone who sounds like they need a rectal tube! On the side: Remember pressure sores and incontinent associated dermatitis are two different things. IAD can get very bad, but it is not a pressure ulcer. A lot of people make the mistake that once the skin opens it's a stage II.
Thanks, I hadn't heard of IAD as it's own thing
Esme12, ASN, BSN, RN
Concur w/ recital tube. For the yeast, I have found using a thick moisture barrier ointment mixed together w/ an antifungal cream works well. The key is to get the skin folds very clean and thoroughly dry (this takes time, especially if rubbing is painful...air drying is best but hard, if not impossible to do depending on pt. situation). Once dry, apply a layer of the above mentioned cream. I find that Nystatin powder usually becomes a nasty, pasty mess b/c it is applied too liberally and then not cleaned up thoroughly between applications.
NC29mom, ASN, LPN, RN
DIFLUCAN STAT! will also help with yeast. Never been huge fan if nystatin powder....
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