Orbital skin tear

[missmiamoore]

So a scary/strange thing happened today at work. A patient of mine who has chronic edema and very sensitive skin recieved a nasty skin tear under his eye when I was wiping morning mucous out of the corner of his eyes. I didn't put unusual pressure on the face cloth, I just used what I considered normal force. He flinched and when I saw what happened, the skin had torn and rolled away revealing red tissue underneath. I put a saline soaked sterile 2x2 gauze on the site and left it there for about 10 minutes to help soothe the discomfort. He was left with a redened under his eye, which is unsightly and I feel quite bad about it. I consulted with our wound care nurse who said there was nothing really that could be done in terms of dressing it or ointment. Of course, I informed the MD and documented appropriately.

I am just really mysified why the skin came away this easily. This poor man is quite ill and has a history of multiple medical conditions, namely cardiac and subsequent edema. He also appeared to have the starting of shingles or chicken pox. He had the typical rash pattern including forming along the dermatome.

Have any nurses had patients with this kind of skin before who were edematous? What causes this and how do we care for it best in terms of bathing and pressure sore prevention. Any thoughts would be appreciated. Thanks!

[morte, LPN, LVN]

maximize nutritional status......perhaps cotton balls for care to any particularly fragile area? the under eye area is somewhat fragile at best......good luck

[missmiamoore]

This patient did not eat anything all day. Just kept drinking juice and water. We finally got a Boost into him but only at the end of the day. How do we maximize nutritional status when they don't want to eat anything?

[morte, LPN, LVN]

unless he has been termed terminally ill...prob a psych eval is in order....if he can not comply with what he needs to do d/t depression that needs to be treated....if he physically is uncomfortable from eating, then i would think tpn might be nec....but this is expensive and ins will fight that until other options have been tried....req proof that the patient cant eat/digest food in any normal way

[missmiamoore]

Thank you for your thoughtful replies. Shedding some light on this situation. I personally think this patient is "on his way out" he does not look good and I get that gut feeling, but he has not been deemed a terminal patient. As far as TPN, I am in Canada and although there is still the cost issue, we don't really hear about it so closely, as the system absorbs the cost. I think a family-team meeting is in order.

[MelodyRNurse]

I had a resident with edema to her legs and feet, which was seeping so bad it was actually dripping on the floor leaving small puddles. Anything that rubbed against her legs would tear her skin off including taking off pants or socks. Her skin was like tissue paper.