Pressure areas/friction

In our weekly skin meeting we have come up against a dilemma, and I'm hoping for some creative ideas here...Elderly man with renal failure, diabetes,noncompliant......watter matress on bed, moon boots to feet, sheepskin on foot of bed......The resident continues to rub his feet back and forth on sheets removing the boots and causing severe irritation, pressure...etc. Any ideas,suggestions, experiences?????????????

Thanx

Nursenan

[Brownms46]

When I worked Ortho at the VA hospital, we used to have our total hip replacement in the bed for about 30 days...waaaay back in the olden days..:chuckle. You could only turn them slightly to the right or left. To keep them from having skin breaksdown, we would go around every two hours, and apply tincture of benzoin and baby powder to their behinds, and their ankles and heels. Never had one break down. I don't know what the long term effects where...say outside of the 6mos I was there, but I know no one went home with any skin breakdwon while I eas there.

[lisamct]

Hi Nursenan,

I nurse clients with severe learning disabilities and one of our older men did the same thing. He had a pressure relieving mattress on his bed and wore sheepskin boots to prevent pressure areas but he continually rubbed the boots off whilst in bed.This is how we solved it; we found lighterweight sheepskin boots with the fur only at the heel in case his feet were getting too hot. We also used a 'sliding sheet' under his feet stopping the friction between his feet and the sheets so stopping him rubbing the boots off. I dont know if you'll use sliding sheets in the USA (im in the uk) their a moving and handling sheet mostly used for turning patients in bed, its a kind of cylinder of fabric were each side slides against one another to facilitate frictionless movement. If you dont regularly use sliding sheets and this sounds like it might be a solution let me know and I'll e-mail you some info.

Lisa

[Vsummer1]

This might be a stupid answer, I am only a first semester student.

One of the things they suggested was putting on high top shoes to prevent foot drop. Perhaps this would work with him because the shoes would be harder to take off?

Feel free to correct me on why this wouldn't work, because I love to learn!

[ktwlpn, LPN]

Originally posted by Nursenan0

In our weekly skin meeting we have come up against a dilemma, and I'm hoping for some creative ideas here...Elderly man with renal failure, diabetes,noncompliant......watter matress on bed, moon boots to feet, sheepskin on foot of bed......The resident continues to rub his feet back and forth on sheets removing the boots and causing severe irritation, pressure...etc. Any ideas,suggestions, experiences?????????????

Thanx

Nursenan

How about multi-podus boots?

[adrienurse, LPN]

Wow, I've been there. Kicks the booties off every time, right? Sometimes all you can do is to provide a wedge or enough pillows under the calves to raise the heels off the mattress.

Try changing your focus to why he is rubbing his feet. Restless leg syndrome? Diabetic neuropathy (if so, have you tried amytriptaline or else some other kind of analgesia)? Plain old restesseness? Maybe he needs to get out of bed to help release some of that energy -- or al least dangle.

Sometimes a topical "deep-cold" gel will help to soothe the neuropathy.

Good luck!

[Vsummer1]

Originally posted by ktwlpn

How about multi-podus boots?

Uh oh... new term for me... what are multi-podus boots?

[Tim-GNP]

Everyone has given you some wonderful ideas... I just wanted to add one little item that comes from my own experience in LTC.

Be sure that you document in his nurses notes, and on his plan of care that this is his behavior [removing the boots]. When DOH comes in for survey, and if he develops breakdown on the heels... they will attempt to determine if it was 'avoidable.' If the papers aren't 'nice and pretty' then your facility will get a deficiency.

Be sure to document other alternatives---even if they failed.

[Youda]

If he's diabetic, he's probably got some neuropathy and compromised circulation. A diabetic's feet can itch and burn like the devil with these problems. The above ideas are good ones, but if his feet are itching and burning, he'll figure out a way to rub or scratch his feet/legs no matter what you do, because he's uncomfortable. It isn't noncompliance, folks! You need to look to the CAUSE of the problem, not just treat the "symptom" of it. Work with the doc for some ideas. Some medications may help relieve the patient's discomfort.

[Sleepyeyes]

Renal failure??

Is his skin itching???

Uremic frost???

Can the doc prescribe an anti-itch med???

I'd really prefer to see him on a RIK mattress--no booties, no sheepskin, nada, except the sheets. And try some skin prep to the heels qs for a protective barrier.

[Nursenan0]

Thanx everyone for your experience!!!!!

I'm fairly new at my facility and knew nothing about this patient except what i related to you. I took your ideas into work and presented them.....Surprise! No one had thought to treat the cause of this mans distress. Your wonderful....thanx again!!!

Nursenan