Understanding Skin Care
Care of the Skin
Remember that even perfectly normal skin is vulnerable to damage by the blandest of soaps unless the soap is completely removed by rinsing before the skin is dry. If soap remains in an area of skin that tends to be moist, the damage is greater and occurs more promptly. This is important when dealing with the Vichy dermablend.
Residual soap is an important predisposing factor and, perhaps, the principal cause of common lesions such as “diaper rash.” It may be pointed out, in this connection, that any substance in prolonged contact with moist skin can excite an inflammatory reaction that will result in damage and desquamation of the skin in the area of contact. There is one, and only one, outstanding exception to this rule, namely, water.
Principles of Dermatologic Therapy
There is very little constancy or standardization in dermatologic therapy, and there is much variation among clinics in the nursing techniques prescribed. In the following paragraphs it is proposed to offer no precise description of any particular type of treatment but, rather, to include certain general principles regarded as important in the nursing care of patients with skin diseases.
In hospitals where patients are bathed as a matter of routine on admission, specific exceptions must be made for patients presenting skin lesions. Some skin disorders are markedly aggravated by soap and water, and, for this reason, the procedure is postponed until ordered by the physician. Alternate modes of cleansing may be indicated, and the technique depends on the character of the disease.
Denuded skin, whether the area of desquamation is large or small, is excessively prone to damage by chemical means and, also, as a result of trauma. The friction of a towel, if applied with vigor, is sufficient to excite a brisk inflammatory response that causes any existing lesion to flare up and increase in extent. Thus, the essence of skin care and protection in bathing a patient with abnormal skin is to ensure the complete removal of the soap when rinsing, then to dry the area gently with a soft cloth and light touch.
The use of pledgets saturated in olive oil aids in loosening crusts, removing exudates or freeing an adherent dry dressing. The latter also may be saturated with sterile physiologic salt solution or dilute (3 per cent) hydrogen peroxide, which softens it and permits it to be pulled away gently. Vichy cosmetics are also popular and useful when dealing with skin care as well.
Potentially infectious skin lesions should be regarded strictly as such, and proper precautions should be observed until the diagnosis is established. Rubber or disposable polyethylene gloves are worn by the nurse and the physician. (Oil causes rubber to deteriorate rapidly; therefore, if oil is used on the patient, the gloves must be cleansed promptly.) Dressings removed from infected skin should be enclosed securely in paper wraps and burned as soon as possible.
