WOUND CARE (pressure sores)

Risk factors: smoking, edematous tissue (eg: low albumin with poor nutrition), reduced mobility, moist skin (from perspiration, urine), steroids - for more risk factor information, see Norton or Braden scales

Prevention: regular exam of major sites at risk, turn q2h with minimal shearing, sheep skins, pressure relief mattress (Therarest, Advance 2000, polyester fibre padding, foam mattress, water bed), foam or gel cushions, protect normal skin with barrier cream or moisturizer, use mild soaps, clean immediately if soiling occurs

Stage 1 (pre-ulcerative lesion): Non-blanchable erythema, swelling, induration, warmth

Rx: cleanse with NS, apply Tegaderm, Duoderm or Opsite (protects from shearing)

Stage 2: Partial thickness skin loss involving epidermis and/or dermis

Rx: cleanse with NS, apply Duoderm or Tegasorb and check daily

Stage 3: Full thickness skin loss into subcutaneous tissue- may extend down to fascia

Rx: saline gel (Normagel or Intrasite gel) and absorptive dressing (gauze, Mesalt, Kling soaked in proviodine)

Stage 4: Full thickness skin loss with extensive destruction of tissue, necrosis or damage to muscle, bone or supporting structures

Rx: irrigate with NS and Kling soaked in proviodine (packed into cavity)

PRURITIS (persistent, generalized itching)

Can lead to restlessness, anxiety, skin excoriation and secondary infection.

Etiology: dry skin, obstructive jaundice, uremia, underlying malignancy (lymphoma, myeloma, prostate), allergy, systemic drug reaction, superficial irritants, infections

Treatment:

• Non-pharmacological: elimination of suspected allergens or irritants, close-cut manicure (to reduce risk of excoriation/infection), non-allergenic sheets, bathing with tepid water, mild soap and bath oils (Aveeno)

• Topical Rx: moisturizer (Alpha Keri), calamine lotion, menthol/camphor, steroids, doxepin cream

• Systemic Rx:

• antihistamines (Benadryl 25-50 mg po q6h; **Atarax 25-50 mg po q6h; Chlor-Trimeton 4 mg po q4-6h; Periactin 4 mg po q4-6h)

• phenothiazines (Promethazine 25 mg po qhs; **Trimeprazine 2.5-5 mg po tid; Chlorpromazine 25-50 mg po tid-qid)

• Doxepin 10 mg po od-tid
• Cholestyramine resin 4 g po od-qid (if jaundiced)
• Steroids (if allergic or inflammatory condition)
• Benzodiazepines
• Ultraviolet light therapy (with hepatic cholestasis and chronic renal failure)