The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Chapter 25.26 picas Prevention of Skin BreakdownJean Tuthill RN, MSN, CWOCN and Suzanne R Garnier RN, BSN, CWOCN■ Maintenance of skin integrity in people with HIV poses a number of challenges to health carepractitioners and caregivers. Because of the nature of HIV, it can be difficult, if not impossible,to heal open wounds or ulcers once they appear. It is for this reason that clinicians must workclosely with patients and their caregivers in instructing them in principles of skin care. Theclinician should teach symptomatic relief of some of the more common skin problems and alsoaddress basic assessment of skin so that the caregiver can report problems as soon as theyoccur. Vigilant caregivers in the home are the patient’s best defense against the long-term complicationsof pressure or decubitus ulcer formation. (See Tables 25-1 and 25-2)While assessing and treating skin disorders is clinically important throughout the course of HIVinfection, the challenges of maintaining skin integrity are greatest for patients with advanceddisease. Prevention and treatment of late-stage dermatologic complications is a critical aspectof comprehensive palliative care for patients with HIV disease, and can also be an importantmeans of involvement and empowerment for family caregivers in the care of their loved oneswith AIDS.Because there are many dermatologic conditions associated with HIV it is essential that thepatient have a thorough medical evaluation for diagnosis and treatment of these skin problemsonce they occur (see Chapter 9: Dermatologic Problems). Equally important is the nursing assessmentof the individual to determine not only the presence of any open areas but to determinethe patient’s risk for skin breakdown at any time during the continuum of the illness.Table 25-1: Guidelines for Caregiver Teaching Related to Skin Care• Inspect skin every day for any pink or reddened areas and report immediatelyto physician or nurse.• Avoid massage over bony prominences.• Minimize skin exposure to urine or feces from incontinence, or perspiration.• Avoid rubbing skin with washcloth or towel when bathing and drying.• Cleanse skin at time of soiling and at regular intervals.• Use gentle cleansers such as Dove or Neutrogena.• Avoid deodorant soap.• Avoid hot water.• Turn patient frequently. (Every 1-2 hours in bed. Reposition when in wheelchair.)• Use pull sheets to move or reposition patient in bed. Do not drag patientacross bed to reposition.• Maintain adequate dietary intake of protein, calories, and fluids,avoiding caffeine and alcohol.XXVU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 505