Perineal Care Reflection

I was assigned to patient B.P. She was admitted on September 6th from RMC. Her admitting diagnoses are acute embolism and thrombosis of unspecified deep veins of lower extremities; Unspecified Dementia without behavioral disturbance; Major Depressive Disorder, Single episode; Intervertebral Disc Degeneration, Lumbar region; Essential hypertension; Vitamin Deficiency, Dorsalgia, and pain. She had two patches covering wounds on forearms bilaterally. There was an order in her chart for occupational therapy and physical therapy, but interacting with her throughout the day, I wonder how often she accomplishes it. They also have behavioral monitoring and side effect evaluation of the psychotropic medications she is taking. B.P seemed very confused through the whole day. In the morning I went in and introduced myself and asked her some questions to evaluate her mental status and she immediately brought up her headache. I asked her if she knew where she was and she was unable to answer that along with what the date was. Clarissa then helped me change her depends and she was able to

express that she was experiencing dryness and pain on around her buttocks. There was a little spot of redness, probably from sitting in one position for long periods of time without being repositioned. After her breakfast was delivered to her, I went back to check on her and she had been barely able to eat anything because her food was not cut up into bite size pieces. So I went ahead and did that and she ate all of it. Throughout the rest of the day I was able to use the Doppler to check a pedal pulse, and use a glucoscan to take blood glucose level. After lunch I performed a head to toe assessment on B.P.
Today I feel like I advocated for my patient. Before we were getting ready to leave, and she stated that she felt “wet”, so we went ahead and changed her. She had not been changed the whole day since we had changed her when we got on the floor. I was also upfront with the nurses about the potential breakdown of skin from pressure on her back. Even though the CNA’s may be busy and have other patient’s to take care of, I feel like they need to do a thorough check up on patient’s even if she had not pressed her call light.
Going off of that situation I used my nursing judgement in what could be breaking the skin down. Since she is placed in incontinence briefs, if she sits in urine or stool for excessive amounts of time it can lead to skin breakdown, along with moisture in general. Moisture in both, the briefs and the bed pad. Secondly, the position she was sitting in is probably not the best way to prevent shear and friction since she was in almost a reclined chair position. Where a lot of the pressure is place directly onto the coccyx. I was able to shift her weight off of her right side and onto her left and position a pillow underneath to relive some of it as well. I feel like as the clinical goes on I am getting better with my clinical judgment and able to identify some problem areas.
While changing B.P we performed basic perineal care.

She had mentioned that she felt a pinching and felt uncomfortable at times. It is very important to provide good perineal care at all ages. Good technique can potentially prevent incontinence-associated dermatitis in older adults. Incontinence can seriously impact skin integrity, increasing their risk of developing an infection or wound. IAD is caused through prolonged exposure to moisture from urinary or fecal incontinence. Some interventions that can prevent IAD would be to cleanse the skin and remove contaminates in a timely manner, repair the skin if there is breakdown, and protect the skin with a barrier cream (Payne, 2017). Improvements for the facility would be to maybe remind the staff to perform hourly assessments of individuals who are incontinent to urine or stool. Maybe that way prevention of skin breakdown would

decrease.