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Skin Care in the GI Patient Gwen Spector RN, BSN, CGRN, COCN Department of Pediatric Gastroenterology Children’s Medical Center Tuesday, January 28, 2014
Skin Care in the GI Patient
Gwen Spector RN, BSN, CGRN, COCNDepartment of Pediatric Gastroenterology
Children’s Medical Center
Tuesday, January 28, 2014
Contents Skin A & P Skin Hygiene Common Skin Problems Skin problems assoc. w/ GI conditions Activity
Tuesday, January 28, 2014
Skin 101 Largest organ Functions
1. Protection2. Thermoregulation3. Sensation4. Metabolism 5. Nonverbal
communication
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Skin Deep1. Epidermis: layer of protection
Outermost layer, dry2. Dermis: layer of life
Innermost layer, moist3. Hypodermis: layer of support
Subcutaneous fat and tissue
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Skin Deep
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Acid –Base Balance Acid Mantle pH a measure of acidity or alkalinity of a
solution Neutral: 7.0 Acid: < 7.0 Base (alkaline) : > 7.0
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pH Values0 Sulphuric/battery acid1 HCL/stomach acid2 Lemon juice3 Grapefruit/orange juice4 Tomato juice5 Black coffee6 Saliva/milk7 Water: regular/distilled8 Sea water9 Baking Soda10 Milk of Magnesia11-12 Ammonia13 Bleach14 Lye
pH of skin pH of skin
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Healthy Skin Clean Intact Slightly acidic ~5.5 pH Well hydrated Even skin tone/texture Normal flora
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Skin Assessment Use your senses:
Listen Look Smell Feel
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Most Common Skin Problems Contact dermatitis
Irritant Allergic
Mechanical Stripping Friction
Infection Fungal Bacterial
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Most Common Skin ProblemsSkin Problem Cause TX
IrritantDermatitis
Chemical irritation from contact with irritating substances
Remove causeKeep skin c/dBarrier
Allergic Dermatitis
Irritation from allergic response to product
Remove productSteroidsPatch test
Mechanical FrictionStripping
Gentle techniqueMild products
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Most Common Skin ProblemsSkin Problem Cause TX
Fungal MoistureImmunosuppressionDiabetes
Keep skin c/dAntifungal
Bacterial Alteration in skin Keep skin c/dAntibiotics
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Goals of Treating Skin Problems
1. Return skin to normal/baselinea. Keep skin clean/dryb. Remove causative factorsc. Choose and use appropriate skin care productsd. Protect the skin, maintain moisture balance e. Prevent future problems
Tuesday, January 28, 2014
Cleaning Wash hands well Clean warm water, soft cloth Mild soaps/cleansers (pH balanced) Clean residue off Don’t use harsh products like alcohol, H2O2, etc Pat dry, don’t scrub Don’t apply a lot of creams and meds (less is
more)
Tuesday, January 28, 2014
pH of Soap/Cleansers
Cleanser pHCetaphil 6.5Dove 7.0Lever 2000, Ivory 9.0Camay, Dial 9.5Zest, Palmolive 10.0
Anything > 9.0 is alkaline and can be irritating to the skin
Most baby soaps are pH balanced
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Protecting the Skin Balance of moisture Building a barrier
Product choice: Lotion (mild) Petroleum Zinc oxide for more severe Skin sealant: 3M no sting
Layers
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Product choosing Choose appropriate
products for problem Titles can be misleading Avoid harsh ingredients pH-balanced RX vs. OTC Less is more
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High Risk Patients Immunosuppressed Malnourished Poor hygiene Limited mobility/sensation Neonates Sensitive skin Existing alteration in skin integrity
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GI Conditions Prone to Skin Breakdown
1. Ostomya. G-tube/J-tubeb. Intestinal Ostomies
2. Diarrhea/Perianal Disease
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Gastrostomy/Jejunostomy Common Problems
Irritant dermatitis Keep skin c/d Protect skin with barrier
Hypergranulation tissue Stabilize tube Treatment to decrease granulation tissue Foam dressing
Fungus Antifungal
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Stabilizing the G-tube
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Gastrostomy/Jejunostomy More problems:
Stoma formation: Resize button Protect w/ ace bandage, etc. Maalox
Infections: Wash with saline Culture Treat w/ antibiotics
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Gastrostomy/Jejunostomy
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Gastrostomy/Jejunostomy: Skin Problems
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Gastrostomy/Jejunostomy: Skin Problems
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Intestinal OstomiesIleostomy High output Digestive enzymes Needs pouching systemColostomy Output depends on location Less enzymes Doesn’t always need a
pouch
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Intestinal Ostomies Peristomal problems
1. Contact Dermatitisa. Irritant b. Allergic
2. Fungal3. Folliculitis 4. Mechanical
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Intestinal Ostomies Treatment:
Keep skin clean/dry: no soap Barrier
Pouching system Barrier paste Barrier powder Skin sealant
Shave w/ disposable razor Antifungal powder
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Peristomal Complications1. 3.
2. 4.
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Diarrhea Diagnoses:
Intestinal failure IBD J-pouch/colon resection Pancreatic insufficiency Food intolerance Intestinal infections Medication side effects Soiling from encopresis
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Diarrhea Skin problems:
1. Irritant dermatitis2. Fungal
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Diaper Dermatitis
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Perianal Disorders Diagnoses:
Abscesses Enterocutaneous Fistulas Anal fissures Skin tags
Skin problems: Irritant dermatitis Bacterial infection
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Perianal Disorders
Crohn’s patient: Perianal disease
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Treating the Perianal Area Keep clean/dry:
squirt bottle unscented wipes
Protect Skin Cream: zinc oxide/petroleum powder
Treat Infection Antifungal cream/powder Antibiotics
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Tape/Adhesive Tips Application
Apply to c/d skin w/o tension Porous tape Skin sealants &/or thin
hydrocolloids Secure w/ non-adhesive
products
Removal Push-pull method to
remove Adhesive removers
Problems: Change product
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Now Take it Off
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In Summary
Clean & Protect
Assess frequently
Remove cause
Educate family
Handle with Care
Tuesday, January 28, 2014
