A 78-year-old long-term care resident has new-onset fecal incontinence three times a day from antibiotic-associated diarrhea. Which interventions should the nurse include in the care plan to maintain perineal skin integrity? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Incontinence-associated dermatitis (IAD) results from chemical irritation of the skin by stool and urine, plus mechanical friction. Prevention bundle: (1) gentle cleansing with a pH-balanced no-rinse cleanser, pat dry; (2) barrier protection with zinc oxide or dimethicone; (3) frequent repositioning and moisture-wicking pads to limit exposure; (5) shift-by-shift skin inspection with attention to early IAD (erythema, denudation, satellite lesions). Choice 2 is incorrect: ordinary alkaline soap, vigorous scrubbing, and a washcloth strip the skin barrier and worsen IAD. The standard is gentle, pH-balanced, low-friction care.
IAD is inflammation and breakdown of perineal and gluteal skin from prolonged exposure to urine or stool, distinct from pressure injury — IAD is chemical and friction-driven, occurs over non-bony areas, and presents with diffuse erythema, denudation, and satellite lesions; it often coexists with pressure injury in dependent patients. The skin care bundle has three steps: (1) gentle cleansing with a pH-balanced no-rinse cleanser after each episode, (2) moisturize if needed, (3) apply a barrier such as zinc oxide, dimethicone, or a petrolatum-based ointment. Avoid alkaline soap, vigorous scrubbing, and rough washcloths. Moisture-wicking pads — disposable underpads and incontinence briefs — draw moisture away from the skin and reduce contact time, while cloth pads and double-padding hold moisture against the skin and increase IAD risk.
A 78-year-old long-term care resident has new-onset fecal incontinence three times a day from antibiotic-associated diarrhea. The nurse plans care to maintain perineal skin integrity.
Incontinence-Associated Dermatitis (IAD) — Inflammation and breakdown of perineal and gluteal skin from prolonged exposure to urine or stool. Distinct from pressure injury — IAD is chemical and friction-driven, occurs over non-bony areas, and presents with diffuse erythema, denudation, and satellite lesions. Often coexists with pressure injury in dependent patients.
Skin Care Bundle for IAD — Three-step prevention: (1) gentle cleansing with pH-balanced no-rinse cleanser after each episode; (2) moisturize if needed; (3) barrier — zinc oxide, dimethicone, or petrolatum-based ointment. Avoid alkaline soap, vigorous scrubbing, and rough washcloths.
Moisture-Wicking Pads — Disposable underpads and incontinence briefs designed to draw moisture away from the skin and reduce contact time. Cloth pads and double-padding hold moisture against the skin and increase IAD risk.