# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372730&lang=en  
> language: en  
> subject: Elimination  
> category: BCC

## Question

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.

1

Inspect the skin every shift for early signs of incontinence-associated dermatitis (erythema, denudation, satellite lesions).

2

Use ordinary bath soap and a washcloth and scrub vigorously to ensure thorough cleaning.

3

Apply a barrier cream or ointment containing zinc oxide or dimethicone after each cleansing.

4

Reposition the patient at least every two hours and use moisture-wicking incontinence pads.

5

Cleanse the perineum with a pH-balanced no-rinse cleanser after each incontinent episode and pat dry.

## 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.

## In-depth explanation

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.

## Clinical scenario

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.

## Key concepts

- **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.

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