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Skin Care After Spinal Cord Injury

WHAT YOU SHOULD KNOW:

Skin Care After Spinal Cord Injury (Discharge Care) Care Guide

  • Having a spinal cord injury (SCI) can cause serious problems for your skin. You may develop pressure sores. Pressure sores are also are called pressure ulcers, decubitus ulcers, bed sores, or ischemic ulcers. A pressure sore is when an area on or under the skin is dead or dying.

  • Pressure sores are caused when the blood flowing to the area is slowed down or stopped. This happens most often when you sit or lie on a bony area for too long. Bladder or bowel accidents can make your skin wet which makes your skin even weaker. You may not be able to feel a skin cut or scratch until it becomes a larger problem. Sliding from the bed to a chair or having muscle spasms can rub or tear your skin.

  • Pressure sores are described based on the stage they are in. Stage one is an early pressure sore. Stage four is a later pressure sore. It is easier to heal a stage one pressure sore than a stage four pressure sore.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

How do I take care of my skin and prevent pressure sores?

It is much easier to prevent a pressure sore than it is to heal it. Follow these guidelines to help prevent pressure sores:

  • Keep your skin clean and dry.

    • Carefully and completely look at your skin two times each day. Use a mirror or ask a family member or someone else to do it for you. Look especially at the areas that may most easily get sores. These include your tailbone, hips, or base of your buttocks. These also include the bony areas of your foot and heel.

    • Shower or bathe often, making sure to wash between the folds of your skin. Use an electric shaver to keep from nicking your skin when shaving. Bladder or bowel accidents can make your skin wet, which makes your skin even weaker. Wash and gently dry your skin as soon as possible after a bowel or bladder accident. Change your clothes as soon as possible if they are wet. You may use lotion on your skin, but do not use powder.

  • Move often to avoid sitting or lying in the same position for too long.

    • Do pressure shifts at least every 15 to 20 minutes: The kind of pressure shifts that you can do may depend on where your spinal cord is injured. Always make sure that your wheelchair is locked before beginning any pressure shifts.

    • Tilt back pressure shifts: Tilt back pressure shifts take the pressure off your buttocks by allowing you to rest on your back. Someone must help you perform this shift unless you have a power tilt wheelchair. The person helping sits behind you and tilts your wheelchair backwards into their lap. This tilts you to at least 45 degrees and should be done for 3 to 5 minutes at a time.

    • Lateral pressure shifts: Lateral pressure shifts are done to take the pressure off one buttock at a time. Remember to shift both directions each time you do this pressure shift. Put your locked wheelchair next to the bed. Lean sideways onto the bed and stay in that position for one minute, making sure you are completely off that buttock. Crossing your legs may help to get your buttock completely off the chair.

    • Chair push-ups: Chair push-ups are done to take the pressure off both buttocks at the same time. Put your hands on the arms of the chair or on the wheels of your wheelchair. Push down to lift yourself up and hold that position for 30 seconds to one minute.

    • Forward pressure shifts: Forward pressure shifts help take the pressure off both buttocks. Lean forward and reach toward your feet or the floor and hold that position for 30 seconds to one minute. Make sure you are leaning far enough forward to completely relieve the pressure off your buttocks. You may want to put loops on the push handles at the top back of your wheelchair. Putting your arms through the loops can help make sure that you do not loose your balance. Loops can give you confidence to lean far enough forward for the shift to completely relieve pressure on your buttocks.

    • Change position often: Change position at least every two hours when you are in bed. If you are unable to turn yourself, ask someone to help you.

    • Exercise often: Have caregivers help you with range of motion exercises. These keep your muscles, tendons, and ligaments strong and limber and increases blood circulation to your skin.

  • Eat a healthy diet. Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Good skin care requires eating enough protein, vitamins, and minerals. Caregivers may suggest that you take food supplements to make sure you are getting enough of these important things. Do not take any vitamins, herbs, or food supplements without first talking to caregivers.

  • Drink enough liquids. Drink 6 to 8 (8 ounce) cups of healthy liquids each day. Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. Limit the amount of caffeine in your diet. Caffeine may make you urinate too much and lose too much body fluid. Caffeine may be found in coffee, tea, soda pop, and sports drinks and foods. Try to drink enough liquid each day, and not just when you feel thirsty.

  • Prevent injury by protecting your skin.

    • Avoid wearing clothes that are too tight or too loose. Clothes with thick seams, buttons, or zippers can also cause sores.

    • Use special equipment for sitting or lying that can protect your skin. Check with your caregivers to get specially adjusted seat cushions, mattresses, pillows, and sheepskin.

    • Avoid moving or doing things that rub, scratch, or cut your skin. Take special care when transferring from bed to wheelchair to commode. Sliding from one place to the next can pull or stretch your skin and tear it. Lift yourself or have caregivers lift you rather than sliding or being pulled.

  • Quit smoking. It is never too late to quit smoking. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. Most important for someone with an SCI, smoking decreases oxygen to the skin. This makes it easier to get a pressure sore and slows healing. You will help yourself and those around you by not smoking. Ask your caregiver for more information on how to stop smoking if you are having trouble quitting.

What should I do if I see a pressure sore starting?

When you see signs of a pressure sore it means that damage is already happening. Act quickly to prevent it from getting worse. The only way for the sore to heal is to keep pressure off of it. This may mean that you have to stay in bed, but staying in bed puts you at risk for developing other problems. You can develop a pressure sore in another area, have respiratory (breathing) problems, or develop a urinary tract infection . Caregivers will work closely with you to help the pressure sore heal.

  • Caregivers will clean the area often to remove dead tissue, skin, or fluid draining from the sore.

  • Make sure that you or anyone else who touches the area washes their hands thoroughly first.

  • Find out what caused the pressure sore and change the problem so another pressure sore does not develop.

Do not:

  • Do not massage the area of the ulcer. Massaging the area can cause further damage to the skin.

  • Do not use a donut-shaped or ring-shaped cushion. These cushions can slow blood flow to that area and cause worse problems.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. Accepting that you have a spinal cord injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spinal cord injury.

  • You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact the following for more information.
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia , 30309-1402
    Phone: 1- 404 - 355-9772
    Web Address: www.asia-spinalinjury.org
  • National Spinal Cord Injury Association
    1 Church Street, Suite 600
    Rockville , MD 20850
    Phone: 1- 800 - 962-9629
    Web Address: www.spinalcord.org

CONTACT A CAREGIVER IF:

You have:
  • A reddened area on your skin that does not turn white when it is pressed.

  • A blister or open sore, with red and irritated skin around it.

  • A sore that looks like a crater.

  • A deep sore that may be painful and draining fluid.

  • Signs and symptoms of a worsening infection. These include greenish or yellowish drainage coming from the sore. These include a bad smell coming from the sore.

  • You have chest pain or trouble breathing that is getting worse over time.

SEEK CARE IMMEDIATELY IF:

  • You have a fever.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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