2. Keep skin moisturized. Dry skin is more susceptible to pres-
sure ulcers. Advise patients with dry skin to use a moisturizing cream
in the leadup to surgery, and to shower only every other day — show-
ering can dry skin out more — and to use a soft sponge for gentle
cleansing in the shower in the weeks leading up to surgery, as vigor-
ous scrubbing can make skin more vulnerable to breakdown, accord-
ing to leading pressure ulcer researcher Courtney Lyder, ND, ScD(H),
FAAN, a professor of nursing at UCLA.
"While there's no clinical research on this, it's general knowledge in
the field that having good moisture is one of the things that prevents
skin breakdown," says Carlos Galeano-Rodriguez, MD, certified
wound specialist physician with Vohra Post-Acute Physicians in
Pittsburgh, Pa.
3. Turn patients in pre-op. If immobile patients are waiting long
in pre-op, turn them at least every 2 hours by 30 degrees — alternat-
ing onto their right side, back and left side. When moving from the
back to the side, place a pillow behind them, tucked under the
sacrum, and place another between the legs to keep the ankles from
resting on top of each other and creating pressure. When a patient is
on his back, avoid putting a pillow under the knees, as this can
increase pressure on the heels. Instead, put a pillow under the calves,
so that the heels are lifted. If patients are in such pain that it's not pos-
sible to move them by 30 degrees, encourage them to engage in micro
turns by subtly shifting their weight. Don't let patients drag them-
selves in order to shift on their own, as dragging can lead to skin
breakdown.
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