The Link Between Continence and Wound Care
Can poor continence care lead to dangerous wounds in nursing homes? Many families don’t realize that incontinence can directly increase the risk of painful and infected pressure injuries. Proper continence management is key to preventing these serious wounds. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Jessica Tonia to talk about the link between continence and wound care, and what nursing homes should be doing to protect residents.
Tonia:
Called shower days, and they use that as their dedicated skin round to really investigate and check the patient. And now on that, it’s also part of our assessment, al daily assessment. When you go in and say hi to the patient, you’re looking at that patient’s skin. While you’re doing that, every interaction you have that patient, you’re looking at their skin. You have to make that a priority.
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I will be your host for this episode. Today we’re talking about the link between incontinence of a resident and how it affects wound development. I. Skin integrity, but we’re not having that conversation alone. We have the fantastic Jessica Tonia.
It took me a little while. I had to like phonetically, spell that out. But it’s Jessica Tonia registered nurse with us today to talk about that link between continence care and wound development. As I mentioned, we’re talking about incontinence, care, incontinence, and wound care and wound development. We’re not doing that alone. Today we have Jessica Tonia. I. A board certified family nurse practitioner with a rich background in emergency critical care and forensic nursing.
Before becoming a nurse, she spent years in biotech purifying monoclonal antibodies. Jessica was a frontline ER nurse during the COVID to 19 pandemic, and recently earned her MSN with a focus in family practice. She brings sharp clinical eyes and legal lenses to healthcare, and we’re so happy to have her on the show.
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Jessica, welcome to the show.
Tonia:
Oh, thank you. How are you doing today?
How does incontinence contribute to skin breakdown and wounds?
Schenk:
I’m rocking and rolling. Can’t complain. Thank you. We’ve had a lot of shows about pressure, injuries, wounds, that kind of thing, but I don’t think we’ve had one dedicated specifically to how I. Continent care affects the development of wounds and the healing of wounds.
So let’s start from just the basics, Jessica. What does incontinence have to do with how the skin breaks down at all?
Tonia:
So incontinence, basically, when a patient they’re either bout we have, we call like bowel or bladder incontinence. They’re not able to hold in their urine or fe they could be both, could be one or the other depending on their condition.
Sometimes you see this a lot when patient gets older, like they have dementia, come bed, bam. And that’s where the incontinent come in. So what happened is when you’re not able to control your bowels and bladder. It gets released spontaneously, and then when it leak, it just. You have no control, so it just leaked over you.
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And unfortunately because of the material, it’s extra moisture and also we don’t really think of it, but feces and urine, that’s acidic. It goes against the skin. So when it goes against the skin with that extra moisture, it makes it really cards a lot of resect them up for pressure injury that we see, it’s really hard to control the wound it, it leads more likely to develop.
Wound to form.
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What are the best practices for preventing pressure injuries in incontinent patients?
Schenk:
So moisture is the problem, and specifically moisture from either the feces or the urine is even more of a problem because of the acidic nature of it, and it breaks the skin down itself.
Tonia:
Yes it does. It breaks down the skin. And if you had a wound or you have something that’s developing, like for example a sacrum, like you had a stage one pressure in the sacrum area, which is commonly can cause incontinent there, that’s just gonna make things worse.
It’s just gonna open up. Eventually the skin gets fragile and it opened up and then. Now you have a possibly stage two even leading all the way down the stage four if it’s not monitored correctly.
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Schenk:
So let’s take the BB again. Let’s say that we have a resident that might be both bowel and bladder incontinent, okay?
What are some of the best practices to keep that the sacral area dry and, not exposed to it?
Tonia:
It, you have to be really proactive. It’s really monitoring if depending on the patient, if they’re mobile, like they can get out of bed, you want ’em, keep on moving because all that moving chi that fluid and keep the skin.
If they’re bed bound, you have to turn ’em every two hours. You may have to look at devices like professional mattresses. They have like little like air pump that actually move the pressure point off the body. You just don’t wanna over the skin, over the bone. That’s where the pressure engine can develop.
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You can look into lifting the pillows to lift like. There’s one of the saying that we always say nursing, they float your heel, meaning you put a pillow on the person heel, and that’s where the pressure injury can form there. So you wanna look device, you keep them clean, keep the sheet clean.
Just a lot of cleanliness and making sure that everything’s working and big. It’s being proactive.
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How can nursing homes improve continence care to reduce wound risks?
Schenk:
How about the idea of absorbent products, like when should we be using those as opposed to some other intervention for incontinent residents,
Tonia:
If you can use ’em, you can, especially if they’re mobile.
Like you can use like a depend product, but you have to make sure they’re clean every time they go to the bathroom. And you wanna really take ’em all. You don’t wanna leave them in as they, they go. They have an incontinent, you have to make sure they’re clean and replace it with clean, dry one.
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Schenk:
It’s interesting you mentioned that mobility and keeping somebody moving, even if they’re wet, might help prevent a wound from developing.
Tonia:
Because that movement it lets the body shift its fluid if it can move the fluid so that way, if you move around it shift the fluid so you’re more likely to pel the fluid. Also keep the skin loose and last a little bit so it can recover quickly.
So that’s why we always wanna move. Also the same reason why we always wanna move to put in blood clot from formula as well. The movement is good. If we can try to keep the patient mobile and change in condition, the better.
Schenk:
Better. Tell me about the difference, if any, between the a, a moisture associated skin damage. And a pressure injury, if there are any differences.
Tonia:
There are a couple of differences. Usually the moisture is usually in, it’s usually involved, like where it’s mostly involved around the peritoneum, like the genital area. You’re mostly gonna see it in the buttock. Genital, you might see it a little bit down like the leg there, because, just ’cause the way gravity is.
Pressure injury, it can form, it really form over the bone. Anytime you have boning, provenance, like heels had bone and they have skin, that’s where they can form.
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Schenk:
So I guess you could potentially, you could have moisture associated skin damage at a pressure point that develops into a pressure injury.
Tonia:
It could. But that can be really hard to just tell. Like it could be a lot of factors involved. So it impossible that way.
What are the common challenges in managing both continence and wound care?
Schenk:
So what are some of the common challenges that a nurse faces in long-term care with incontinent residents and wound care?
Tonia:
A lot of it’s just staffing, I think.
I think staffing and supply and time management. If you have to be really vigilant, that’s knowing who your patient are they able to get out of bed? If they’re bed bound, now we have to make sure they’re on a two hour cycle. Make sure the sheets are clean or in the right mattress, or you have the right absorbent product, skin barrier.
You have to make sure all that and you have to make sure you can be able to delegate that to a nurse person. We are facing a shorter than long-term care facility where they don’t always have that and the nurses are doing everything and that tend to put a strain on the care it’s a lot of like teamwork and working together and, having the right supply and even like policy to help enforce that in place.
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How does moisture-associated skin damage differ from pressure injuries?
Schenk:
Tell me about perhaps some of the factors that go into whether or not you would use absorbent products on a resident versus not. Who qualifies for it and who probably shouldn’t have them.
Tonia:
I’m trying to think. There’s really, I think one of the thing I would think about is patient that have sensitive skin. Like they’re prone to develop an eczema or so in the skin. You may be careful with an absorbent product or you might have to find a special absorbent product for that skin type.
Everybody has different skin type and a lot of there are special absorbent for different type of skin type that might have it. If you’re using a certain brand, that’s one thing. You have to make sure are they developing something like a rash? Because of that, then you have to think about getting a specialized product for that patient.
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Schenk:
So it, would it be fair to say that the default for any resident that’s incontinent of bowel and bladder is to be vigilant for pressure injuries to the sacral area or to the buttocks?
Tonia:
Yeah, they can be vigilant. It hard to be vigilant too, how do you look? You need somebody to help monitor that too.
Like it’s hard, look at your backside, but they should be vigilant if they can, if they’re mobile and they understand and they know how to like clean, they should be teaching educated how to do it.
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Schenk:
So how can nurses spot the early signs of skin damage that, that, that comes from incontinent residents.
Tonia:
So it depends on the po. A lot of times it depends on the policy of their facility. Lot they’ll have you can have skin round, dedicated skin round that would come to your, that would come to each patient a week, once a week to see, or once a day. You can have, I know in some nursing home they have what’s called shower days and they use that at their dedicated skin round to really investigate and check the patient.
Now that it’s also part of our assessment, our daily assessment. When you go and say hi to the patient, you’re looking at that patient’s skin. While you’re doing that, if every interaction you have, that patient, you’re looking at their skin, you have to make that a priority.
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What role do absorbent products and skin barriers play in wound prevention?
Schenk:
What is a skin barrier? In terms of continent care?
Tonia:
So a skin barrier to help, like it’s like a cream that kind of help like moisturizer and provide that extra set protection between whatever the surface is and the body. So it it’s like a extra layer of protection for the skin. It provides what it needs, like moisturizer and protection that it needs, and it help reduce the chin.
But again, it also, it depends how often you’re applying it, how you’re doing it, that how it worked like.
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Schenk:
As a layperson. As a non-clinician, it seems like almost a I don’t know, like a oxymoron or a kinda like a strange thing to say that moisture’s bad, but we’re gonna put a moisturizer on your, on your body.
So explain that. Like how is it that moisture typically is bad, but this skin barrier is okay.
Tonia:
It moisturizer, it’s like it gives. More moisture than we really need. The skin just needs the right balance. And unfortunately it can be very finicky at times. And everybody’s skin is different.
I have sensitive skin. I need a little bit more to keep my body hydrated. Other people may not. So it really depends on the product and the product that you’re using and how often you use it. Some people need it once a day. Maybe they need a fresh and some people need a little more. It’s about knowing who it, you have to know yourself, right? You have to know what you are. And if you’re not sure, you can see a dermatologist and see how they can investigate. They can figure out the right product for you.
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Schenk:
Sure. Okay. So what role does, like advocacy on behalf of the resident’s family mean in this situation?
Like what can people do?
Tonia:
People it, big part of it is education. We’re nurses. We have to educate everybody. You educate the resident how to keep clean, how to do product, and educate the family. Sometimes patient doesn’t know what to do. You have to educate the family to be vigilant as well. And that’s even, this is anywhere, like anywhere, even a hospital setting, long-term care facility.
You have to be your own advocate and that’s how nurses can help with that to teach you how to do it. Spot these things.
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How can caregivers identify early signs of skin damage in incontinent patients?
Schenk:
But I guess at the end of the day, if your loved one is incontinent of bowel or bladder and is perhaps, not necessarily bedbound, but re relies on the nursing home staff for bed mobility, then that individual’s at risk.
And you wanna be extra vigilant.
Tonia:
Yeah. You wanna be extra vigilant. You’re gonna have to you may, you have to speak up to them. You can be part of it too. You can be part of the skin assessment with the nurse because you wanna know, any que ask question, do whatever. Be proactive.
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Schenk:
Excellent advice. Jessica, I really appreciate your time today and coming on the show and sharing your knowledge with us.
Tonia:
Thank you so much. I appreciate being here. Thank you.
Schenk:
Folks, I hope you found this episode educational. If you have an idea for a topic that you would like for me to talk about, please let me know.
If you have an idea for a guest that you’d like for me to talk to, please let me know that as well. New episodes of Nursing Home Abuse podcast come out every single Monday, and once, please do anything like, you could just yell out your window that you want. A nursing gonna be podcast coffee mug, and you’ll get one.
It’s gonna fall from the sky. It’s gonna land in your hand. But I hope that I’m gonna eventually get rid of these pod these podcast coffee mugs from my house at some point. So please aid me in that process. And with that folks. We’ll see you next time.
Jessica Tonia’s Contact Information:
- Nurse Jessi Consulting, LLC on LinkedIn
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