Bedsores/Skin

*** PRESSURE SORES • Turn in bed Q2-4 hrs • Avoid pressure/friction except in last few days • Use skin prep (Sween, Hollister, Bard) • Egg crate, thick foam, air-mattress • Do not massage • Clean, rinse, dry & Open wounds: kept moist to heal; Protein supplement, multivitamins, Vit C 500mg TID, and Zinc 220 BID; Foley catheter & BEDSORE with INTACT skin (reddish): Ointments: A&D, Vaseline, zinc oxide, Desitin • (Op-site, Tegaderm), change every 5-7 days or PRN • Granulex spray BID or prn • Blister (skin break partially): Irrigate well with saline • Use saline • Carington wound gel • Duoderm, Tegosorb, Change each week & Sore with exposed Bone / muscle exposed: Bedside surgical debridement; Travase or Elase; Carrington wound gel; Wet to dry gauze; if granulating & Infected bedsore: Wet to dry; Carrington wound gel; Silvadene; no semi-permeable or occlusive dressing when infected • Granular (clean pinkish): Moisturizing ointments; MVP film; Granulex

*** PERISTOMAL CARE: • Cleanse, rinse and dry • use skin Prep • device fit & sealed • Rapid attention to skin breakdown

*** MALIGNANT ULCERATIONS: A radiation ** Anti-inflammatory ** steroids ** Odor/drainage: Dakin’s soaked dressings, Benzoyl peroxide 10% solution packing (protect surrounding tissue) ** Air freshener ** Flagyl PO/gel ** Bleeding lesion: Alum in 1% solution; 1:1000 epinephrine soaked gauze; Gel foam

*** SKIN INFECTIONS: • Infected sores, Erythema, purulence, foul odor, pain • Culture *Rx ** Dakin’s dressings ** use Acetic acid if green (Pseudomonas) ** Metrogel topical BID ** Flagyl po QID ** Silvadane ** Cipro
Impetigo-superficial-infections: Bactroban (mupirocin) topical, Erythromycin, Dicloxacillin, Cephalexin

***Cellulitis: Penicillin, Erythromycin, Cephalexin , Augmentin, Clindamycin & Candidiasis: Nizoral, Lortrisone, or Mycolog topically, Nizoral for 2 wks.

***MSSA : Methicillin sensitive Staph aurius : Dicloxacillin / Cephalexin : 500 mg po qid; Septra 1-2 tab po bid. But Nafcillin Clindamycin are IV. But Clindamycin 300-450 mg po qid.

***MRSA: Methicillin resistance Staph: Doxycyclin /Minocyclin 100 mg po bid; Septra DS 1-2 tab bid. Clindamycin 450 mg QID. But Vancomycin & Clindamycin are given IV.

*** DRY /SKIN: • After bathing apply Lanolin, Vaseline Intensive Care, Vaseline, Bag balm ** Atarax (hydroxyzine) ** Steroids: 1% hydro-cortisoneoint/0.1% Triamcinolone oint / Prednisone 20-40 mg po daily ** Phenergan only if allergies ** Benzodiazepines

*** WET SKIN: ** Wash & dry ** Special cleansers ** Zinc oxide ** No ointments or creams ** Calamine lotion ** Starch ** zincoxide ** talc ** Lotrimin ** Burrow’s solution

*** MOUTH CARE: Dry mouth *Rx: ** avoid anticholinergic drugs ** Lip balm ** Frozen tonic water, fruit juices, pineapple chunks ** Sugarless lemon drops ** Chewing gum ** Artificial saliva ** brush ** rinse (H2O2) ** Soda water ** Cepacol n Ulcerations: • Herpes: ** Zovirax (acyclovir) 200mg q4h 5 days • Aphthous ulcers: ** Glyoxide rinse n Periodontal infections: ** Peridex wash, oral Pen VK, Flagyl, Velosef ** Kenalog, Lidex or benzocaine in Orabase & Foul, fungating lesion: ** Flagyl & Yeast ** Mycelex troches 5x/day are very effective ** Nizoral (Hepatotoxic) ** Nystatin suspension 1 tsp q4h n Painful mouth: ** Xylocaine 2% viscous solution 1-2 tsp or 10% oral spray q3h ** Antacid ** Glyoxide rinse ** Tessalon perles, 1 or 2 dissolved orally q8h Anesthesized Throat

*** Taste alternation: ** Zinc, Vit C

*** URTICARIA: *Rx: ** Antihistamine ** H2 blockers (Pepcid) ** TCA (Elavil) ** Benzodiazepine ** Local application

*** PRURITIS: • Dry skin: ** NO hot baths ** avoid irritants ** lubricants ** cornstarch & bak-ing soda tepid bath ** cotton dressing ** 1% Hydrocortisone cream ** Antihistamine ** Decadron

*** CANDIDIASIS: 70% • Sore mouth • Painful Dysphagia • increased risk with: Steroids, antibiotics, radiotherapy, chemo, dentures *Rx ** Nystatin oral susp / Popsicle ** Ketoconazole ** Diflucan ** prophylactic Mycelex troches