Holly M. Hovan MSN, APRN, ACNS-BC, CWON-AP
I'm sure you're all familiar with the terms "prednisone skin," "thin skin," "fragile skin," or "easily bruises." One or all of these phrases are commonly used to describe our geriatric population's aging skin. As we age, so does our skin. Skin loses elasticity and often gains wrinkles. Skin conditions that were maybe never present throughout life can crop up with aging. Keep in mind that the environment and different exposures (to sunlight, smoking, and stress) can cause our skin to age differently. Additionally, certain drugs, obesity, diet/lifestyle, habits, exercise, repetitive movements, and family history can also influence how our skin ages. Exposure to radiation (for cancer treatment) can also cause skin changes several years after treatment is complete. Regardless of the reason, as we age, our skin composition changes, and undoubtedly the risk for skin tears increases.
How Skin Tears Occur
You may notice that your elderly patient bruises just by bumping into the bed rail, or that the tape used to secure gauze after a blood draw seems to tear their skin; these problems are not uncommon. Though prevalent, skin tears are usually easily treatable and, in some cases, preventable.
Skin tears usually occur as the result of an accident (bumping into something, a door knob, wheelchair pedal/leg, or other object). Sometimes skin tears can occur as a result of direct trauma, such as removing tape or dressing. Prevention is always best, just like with pressure injuries. However, if we're unable to prevent, then we must treat and heal. Usually, when left undisturbed and protected with a dressing, skin tears resolve quickly - but they can be recurrent.
Treatment and Prevention Strategies for Skin Tears
When a skin tear is first noticed, it is important to attempt to replace the "skin flap" or piece of skin that was torn. With a large skin tear, sometimes steri-strips can be helpful with this, but with small skin tears, they're often not needed. A non-adherent layer, along with bordered foam dressing, usually does the trick to cover. Dressing changes depends on the amount of drainage; some wound dressings can be left in place for a week, while others are changed MWF or biweekly. It is helpful to mark the direction with arrows on the secondary dressing, so that when it is removed, the skin flap is left in place and not torn in the opposite direction.
Alginates or more absorptive dressings are also handy if there is a lot of drainage, a weepy leg, etc. Also, dressings impregnated with silver can be used as needed for infection. It is important to note that the antimicrobial properties of silver, just like antibiotics, should not be overused. When using silver or other antimicrobial dressings, it is important to re-evaluate wounds frequently to determine continued need.
In terms of prevention, protective arm sleeves are helpful. The use of paper or gentle release tapes is also a better alternative to nylon tape, when it comes to sensitive or aging skin. In addition, it is important to routinely moisturize dry skin with an appropriate moisturize barrier. As we age, hydrating dry skin helps to replenish missing skin and keep skin healthy and intact. Oral hydration is important as well. I am sure we've all heard the saying, "a dry cell is a dead cell!"
Prevention and treatment of skin tears is something that can sometimes seem like a small task, however means so much to our patients' comfort and well-being. Though small, skin tears are painful. And, as we know, if skin is open, we have a route for possible infection. So, prevent as able, treat with care, and monitor for changes!
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.