Skin Breakdown

​fesk

I thought I saw a post here asking what people do about waking their LO to change them so they are not wet. I cannot find the post. We just recently started to have to deal with nighttime incontinence, and I'm looking for advice on how best to handle. 

Sometimes my mother wakes in the middle of the night, and I change her then. Otherwise it may be in the morning but I think the latest has been 6 am.

I will admit to knowing nothing of how best to handle this. There are no issues yet but I need to know how to avoid. How do you protect the skin and do you change only when your LO gets up in the morning or do you wake at a set time each night?

All input and advice appreciated. Thank you in advance.

oehlsena

Our LO has had nighttime incontinence to the point that she can nightly soak through waterproof sheets all the way to the foam mattress beneath. Our response to this has been limiting fluids after 6 PM and offering jello and fruit when she gets thirsty. She will get put to bed at 8:30-9:30 with a last bathroom trip then. I will get up between 4-6 AM to help her to the bathroom. I just enter the room with a big smile and tell her it is time to go to the bathroom. Sometimes I do need to shake her awake. This is a good time  to change her pull-ups and her incontinence bed sheet. Then I will put her back to bed. I try to have her back up at 8 AM, then, for breakfast.

Edit: it is also key to give her water after she lays back down before breakfast and to make sure it is back beside her bed. Otherwise she will get distressed. She also forgets to drink anyways, so dehydration is something to beware of. 

May flowers

Hi Fesk, we use a really absorbent diaper with a booster pad in it, and no liquids after 6pm. We do the last bathroom break at 9pm right before bed. We put the thick zinc cream on his bottom and powder on the rest of his privates. 

If he is restless at night we change him, if he is sleeping well, we don’t. In the morning (9 am) we bathe him anywhere urine has touched and follow it up with Eucerin cream, the thick stuff. We also use Eucerin on his arms, hands and legs. So far, his skin has been in great shape.

We also make sure he eats/drinks a lot of protein, important for the skin. He likes meat, but they also make high protein Ensures. Hope that helps!

mommyandme (m&m)

Fesk, I do not wake mom up to change her at night.  I wouldn’t wake a baby to change them either, would only change if the babe awoke themselves.  Same approach for my mom.   I change mom in bed in the morning and always wash her with warm soap and water.  I don’t limit her fluids but she’s in bed at 6:30 these days.   We have super absorbent adult diapers and a couple of chux underneath her. The chux are usually clean but the diaper is full full.  I also use desitin as her barrier cream, always. It’s a preventative and has worked really well.  I must wipe off all the desitin before I wash her, with a skin cleaning wipe, because soap and water doesn’t take it off completely.  Then after washing and making sure she’s very dry, I apply it liberally again.  The other barrier creams I’ve used just haven’t held up under the pressure.  Before bed I make sure to wipe her clean with wipes, dry her completely, then I apply desitin again.  As I said… I need to buy stock in Desitin cause I buy it by the tub.

So far so good.  I’ve had the hospice nurse evaluate my routine and she approves.  Good luck. 

Olly_Bake

Fesk, I was the one that started the post. I had gotten a couple of responses and the first person that responded, I wanted to reread their post again once home but it was gone for some reason. I didn’t want anyone to get judged or feel judged so I just deleted the entire post. The first poster responded they rely heavily on Desitin to keep from having a rigorous changing schedule. But I don't think mine is rigorous either.

Skin care is close to my heart. We loss mom because of skin breakdown. Told mom I was sorry but the family drama with my siblings including the one that still lives in the home had gotten the best of me. Within four months, mom ended up with a bed sore that turned into a bed wound that turned into sepsis. By the time sibling gave home health the okay to treat outside the home, it was too far gone and it was too late to operate.

Hence the reason I was and am still concerned with prevention. Right now I do awake dad every three or four hours while there to see if he needs changing. At noon, I went to check and he goes, “you don’t have to check me believe me I know when I’m dirty or wet.” I told him let’s bet a $100 dollars. He smiles and let me check him. Glad we didn’t shake on it, I would have lost.

We use Medline Zinc paste because it is what the previous hospice provided and what was used on him in the hospital. Still haven’t found a good moisturizer for other skin care. I am using an advance therapy lotion daily and baby oil off and on but his legs or feet are still shedding. 

Olly_Bake

Hi MommyandMe, I believe it was you that posted yesterday. So glad you reposted because I desperately wanted to re-read your post.

Fesk. I like the way you worded the post.

MayFlowers, I've been trying to implement more protein (trying premier protein). I have to work at it to get him to get an entire box down in a day. Some with meals and some in coffee. I saw Eucerin in the hospital but never saw that one get used. But yes, it is very thick.

mommyandme (m&m)

Olly_Bake, 

I am extremely frightened of bed sores and skin breakdown.  I’ve not gotten a hospital bed, one reason being because I fear they exacerbate the problem.  An unreasonable fear I bet, but still.  

I am so terribly sorry for your mom’s passing and that somehow you have felt a bit of responsibility. Im so sorry.  One sob filled day I expressed to my husband that I’ll never be the same after mom is gone because of the regrets I will, no doubt, harbor for the rest of my life.  Each day is so hard and it comes down to we’ve done our best and our LOs are/were better off for it.  I try to remember that.  This is all so hard am I’m so sorry.   

Thank you for sharing and your kindness. 

live in daughter

Hi Fesk, agree with the other posts- using protective cream at night. We did not wake our Mom during the night- thought sleep was best for her. She would awaken at times during the night and we would change depends and get her on the commode.

We would give our Mom Boost drinks to help get protein into her.

We ordered a small air device for her to sit on during the day. It helped to distribute her weight and prevent pressure on her bottom. It was comfortable for her and she never developed any skin issues.

Hope this helps.

​fesk

Thank you all so much for your replies.

Oily, I'm very sorry to hear about the loss of your mom. Things are difficult enough without the family dynamics.

I have been limiting water after 6:30 or so. She has a healthy appetite, so I believe she is getting enough protein, but I will look more closely at her diet to confirm. 

I am glad to see many do not wake their LOs. My mom had sleep issues in the past (and occasionally still does) so if she can sleep, I prefer to let her.

I will look into both Desitin and zinc cream. I'd prefer something easier to wipe off but they probably all are difficult to an extent.

Again, thank you all - very much appreciated.

abc123

Dear Fesk, I use a product called CALMOSEPTINE OINTMENT. It’s in a green and white tube. It cost less than $7 per 4 ounce tube. Works great. Mom has been confined to bed for at least 6 months now and not any skin breakdown. We keep her clean and dry, turn her every two hours to the minute. All of these things work together to prevent breakdown. 

A few nights ago, I shared this info with you and it disappeared. I wish you and your LO the best.

​fesk

Thank you, abc123. I will look into that as well.