From the Guidelines
For a long-term care patient with erythema over the trochanter area, immediate action should be taken to prevent pressure ulcer development by repositioning the patient off the affected area and implementing a turning schedule every 2 hours, as recommended by the American College of Physicians guideline 1.
Key Interventions
- Reposition the patient off the affected area and implement a turning schedule every 2 hours to reduce pressure on the trochanter area.
- Use pressure-redistributing surfaces such as foam or air mattresses, and ensure proper positioning with pillows to offload the trochanter.
- Gently clean the area with mild soap and water, pat dry, and apply a protective barrier cream like zinc oxide.
- Assess the skin thoroughly, documenting the size, color, and whether the skin is intact.
- Notify the physician or nurse practitioner for evaluation, especially if there are signs of skin breakdown.
Rationale
The trochanter is a high-risk area for pressure injuries due to bony prominence and limited tissue padding, and early intervention can prevent progression to more serious pressure ulcers that are difficult to heal in elderly or debilitated patients, as noted in the guideline 1.
Additional Considerations
- Ensure adequate nutrition and hydration to support skin healing, as recommended by the American College of Physicians guideline 1.
- Monitor the area closely during each shift, watching for worsening redness, warmth, pain, or skin breakdown.
- Consider using advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers, as recommended by the American College of Physicians guideline 1.
From the Research
Assessment and Management of Erythema over New Tracheostomy Site
- Erythema over a new tracheostomy site in long-term care (LTC) patients may indicate the onset of infection or other complications 2, 3.
- It is essential to assess the site for signs of infection, such as increased redness, swelling, or purulent discharge, and to monitor the patient's overall condition, including temperature, white blood cell count, and respiratory status 4, 5.
Prevention and Treatment of Infection
- The use of perioperative antibiotic prophylaxis has been shown to reduce the risk of wound infection in patients undergoing tracheostomy, although the evidence is not yet conclusive 2.
- Topical antibiotics applied to the tracheostoma may also be effective in preventing exogenous colonization and infection of the lower airways 3.
- A multidisciplinary approach to tracheostomy care, including the use of tracheostomy bundles and protocol-directed care, can help to reduce the risk of complications and improve patient outcomes 5.
Nursing Care and Management
- Nurses play a critical role in the care and management of patients with tracheostomies, including assessing the tracheostomy site, providing humidification and suctioning, and supporting the patient's respiratory, nutritional, and communication needs 4, 6.
- Education and training are essential for nurses to develop the skills and knowledge needed to provide high-quality care to patients with tracheostomies 6.