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SKIN PROBLEMS Positioning the patient Relevant for: 1. Patient with flexion contraction - There is constant rubbing of the knee against a bed rail 2. Patient who is constantly sliding down in bed or in chair or who is dragged up in bed instead of being gently lifted - large shearing forces to the skin of the buttocks Sensory Level and skin care • Stroke Patients – Spectrum of sensory loss – They are not aware of the normal pressure sensation – Requires shifting position on a regular and frequent schedule • Caregiver – Assumes the responsibility of repositioning the patient – Application of adhesive dressing, touniquets and straps for leg bags *sites of strap attachments should be rotated periodically Pressure relief • Use of foam or eggcrate mattress • Placing pillows in between the legs • Wheel-chair bound patient – Must be taught to shift weight or elevate himself approximately 1 minute out of every 15 minutes WOUND MANAGEMENT • Debridement • Modified thirds solution • Topical antibiotics for abrasions and partial thickness skin hours • Systemic antibiotics if with sepsis • Povidone-iodine