Abrasion Care in Healthy Young Adults by Zulma Chardon, BS, RN, WCN, CWS

> WOUND & SKIN CARE

Abrasion care in healthy young adults By Zulma Chardon, BS, RN, WCN, CWS

ACTIVE YOUNG ADULTS take can be cleaned at the beside, but a say they should “air out” their wounds risks when they zip around on timesaving, cost- effective way to and that wounds must scab to heal. scooters, skateboards, bicycles, or remove surface debris from multiple Explain that the wound bed can roller blades. Resulting falls often abrasions is by showering or using a be kept moist with ointments and cause abrasions. This article reviews faucet with a shower attachment wound gels or specialized dressings. a simple and effective way to care to clean a small area. Provide your Stress that they shouldn’t use alcohol- for partial-thickness abrasions. patient with chlorhexidine solution or based solutions to clean the abrasion a chlorhexidine scrub brush for self- because these products sting and may Initial assessment cleaning.2 Chlorhexidine is a good be harmful to healthy cells.5 Partial-thickness wounds occur when choice because community-associated Once the wound is cleaned, it’s the entire epidermis and top layer of methicillin-resistant Staphylococcus time to apply a dressing and explain the dermis are damaged. These aureus is common among people in how to change it at home. wounds are shallow, pinkish/red, this age group, who have a tendency painful, and highly exudative.1 When to share personal items such as towels Getting dressed you first assess a patient with a partial- and athletic equipment.2 Advise the Finding dressings that are cost- thickness abrasion, make sure the pa- patient to avoid getting chlorhexidine effective and highly absorptive can tient has no other potentially serious in the eyes. Make sure the shower is be a challenge.6 Initially, the best injuries from the abrasion-producing disinfected after each patient. Ran- choice may be a nonadherent, atrau- event besides the abrasion itself and dom culture specimens taken from matic dressing secured with gauze- include these questions. the shower stall should be negative. bandage rolls or a tubular-elastic • When (date and time) did the After the shower and before apply- retainer dressing.7 Exclusively using injury occur? ing a dressing, assess the abrasion occlusive dressings (such as transpar- • How did you get the injury? and remove any remaining debris. If ent films with or without hydrocol- • What’s your pain level on a scale a significant amount remains, the loid, or absorbent acrylic dressings) of 0 (no pain) to 10 (worst pain healthcare provider may need to on multiple-denuded sites is costlier imaginable)? anesthetize the site with a local anes- from the outset because occlusive • Do you have any allergies, includ- thetic before further cleansing.3 All dressings fill quickly, leak, and can ing medication, tape, or latex? debris (dirt, grass, clothing, or asphalt) cause periwound maceration, requir- • Have you injured yourself in the must be removed to prevent tattoo- ing daily dressing changes.4,6 These same area before? ing, which occurs when debris is em- dressings are also prone to falling off • Were you wearing a helmet or bedded in the dermal layer.3 Remov- because of perspiration and nonad- other protective gear? ing debris can be done with a herence to hairy skin surfaces. Re- • When did you receive your last chlorhexidine scrub brush/sponge or member that patients in this age tetanus vaccine? (If it’s been more cotton-tipped applicator. group are sensitive to criticism from than 5 years, the patient will need During the dressing process, peers, and leakage from occlusive tetanus prophylaxis.) educate patients about self-care of the (especially hydrocolloid) dressings • Have you tried to treat the abrasion abrasion. Provide a brief introduction may create embarrassing situations. yourself? If so, what did you do? to basic wound healing. Explain that Don’t shave the periwound area the wound bed must be kept moist because shaving increases the risk of Keep it clean and clean and without a scab.2,4 This infection. Excessively hairy areas After you’ve obtained a targeted his- is contrary to what many patients have can be carefully clipped.8 For high- tory, clean the abrasion. The abrasion learned from parents or friends who drainage abrasions, use antibiotic

68 l Nursing2011 l May www.Nursing2011.com

Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ointment that doesn’t contain neomy- For facial abrasions Remember the patient’s cin (products containing neomycin 1. Follow steps 1 through 5 for non- priorities can cause allergic dermatitis), or use facial abrasions and repeat several When teaching patients about any low-adherent dressing. Apply times per day, especially for the first self-care, consider their likely gauze-bandage rolls and tubular- few days when there’s increased priorities: no scarring, resuming elastic retainer dressings (burn net) as drainage. Be careful not to get oint- normal activities (such as running, cover dressings. When drainage de- ment in your eyes.1,3 swimming, biking, and other creases, the dressing can be replaced 2. Protect the abrasion from the sun. sports), and minimizing the cost of with a less-absorptive one. Wear a hat. You may not need to treatment. Stress that wound heal- For small, low-drainage abrasions, wear a bandage if you maintain a ing requires a team approach, and several options exist: transparent- regular wound-cleansing schedule the most important team member film dressings, antibiotic ointment/ and keep it moist with ointment. is the patient. Encourage any inter- flexible fabric adhesive strips, hydrogel/ 3. Once your wound is healed, use est that leads to patient adherence nonadherent pads, and nonadhesive generous amounts of sunscreen SPF to the treatment plan, such as fol- pads under transparent film. 30 or higher. Newly healed skin is lowing the healing process through If you suspect a wound infection, more prone to sunburn, which may photos on their smartphones. consult with the healthcare provider, result in blistering.3 Compliment them on keeping their who may prescribe an oral or I.V. anti- On return visits, obtain an oral appointments for dressing changes biotic depending on infection severity. temperature, remove the dressings, or keeping the dressings intact and and assess for erythema, warmth, dry between visits. Follow-up edema, induration, and pain.4 Docu- By fully engaging patients in self- The healthcare provider will give ment the amount and character of care, you can prevent complications most patients the option of returning any drainage. and promote healing with minimal for dressing changes or changing the If wounds are cleansed correctly scarring. ■ dressing themselves at home. En- and no infections or scabs develop, courage patients with multiple abra- most abrasions heal in 10 to 14 REFERENCES sions to return for follow-up. If they days.1 1. Burnsurgery.org. Initial wound management. decide to do their own wound care, Partial-thickness burn. http://www.burnsurgery.org. 2. State of Rhode Island Department of Health. advise them to use the prescribed Patient teaching Health Advisory: Community-acquired MRSA. dressings until the wounds are no During initial and subsequent visits, http:www.health.ri.gov/disease/communicable/ providers_mrsa060705.php. longer draining to prevent scabbing. talk with your young adult patients 3. Hogue, Robert, MD: Personal and professional Before you send your patients about safety and wellness topics: communication. home, provide them with these • Advise wearing a helmet, elbow/ 4. Gokoo C. A primer on wound bed preparation. guidelines for self-care. knee pads, and other protective gear J Am Coll Cert Wound Specialists. 2009;1(1):35-39. 5. White RJ, Cutting K, Kingsley A. Topical antimi- For nonfacial abrasions while biking, skateboarding, roller- crobials in the control of wound bioburden: part 2. 1. Use a clean, warm soapy wash- blading, and riding scooters or mo- Ostomy Wound Manage. 2006;52(8):26-58. cloth to remove all dried drainage. torcycles. 6. White R, Cutting KF. Modern exudate manage- • ment: a review of wound treatments. http://www. 2. Pat the abrasion dry gently with a Stress the importance of eating a worldwidewounds.com/2006/september/White/ clean towel. balanced diet rich in fresh fruits and Modern-Exudate-Mgt.html. 3. Apply a thin layer of antibiotic vegetables. 7. Ubbink DT, Vermeulen H, Goossens A, Kelner RB, Schreuder SM, Lubbers MJ. Occlusive vs. gauze ointment to the abrasion after each • Discourage smoking. dressings for local wound care in surgical patients: cleansing.1 • Address scarring, which is often a a randomized clinical trial. Comment in: Evid Based Nurs. 2009;12(2):52. 4. Apply a dry, clean bandage and concern for young adults. Explain 8. Woundpedia. Surgical site infections. http:// secure it with hypoallergenic tape. that whenever skin is broken, scar- woundpedia.com/index.php?page=stream&topic=1 Keep bandages dry between changes. ring or skin discoloration is possible 9&docID=361. 5. Contact your healthcare provider if but may fade over time. Advise pa- you experience redness, warmth, swell- tients that using generous amounts Zulma Chardon is a senior RN manager in the Student Health Care Center at the University of Florida in ing, increased soreness, pus, or red of sunscreen SPF 30 or higher once Gainesville. streaks near the wound, or if your tem- the wound is healed may prevent the 3,4 3 perature goes above 100ºF (38ºC). site from becoming darker. DOI-10.1097/01.NURSE.0000396452.12370.39 www.Nursing2011.com May l Nursing20111l 69