The nurse is caring for an infant with bladder exstrophy. As part of the nursing plan, the nurse monitors for abdominal skin excoriation. Which intervention would best promote healing and prevent further skin breakdown?
A) Cleaning the area well with a scented diaper wipe
B) Applying a barrier/healing cream or paste on the skin
C) Keeping the bladder moist and covering it with a sterile bag
D) Covering the area with sterile gauze pads after bathing
B
Response:
The nurse should use barrier/healing cream or paste on the surrounding skin to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on non-intact skin and can worsen skin breakdown. It is important to protect the bladder, but this will not address the skin excoriation. Meticulous attention to cleanliness is important, but the nurse should sponge bathe the infant rather than immerse the infant in water to prevent pathogens in the water from entering the bladder.
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A) True B) False
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