During your assessment, you note that she has very dry, thin, almost transparent skin. She has limited

Question

mobility from her stroke and is currently bedridden. There are several areas of ecchymosis on her upper
extremities.

She is alert and oriented to person only. You review the transfer summary from the long-term
care facility and note she has a history of urinary and fecal incontinence.
Given R.L.'s Norton score, describe specific measures you would implement to prevent
further skin breakdown.

Answer 1

• Provide adequate nutrition and fluid intake, focusing on her specific protein, calorie, and fluid
needs.
• Apply topical emollients to moisturize the skin: apply lotion every 4 hours, or creams every 8
hours, or barrier ointment and thick creams every 12 hours.
• Avoid use of rubber- or plastic-backed underpads because they trap and hold urine and feces
against the skin, thereby promoting breakdown.
• Avoid massaging reddened skin or skin over bony prominences.
• Change her position at least every 2 hours; use a written schedule for turning and repositioning.
• Use proper positioning, transferring, and turning techniques.
• Use a pressure-reducing device such as a foam pad, pressure-reducing mattress, or alternating
pressure pad when R.L. is in bed. Consider referral for a specialty bed.
• Wash and dry her promptly when she is incontinent.