Dry lips and skin in the hospice setting
By Valerie Hartman, RN, CMT, CR
Hospice nurses and nurse’s aides working in end-of-life care all know how important it is to find the right product to soothe stressed skin. I think any caregiver at home or family member visiting a loved one in a skilled nursing facility or inpatient hospice unit will quickly notice skin changes. Lips almost always become dry when mouth breathing occurs; winter weather and heating make skin conditions worse for those confined inside; natural nutrition and elimination changes contribute to lack of hydration. Certain illnesses and medication side effects also contribute to skin and dry mouth conditions.
Improve the conditions for more comfortable skin:
- Be aware – Inspect skin
- Give more attention to the products being used
- Increase the frequency that the products are applied
- Consider dry skin as a source of discomfort; especially dry hands, feet, lips, and the face.
- Remember – Each hand has 1000 nerve endings, each foot, 7200. The face has a rich supply for nerves for sensitivity to protect vital sensory organs, like the eyes. The more nerve endings involved in the location of dry skin, the more discomfort from dry skin.
The Skin – Lotion Application
Applying lotion once a day after the bath is usually not enough moisture for all day comfort. Hydrate the legs, feet, arms and hands, shoulders and neck, with particular attention to the hands, feet and face. Two, three, or even four applications of a good hydrating cream, unscented, is best. I like to use massage cream because massage lotions and creams are usually made from nut and seed oils, are organic, and are made to stay on healthy skin for glide in a massage therapy session. In hospice care, the same product works with excellence to hydrate and soothe the conditions unique to end of life. A very favorite product is a lavender-infused shea butter, a hard product that softens up on warm skin. If your loved one has very cracked and dry, peeling, dehydrated skin usually found on feet (heels), look online or go to a natural health food supplier and ask for a thick hard shea butter in a small tin canister.
In the last days of life moisturizer should be lightly applied to the forehead, around the eyes, on the face overall, and the back of the neck and along the shoulders. If massage cream is not available, use whatever favorite product is in the home, or buy some of the therapeutic lotions available at pharmacies.
For the lips, coconut oil (white congealed oil that can be found in the cooking aisle of the grocery store) is a great product. Coconut oil has a wonderful feel, is not thick or heavy, blends into the natural oil of the skin nicely, and it soothes chapped lips without a taste. In the last days of life this product is particularly useful. Apply it 5 – 6 times a day if your loved one is mouth breathing. Every time you use the toothettes for mouth care, follow up with a light layer of coconut oil. Vaseline is often used for lips and is acceptable, but coconut oil is a better natural option.
Never use a petroleum based skin / lip product (such as Vaseline) if oxygen is being used.
Water based gels can be used if oxygen is in use; apply it much more frequently as it dries and peels quickly.