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[Snowy]

... just been to visit Mum in law, frail, early 80s, practically bed ridden, COPD and heart disease from years of chain smoking, on oxygen.

When I was helping her this morning I noticed that she has lots of those bruise like discoloured patches on her arms and legs. They are not bruises as they are too uniform - on both shins and forearms. The skin is fragile and breaks easily. I remember it from working on the elderly wards but it is so many years ago, I can't remember what it is and whether or not it needs any special treatment. Is it to do with her circulation? Main reason I am asking is that the skin on her forearm had actually broken, so I just covered it with a non adherent dressing and a light weight piece of tubigrip to anchor it.

 

Can any of you give me any info about this and how best to manage it? (I must add she does get very good care from home care services and my SIL and her daughter - also a nurse, but I do sometimes wonder if they are too close to always see everything if you see what I mean!)

 

Thank you! xx

[Plum]

Snowy the friable skin you describe is usually due to use of steroids used over the years to treat her COPD. It also affects blood vessels making the walls very thin and liable to bleed and because of the loss of subcutaneous tissue they are easily seen. Purple blotching can also be caused by medication or some illness when it's likely to appear on the shins.

It may be that she usually has her arms covered and you haven't noticed it before. If it is new then you can ask the GP who may check prothrombin etc., and review medication.

When the skin and blood vessels are like this they are very susceptible to damage and she can help prevent tears by using moisturisers on the skin and by clothing so she doesn't knock herself.

When she has a skin tear then the quickest way to heal is to put the skin back over the wound and pop a steristrip on it. The way you dressed it was perfect If it goes a bit gungy pop some Inadine dressing on to damp down the bacteria.

If you google purpura or senile purpura you'll find out more.

If you suspect rough handling then perhaps look for whether it matches the shape of finger grip Chances are that it's not.

[Snowy]

Thank you Plum - that fits the description exactly and is consistent with her medication and condition. You are right it is not rough handling - she would be the first to complain if it were! Trouble is OH expects me to know exactly what is going on and why and this is way outside my area of expertise!

[Plum]

Right there Snowy as a nurse OH thinks there are only two medicines aspirin and paracetamol. Thinks you are a cardiologist, dermatologist, opthalmologist, neurologist, radiologist, musculoskeletalologist, gastroenterologist and knowallologist and because you can't tell him why he has an ache in his arm you are rubbish and not a proper nurse.

[Ms Marple]

Can I just query - what is COPD - not being a nurse or medical person. Thanks.

[Snowy]

Chronic Obstructive Pulmonary Disease (Disorder?). Used to be better known as chronic obstructive airways disease.

[Ms Marple]

Ta Snowy - feel a bit of a numpty now as it is logical and makes sense especially in light of the whole post!

[Alis girls]

Snowy - you have beaten me to it. We see this a lot in surgery, skin gets very fragile. Occ it breaks - but otherwis looks very red and a bit scarey if you are not sure what it is.

[Snowy]

Thanks guys! It just bugged me that I couldn't remember what it was - when we normally see her she has long sleeves and trousers on, but as Plum said, she had had on shortie PJs so it was so much more noticeable

 

Anyway, the latest update is that she is now in hospital - has broken her hip!! She was complaining of hip pain last week but was x rayed and told there was nothing wrong. Called the doctor out this morning as she was in pain again, admitted and x rayed and confirmed it's fractured! Poor MIL is now awaiting surgery Not sure how much more she can take OH is at work so I am on phone duty awaiting updates. Very frustrating living so far away!

[Ain't Nobody Here]

I am sorry to hear that - poor lady . I hope the surgery isn't too traumatic for her .

 

I was reading your post with interest as my dad's skin is so fragile looking and is often discoloured too .

[Plum]

Heck Snowy what bad luck. They repair them under spinal now which is a bonus with her chest. I am full of admiration for my elderly patients when they tell me about the op, they seem to take it in their stride. All the best for her. xx

[Alis girls]

wish her well

[Seagazer]

I hope the op goes well.

[The Dogmother]

Best of luck to her Snowy, and well noticed to you re the purple splodges.