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CHAPTER 32 Skin Integrity & Wound Healing
13.Assess the abdominal binder every 2 to 3 hours. Observe that the binder has not shifted up or down or compromised the patient’s breathing. Remove it to assess the underlying skin and dressings. Change wound dressings if they are soiled, or as prescribed. Applying a Triangular Arm Binder A triangular arm binder or sling is used to support the upper extremities. Obtain a commercial sling (consisting of a sleeve for the arm and a strap to go around the neck) or a triangular piece of fabric.To form a splint from a triangular cloth, follow these steps: 14.Ask the patient to place the affected arm in a natural position across the chest, elbow flexed slightly. Slight flexion prevents swelling of the hand and relieves pressure on the shoulder. 15. Place one end of the triangle over the shoulder of the unin- jured arm and allow the triangle to fall open so that the elbow of the injured arm is at the apex of the triangle. 16. Move the sling behind the injured arm. 17. Pull up the lower corner of the triangle over the injured arm to the shoulder of the injured arm. 18. Tie the sling with a square knot at the neck on the side of the arm requiring support. A square knot will not slip and is easy to untie. 19.Adjust the injured arm within the sling. To ensure patient comfort. ➤
22. For a double T-binder, bring the tails up on either side of the penis. Secure the tail at the waist with pins or clips.
23. Fasten the ties at the waist using pins or clips. What if . . . ■ The patient is obese? Obtain the appropriate size binder before applying. Do not try to posi- tion a binder that is too small for the patient. A poorly fitting binder can constrict circula- tion, cause pressure points that can injure the skin, and can restrict movement of the chest for adequate breathing. A binder that is too tight is uncomfortable and will not provide the proper support of an incision or wound needed for healing.
Applying a T-Binder A T-binder is used to secure dressings or pads in the perineal area. A single T-binder is often used for women. A double T-binder is commonly used for men. To apply a T-binder, follow these steps: 20.Position the waist tails under the patient at the natural waistline. Bring the right and left tails together and secure them at the waist with pins or clips. 21. For a single T-binder, bring the center tail up between the legs of the patient. Secure the tail at the waist with pins or clips. ➤
Evaluation ■ Evaluate whether the patient’s physical condition has changed since using the binder. ■ Assess circulation to be sure the binder is not secured too tightly. Check color, warmth, tingling, sensation, and capillary refill. ■ Assess the depth of breathing to be sure the binder is not restricting ventilation.
■ Check the skin under the binder to be sure there are no areas of irritation, pressure, or skin abrasion. ■ Assess incisions or wounds under the binder to be sure they are not bleeding and are healing properly. ■ Monitor comfort regularly. ■ Assess the patient’s ability to perform activities of daily liv- ing while wearing the binder.
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