Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient’s teaching plan?
A. Rub the skin vigorously with a towel.
B. Take frequent baths.
C. Apply alcohol-based emollients to the skin.
D. Keep fingernails short and clean.
Correct Answer: D. Keep fingernails short and clean.
Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient’s risk of infection. Keeping fingernails short and clean helps reduce the risk of infection. Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).
Option A: Keep linens dry, wrinkle-free. Reduces dermal irritation and risk of skin breakdown. Change position frequently; move patient carefully; pad bony prominences with sheepskin, elbow, or heel protectors. Decreases pressure on edematous, poorly perfused tissues to reduce ischemia.
Option B: Recommend the patient use cool, moist compresses to apply pressure (rather than scratch) pruritic areas. Keep fingernails short; encourage the use of gloves during sleep if needed. Alleviates discomfort and reduces the risk of dermal injury.
Option C: Provide soothing skincare. Restrict the use of soaps. Apply ointments or creams (lanolin, Aquaphor). Baking soda, cornstarch baths decrease itching and are less drying than soaps. Lotions and ointments may be desired to relieve dry, cracked skin.
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