HSC 2024: Undertake agreed pressure area care.

1. HSC 2024: Undertake agreed pressure area care. Sheena Helyer Picture from Tissue Viability Society

2. Learning outcomes The learner will: • Understand the anatomy and physiology of the skin. • Understand good practice when undertaking pressure area care. • Follow the agreed care plan. • Understand the use of materials, equipment and resources available when undertaking pressure area care. • Prepare to undertake pressure area care. • Undertake pressure area care.

3. Anatomy and physiology of the skin

4. Skin Structures

5. Functions of the Skin • Protection • Sensation • Heat regulation • Storage • Absorption

6. Ageing skin • Becomes thinner • Less fat exposes bony prominences more. • More wrinkled • Dermal/epidermal junction is weaker • Less sweat glands • Less able to manufacture Vitamin D • Not as able to resist infection. • Decreased pain perception • Circulation decreased. • Sun damage • Healing takes longer Picture from beauty-personalhealthcare.blogspot.com and immune-health-solutions-for-you.com

7. What can you do to keep your skin healthy? • Drinking plenty of water • Regular skin cleansing • Moisturiser • Plenty of vitamins and minerals in the diet • Getting enough sleep • No smoking • Limit exposure to the sun • Regular exercise

8. Maintaining healthy skin • For tissues to be viable i.e. stay alive, they have a basic requirement for oxygen and nutrients to help growth and repair and for waste products to be removed. • The oxygen and nutrients are transported around the body in the blood by arteries and then through tiny capillaries. • When there is disruption to the blood supply through the capillaries this area of tissue will die and this will result in a pressure sore. Nursing and residential care, November 2007,Vol 9,No 11 p. 516

9. Definition of a pressure ulcer “ Localised injury to the skin and/or the underlying tissue usually over a bony prominence, as a result of pressure, or pressure combined with shear and/or friction. A number of contributing factors are also associated with pressure ulcers. Pressure Ulcer Advisory Panel. 2007.

10. Stages of pressure ulcersStirling Scale. Picture from spinal-injury,net

11. Stages of pressure sores • Stage 1. Discolouration of intact skin, light finger pressure applied to the site will not alter the discolouration. • Stage 2.Partial thickness skin loss or damage involving the epidermis and/ or dermis. • Stage 3. Full thickness skin loss involving damage or necrosis of subcutaneous tissue, but not extending to underlying bone, tendon or joint. • Stage 4.Full thickness skin loss with extensive destruction and tissue necrosis extending to underlying bone, tendon or joint.

12. Sites of Pressure .

13. Risk factors What are they?

14. Risk factors ExternalInternal Pressure Age Friction Chronic disease Shearing Reduced mobility Moisture Incontinence Malnutrition Sensory impairment Skin temperature

15. Mechanisms which cause pressure sores to develop Pressureis when the body tissue is compressed or squashed so much that the blood cannot reach the skin. Picture from wessexhealth.co.uk

16. Mechanisms which cause pressure sores to develop Frictionis when two rough or moist surfaces rub together and cause superficial skin damage.

17. Mechanisms which cause pressure sores to develop Picture from shame-pressure-ulcer.jpg Shear is when the skin is being pulled in two directions which can lead to damage below the surface of the skin.

18. Pressure area care involves:- Picture from annals.org Regular changes of position

19. Pressure area care involves:- Picture from thecompleteword.com Careful positioning

20. Pressure area care involves:- Pictures from wsergo.com hillrom.co.uk 30-swift-slide-sheeto.jpg Care during moving and assistance procedures to avoid friction

21. Pressure area care involves:- Picture from assistireland.ie Pressure-care.co.uk Squirrelmedical.co.uk Carehome.co.uk Provision of suitable equipment

22. The purpose of pressure relieving surfaces is to redistribute weight Picture from staffsfallsprevention.co.uk

24. Strategies to avoid development of pressure sores • Assess for risk factors • Write a care plan for all to follow • Record and document care given • Provide necessary equipment • Ensure that Manual Handling is of a high standard to prevent friction and shearing forces • Check skin frequently and moisturise if necessary • Change incontinence pads on time • Turn and reposition • Improve nutrition

25. For the individual Pain Reduced mobility Reduced quality of life Possible wound infection Death… For the organisation Increased care cost SOVA investigation Legal case Poor reputation Loss of customers Financial loss Consequences of pressure sores

26. This is what we need to avoid! Picture from seattletime.com, thebody.com, sci.washington.edu

27. Complications of pressure sores Picture from clinimed.co.uik Ouhse.edu Infection Necrosis

28. Case Study: Mr Smith Picture from bbc.co.uk

29. Case study: Mr Smith Mr Smith is an 85 year old who lives in a sheltered flat. He has cardiac failure. As a consequence his legs have become very swollen and the skin on his legs is very fragile, occasionally he suffers skin tears that weep. He sits in a chair most of the day and is only able to walk a few steps with 2 carers. He is underweight. His body mass index is 19. His appetite is very poor and he has lost weight in the past 3 months. He is occasionally incontinent of urine . The highlight of the week is when he goes to his daughter’s house on Sundays and has lunch with the family. Work out Mr Smith’s risk factor score using the Waterlow risk assessment tool Describe what you would do to reduce his risk of getting pressure sores

30. Review the learning outcomes The learner will:- • Understand the anatomy and physiology of the skin. • Understand good practice when undertaking pressure area care. • Follow the agreed care plan. • Understand the use of materials, equipment and resources available when undertaking pressure area care. • Prepare to undertake pressure area care. • Undertake pressure area care.

31. Picture from keepcalm-o-matic.co.uk