Introducing the new identity
HSC 2024: Undertake agreed pressure area care.
Sheena Helyer
Picture from Tissue Viability Society
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.
Anatomy and physiology of the skin
Ask the students to examine their own skin and compare with
people of different ages.
3
Ask the students to think of all the structures which would be
damaged if there is a wound in the skin.
4
Functions of the Skin
Protection
Sensation
Heat regulation
Storage
Absorption
Ask the group to think of the functions before they are
revealed
5
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
Group to brain storm all the changes they can think of which
happen to skin as it ages
6
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
Ask the learners to describe what they do to keep their skin
healthy including any products which they use on their skin
7
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
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.
Stages of pressure ulcers Stirling Scale.
Picture from spinal-injury,net
Ask the group if they know of anyone currently with pressure
sores and ask them to describe and grade these sores
10
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.
Talk about personal experiences of caring for people with sores
and if possible show pictures of some deep pressure sores to drive
the message home of how serious they can be and how important
prevention is
12
Risk factors
What are they?
Group discussion.write down suggestions on the flip chart
13
Risk factors
ExternalInternal
PressureAge
FrictionChronic disease
ShearingReduced mobility
MoistureIncontinence
Malnutrition
Sensory impairment
Skin temperature
Mechanisms which cause pressure sores to develop
Pressure is when the body tissue is compressed or squashed so
much that the blood cannot reach the skin.
Picture from wessexhealth.co.uk
Demonstrate what happens with pressure, shear and friction.
Explain how this can happen to people sitting in beds and chairs
and how important good manual handling practice is in preventing
sore development
15
Mechanisms which cause pressure sores to develop
Friction is when two rough or moist surfaces rub together and
cause superficial skin damage.
Mechanisms which cause pressure sores to develop
Shear is when the skin is being pulled in two directions which
can lead to damage below the surface of the skin.
Picture from shame-pressure-ulcer.jpg
Pressure area care involves:-
Regular changes of position
Picture from annals.org
Good teamwork is essential to provide consistent pressure relief
around the clock. Many organisations have their own turning charts
which must be completed and signed. Managers should investigate any
gaps which are not accounted for.
18
Pressure area care involves:-
Careful positioning
Picture from thecompleteword.com
Pressure area care involves:-
Care during moving and assistance procedures to avoid
friction
Pictures from wsergo.com
hillrom.co.uk
30-swift-slide-sheeto.jpg
Pressure area care involves:-
Provision of suitable equipment
Picture from assistireland.ie
Pressure-care.co.uk
Squirrelmedical.co.uk
Carehome.co.uk
The purpose of pressure relieving surfaces is to redistribute
weight
Picture from staffsfallsprevention.co.uk
Go through the Waterlow assessment tool and make sure that the
group understands all the terminology
23
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
Ask the group what they already do to prevent service users from
developing sores.
24
Consequences of pressure sores
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
Split the group into 2 and ask them to come up with as many
possible consequences as they can
25
This is what we need to avoid!
Picture from seattletime.com, thebody.com,
sci.washington.edu
Describe in detail what is happening in these pictures ie.
granulation, epithelialisation, macerated skin edge in top right,
the importance of moisture and heat in wound healing The importance
of infection control measures and protection of the wound. Explain
what the carers role is regarding wound care. Some care staff may
be undertaking simple wound dressings so need to be very alert for
signs of complications
26
Complications of pressure sores
Infection
Necrosis
Picture from clinimed.co.uik
Ouhse.edu
Discuss with the learners the importance of infection control so
that wounds do not become contaminated. Ask them to list on the
flip chart the signs that a wound is becoming seriously infected :-
redness of surrounding tissues, heat, offensive coloured exudate,
pus in the wound. The nurse/district nurse in charge will need to
be informed immediately. Explain to the learners that where there
is dead tissue the wound may appear to get larger before it heals
as the wound needs to get rid of the dead tissue before it is able
to heal.
The trainer may wish to show the learners pictures of other deep
pressure sores to reinforce how the important it is to take every
possible measure to prevent them form happening.
27
Case Study: Mr Smith
Picture from bbc.co.uk
Exercise to complete in pairs to consolidate learning. Feed back
and discussion to follow.
28
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 daughters
house on Sundays and has lunch with the family.
Work out Mr Smiths risk factor score using the Waterlow risk
assessment tool
Describe what you would do to reduce his risk of getting
pressure sores
Learners should be asked to work in pairs for 10 mins. They will
need a copy of the waterlow scale and a copy of the case study. His
score is aprox 22 i.e. high risk of pressure sores. Encourage
learners to think about the care he needs while with his daughter
and their role in explaining his care needs.
29
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.
Picture from keepcalm-o-matic.co.uk
