HSC 2024: Undertake agreed pressure area care.

Sheena HelyerPicture 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

Skin Structures

Functions of the Skin• Protection

• Sensation

• Heat regulation

• Storage

• Absorption

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

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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

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.

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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.

Sites of Pressure .

Risk factors

What are they?

Risk factorsExternal InternalPressure AgeFriction Chronic diseaseShearing Reduced mobilityMoisture Incontinence Malnutrition

Sensory impairmentSkin 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.

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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.

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Pressure area care involves:-Regular changes of position

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Pressure area care involves:-Careful positioning

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Pressure area care involves:-Care during moving and assistance procedures to avoid friction

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Pressure area care involves:-Provision of suitable equipment

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The purpose of pressure relieving surfaces is to redistribute weight

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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

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

This is what we need to avoid!

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Complications of pressure soresInfection

Necrosis

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Case Study: Mr Smith

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Case study: Mr SmithMr 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

Review the learning outcomesThe 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.

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