1. TAKE CARE OF YOUR SKIN! Shoulder blade

2. What’s wrong with this picture? 1._________ 2._________ 3._________ 4._________ 5._________

3. Five things that could cause problems: 1. Toes are pressed against the table 2. Wrist is jammed between arm rest and leg 3. Drink is in lap 4.Sacral sitting (reclined position that puts pressure on your sacral area) 5. Sitting in sun

4. Toes pressed against the table Wrist pressed against chair What would you do about it? 1. 1.Keep shoe off until redness disappears 2. 2.Monitor for red spots or bruising (wrist, feet, etc.)

5. Drink in lap – if it spills, moisture is trapped in lap, groin, and buttocks areas Why is moisture a problem?

6. Moisture CAUSED BY – Urine, Stool – Sweating – Other liquids – Wet clothes or bed linens BE CAREFUL – can lead to: – Shearing or friction injuries – Infection **Persons with bowel incontinence are 22 times more likely to develop pressure ulcers**

7. Action steps for moisture or fungal rash in groin or buttocks Moisture: Leave open to air Wash with soap and water, dry well Use a protectant, Butt Paste, Zinc based cream Yeast or Fungal Rash: Reduce moisture Avoid tight fitting clothes Frog leg while in bed OTC antifungal powder or cream

8. Sacral sitting (reclined position that puts pressure on your sacral area) Pressure issues start as red spot, what to do? 1. 1.Keep all pressure off the red area until color returns to normal 2. 2.Use padding or stay in bed as needed 3. 3.Inspect your skin more often than twice per day 4. 4.Figure out what caused the redness and keep it from happening again

9. Sacral sitting (reclined position that puts pressure on your sacral area) Red spots can open. If this happens….. 1. 1.Call your doctor about the sore right away 2. 2.Stay off the area, even if it means staying in bed 3. 3.Clean with soap and water only 4. 4.Apply antibacterial ointment (purchase at drug store) and light dressing. Use a small amount of tape to hold dressing in place 5. 5.Wash the area and change dressing 2 times each day. 6. 6.Do your skin inspections more often than usual

10. Sacral sitting (reclined position that puts pressure on your sacral area) If not properly cared for, a pressure sore can get worse and require surgery to heal

11. Sunning can cause your body to overheat You may feel: dizzy, weak, faint, thirsty You may have: headache, cramps, upset stomach, elevated temperature, flushed face What to do? Drink plenty of cool water Remove any heavy or dark clothing Stay in a cool place (maybe near a fan) Sponge or mist your body with cool water Take your temperature. If higher than 100, call the doctor

12. What’s wrong with this picture? 1._________ 2._________ 3._________ 4._________

13. Four things that could cause problems: 1. Cigarette in bed 2. Knees pressed together – no padding 3. Ankles pressed together – no padding 4. Lying on remote

14. Cigarette in bed Do not smoke in bed, you might fall asleep Do not hold an ashtray in your lap; heat may go through and burn you Cigarettes can burn your hand or fingers that may have decreased feeling

15. Knees or ankles pressed together – no padding What would you do about it?

16. Action steps for pressure points on ankles or knees 1.Keep pressure off the area by padding 2.Decrease time between turns 3.Inspect your skin more often than twice per day 4.If the area opens, call your doctor 5.Figure out what caused your problem and keep it from happening again

17. Pressure often develops on heels when lying on your back Be careful – it can progress quickly to open sores

18. Lying on Remote (or other objects) Remember, if you have red spot…. 1.Keep all pressure off the red area until color returns to normal 2.Use padding or stay in bed as needed 3.Inspect your skin more often than twice per day 4.Figure out what caused the redness and keep it from happening again

19. What’s Wrong with these Pictures? 1._________ 2._________ 3._________

20. Three things that could cause problems: 1.Legs and feet too close to hot fire 2.Leg pressed against hot oven door 3. Plan to place hot dish on pad in lap?

21. BURNS Put cool compress on the burn right away If there is a blister, leave it alone, do not break it If there is an open blister: Wash with soap and water Apply antibacterial ointment Cover with a dry, clean dressing Change the dressing daily Keep all pressure of the area Call your doctor

22. Action steps to prevent burns 1. Always have an area to place hot pots and pans 2.Watch out for pot handles 3.Be careful of shirt sleeves when cooking 4.Try to have an area in the kitchen that you can reach easily in you wheelchair 5.Do not put a hot dish or object on your lap, including a pizza box

23. What’s wrong with this picture? 1.______ 2.______ 3.______

24. Three things that could cause problems: 1. Position of left foot 2. Sitting on hard surface without cushion 3. Water temperature on hot

25. Position of Left Foot What would you do about it? Check foot for redness, bruising, swelling Reposition foot to be sure it is flat on surface

26. Sitting on Hard Surface Without Cushion 1.ALWAYS use a cushion 2.If red spots happen, stay off it! You must stay in bed What would you do about it?

27. Feet under very hot water Put cool compress on the burn right away If there is a blister, leave it alone, do not break it If there is an open blister: Wash with soap and water Apply antibacterial ointment Cover with a dry, clean dressing Change the dressing daily Keep all pressure of the area Call your doctor

28. What’s Wrong with this Picture? 1.________ 2.________ 3.________ 4.________

29. Four things that could cause problems: 1.Hitting car frame when transferring 2.No shoes 3. Keys in pocket 4. Something in seat of car

30. Hitting car frame on transfer What would you do about a bruise? 1.Watch the bruise 2.It will act like bruises before injury but may take longer to heal due to circulation changes after SCI

31. REMEMBER…………………. Do not carry objects in your pockets Be sure that surfaces are clean and free of debris before transfer

32. Always wear shoes and take good care of your feet Clean your feet every day Inspect carefully for red areas, calluses, ingrown toenails Trim your toenails straight across Wear shoes 1 to 1 ½ sizes bigger than before your injury Wear new shoes for only 30 minutes, then take off and inspect your skin – check again after one hour, and two hours

33. What’s Wrong with this Picture?

34. Easy for your toes to curl inside shoes What Do You Do? 1.Use your fingers (or a caregiver) to feel your toes inside your shoes. Be sure they feel flat

35. Autonomic Dysreflexia

36. What do I do if I get dysreflexia? If not resolved…Go to ER

37. TIPS & TRICKS

42. Prevention Weight shifts – Every 30 minutes, every 15 minutes while on bowel/shower equipment – Hold for at least one minute Turns while in bed – Increase the amount of time between turns by 30 minutes a week – 6 hour max on sides and back – 8 hours max if lying prone Skin Checks – Twice a day – at minimum for healthy skin – More frequently for problematic skin

43. Prevention Follow your weight – If you can’t get on a scale, track waist, upper arm and thigh measurements Eat well – Be mindful of too much “junk food” – Drink plenty of water Wheelchair cushion care – Wash weekly – Inspect cushion before you get in your chair

44. Remember……… Understand pressure points while you sit in chair and lie in bed

45. It is much easier to prevent skin sores than it is to heal them!