Presentation on theme: "Skin Assessment Check skin when giving personal care If patient is complaining of discomfort or pain Check areas at risk of pressure damage (see."— Presentation transcript:
Skin Assessment Check skin when giving personal care If patient is complaining of discomfort or pain Check areas at risk of pressure damage (see body chart ) If area is red, check for blanching Document if skin is at risk such as very dry or over moist Assess for problem skin Assess any breaks/wounds to skin What skin regime are they presently using ? Can patient check and maintain their own skin health? Have they got carers to help them with personal care
Surface Check what mattress and cushions they are using Is it the correct surface level of risk ? Check that mattresses and cushions are correctly installed and working –plugged in,pumped up,foams integrity (fist test) What is the patient laying on –pads,kylies (do they need to?) Sheets- are they wrinkle free? Baggy clothing Do they need their surface upgrading or replacing?
Incontinence Have they been incontinent ? Urine or faeces Are they wearing pads – how often are they changed ? Do they need a continence assessment? What is their skin regime? Do they need emollients ? Skin barriers What are they washing with? Any problems with moisture –moisture lesions Function - can they get to the toilet? What is their toilet regime?
Keep moving Can they move Are they motivated to move Do they need prompting Do they need assistance to move Is there anything we can do to make they more independent Do they need referring-OT /PHYSIO Do they have/need a turning regime ? Do they a positioning plan ? Has the patient been educated to move every 1-2 hours stand / change position,rest on the bed Do they need passive exercises to prevent contractures
Nutrition MUST has it been done,when was it, done is it current? Is the patient at risk ? What is the action plan /care plan Has the plan been followed? if not why not ? What are they eating and drinking? Does the patient know what a good diet is? Do they need a food chart ? Do they need a fluid chart ? Can they fill their own chart in? Can a carer help? Do they need a high calorie diet ? Do they need a high protein diet (do they have any renal problems ) Do they need referring ?