Presentation on theme: "HSC 2024: Undertake agreed pressure area care."— Presentation transcript:
1HSC 2024: Undertake agreed pressure area care. Sheena HelyerPicture from Tissue Viability Society
2Learning 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.
3Anatomy and physiology of the skin Ask the students to examine their own skin and compare with people of different ages.
4Skin StructuresAsk the students to think of all the structures which would be damaged if there is a wound in the skin.
5Functions of the Skin Protection Sensation Heat regulation Storage AbsorptionAsk the group to think of the functions before they are revealed
6Ageing skin Becomes thinner Less fat exposes bony prominences more. More wrinkledDermal/epidermal junction is weakerLess sweat glandsLess able to manufacture Vitamin DNot as able to resist infection.Decreased pain perceptionCirculation decreased.Sun damageHealing takes longerGroup to brain storm all the changes they can think of which happen to skin as it agesPicture from beauty-personalhealthcare.blogspot.com and immune-health-solutions-for-you.com
7What can you do to keep your skin healthy? Drinking plenty of waterRegular skin cleansingMoisturiserPlenty of vitamins and minerals in the dietGetting enough sleepNo smokingLimit exposure to the sunRegular exerciseAsk the learners to describe what they do to keep their skin healthy including any products which they use on their skin
8Maintaining 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
9Definition 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
10Stages of pressure ulcers Stirling Scale. Ask the group if they know of anyone currently with pressure sores and ask them to describe and grade these soresPicture from spinal-injury,net
11Stages 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.
12Sites of Pressure .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…
13Risk factors What are they? Group discussion….write down suggestions on the flip chart
14Risk factorsExternal Internal Pressure Age Friction Chronic disease Shearing Reduced mobility Moisture Incontinence Malnutrition Sensory impairment Skin temperature
15Mechanisms 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.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 developmentPicture from wessexhealth.co.uk
16Mechanisms which cause pressure sores to develop Friction is when two rough or moist surfaces rub together and cause superficial skin damage.
17Mechanisms 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
18Pressure area care involves:- Regular changes of positionGood 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.Picture from annals.org
19Pressure area care involves:- Careful positioningPicture from thecompleteword.com
20Pressure area care involves:- Care during moving and assistance procedures to avoid frictionPictures from wsergo.comhillrom.co.uk30-swift-slide-sheeto.jpg
21Pressure area care involves:- Provision of suitable equipmentPicture from assistireland.iePressure-care.co.ukSquirrelmedical.co.ukCarehome.co.uk
22The purpose of pressure relieving surfaces is to redistribute weight Picture from staffsfallsprevention.co.uk
23Go through the Waterlow assessment tool and make sure that the group understands all the terminology
24Strategies to avoid development of pressure sores Assess for risk factorsWrite a care plan for all to followRecord and document care givenProvide necessary equipmentEnsure that Manual Handling is of a high standard to prevent friction and shearing forcesCheck skin frequently and moisturise if necessaryChange incontinence pads on timeTurn and repositionImprove nutritionAsk the group what they already do to prevent service users from developing sores.
25Consequences of pressure sores For the individualPainReduced mobilityReduced quality of lifePossible wound infectionDeath…For the organisationIncreased care costSOVA investigationLegal casePoor reputationLoss of customersFinancial lossSplit the group into 2 and ask them to come up with as many possible consequences as they can
26This is what we need to avoid! 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 carer’s role is regarding wound care. Some care staff may be undertaking simple wound dressings so need to be very alert for signs of complicationsPicture from seattletime.com, thebody.com, sci.washington.edu
27Complications of pressure sores InfectionNecrosisDiscuss 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.Picture from clinimed.co.uikOuhse.edu
28Case Study: Mr SmithExercise to complete in pairs to consolidate learning. Feed back and discussion to follow.Picture from bbc.co.uk
29Case 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 toolDescribe what you would do to reduce his risk of getting pressure soresLearners 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.
30Review 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.