1. HSC 2024: Undertake agreed pressure area care.
Sheena Helyer
Picture from Tissue Viability Society

2. 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.

3. Anatomy and physiology of the skin
Ask the students to examine their own skin and compare with people of different ages.

4. Skin Structures
Ask the students to think of all the structures which would be damaged if there is a wound in the skin.

5. Functions of the Skin Protection Sensation Heat regulation Storage
Absorption
Ask the group to think of the functions before they are revealed

6. 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
Group to brain storm all the changes they can think of which happen to skin as it ages
Picture from beauty-personalhealthcare.blogspot.com and immune-health-solutions-for-you.com

7. 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

8. 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

9. 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

10. Stages 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 sores
Picture from spinal-injury,net

11. 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.

12. Sites 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…

13. Risk factors What are they?
Group discussion….write down suggestions on the flip chart

14. Risk factors
External Internal Pressure Age Friction Chronic disease Shearing Reduced mobility Moisture Incontinence Malnutrition Sensory impairment Skin temperature

15. 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.
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
Picture from wessexhealth.co.uk

16. Mechanisms which cause pressure sores to develop
Friction is when two rough or moist surfaces rub together and cause superficial skin damage.

17. 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

18. Pressure area care involves:-
Regular changes of position
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.
Picture from annals.org

19. Pressure area care involves:-
Careful positioning
Picture from thecompleteword.com

20. 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

21. Pressure area care involves:-
Provision of suitable equipment
Picture from assistireland.ie
Pressure-care.co.uk
Squirrelmedical.co.uk
Carehome.co.uk

22. The purpose of pressure relieving surfaces is to redistribute weight
Picture from staffsfallsprevention.co.uk

23. Go through the Waterlow assessment tool and make sure that the group understands all the terminology

24. 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.

25. 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

26. This 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 complications
Picture from seattletime.com, thebody.com, sci.washington.edu

27. Complications of pressure sores
Infection
Necrosis
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.
Picture from clinimed.co.uik
Ouhse.edu

28. Case Study: Mr Smith
Exercise to complete in pairs to consolidate learning. Feed back and discussion to follow.
Picture from bbc.co.uk

29. 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 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
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.

30. 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.

31. Picture from keepcalm-o-matic.co.uk