Anatomy and physiology of the skin

The skin protects the body and controls the temperature, the tough outer layer is called the epidermis and is germ proof and water proof and the inner layer the dermis is full of nerve endings, which sends messages to the brain about heat, cold and pain. Pressure sores develop because of long standing pressure onto a particular area of the body causing breakdown of the layer of the skin due to diminished blood supply.

Where the pressure sites?
-Heels
– Inner knees
-Hips
-Sacrum area and buttocks
-Bony areas on your spine
-Shoulders
-Elbows
-Ears
-Any bony prominences

What might put an individual at risk of skin breakdown and pressure sores?
-Poor basic nursing care (hygiene, not being turned hourly)
-Nutrition
-Certain diseases

Describe how incorrect handling and moving techniques can damage the skin? Not being gentle with clients and if you don’t use the correct moving techniques by moving a client the skin can sheer and damage the underlying skin which then can cause pressure sores. Putting too much pressure on certain areas can cause severe bruising to the skin.

What could reduce the risk of skin breakdown and pressure sores?
– Frequent turning of bed bound clients
– Frequent moving of clients that are immobile.
-Good hygiene and basic care
-Use of barrier creams
-Correct handling, moving techniques and use of equipment

What changes to an individual’s skin conditions should be reported?
-Redness
-Discolouration
-Inflammation
-Irritation
-Broken skin

What legislation, policies and procedures affecting pressure area care? The Health and Safety Act with COSHH and Manual Handling Regulations, the Human Rights Act, the Health and Social Care Act) and the Essential Standards, the Mental Capacity Act, the Disability Discrimination Act, the Race Relations Act. Describe agreed ways of working relating to pressure area care? Make sure that the care plans for every individual are up to date, and that for every individual it holds information about any pressure area care they have had or are currently having such as pressure mattresses and cushions etc and if they are bed bound and being turned regularly and make sure that all staff fill in the pressure area moving and positioning charts when needed.

Make sure all staff are informed in the handover of any change in clients pressure areas such as redness, discolouration and breakage of skin. And also make sure that staff are recording any signs of pressure sores onto the individuals body charts which are in the care plans of the individuals. In the event of a pressure sore developing be sure to inform a district nurse for them to assess and give treatment where appropriate. Describe why team working is important in relation to providing pressure area care? Team work is important to ensure that every client gets the appropriate pressure area care, and when moving and positioning (turning) an individual there has to be another member of staff with you to carry out the pressure area care with safety. Ensure the appropriate equipment is used. All the team should be informed of any changes in the client’s condition and pressure area care and this should then be handed over to night staff etc.

Describe why it is important to follow the agreed care plan? It is important to follow the agreed care plan because that’s the plan that both the individual and the individuals family has produced. It’s the way in which the individual wants to be cared for and holds very important and confidential information about the individual. If you don’t read the care plan before attending to the individuals needs you could affect their health and day to day living. For example: A client may have a very serious allergy to nuts and because you haven’t read their care plan or followed what the care plan says about the individual you have given them nuts as a snack in the afternoon which has resulted in her being rushed to the hospital.

Why do you need to check the care plan before undertaking pressure area care? You check the care plans because every individuals care plan is based on every individuals needs which are all different and this ensures that the appropriate care is given. For example if an individual has a pressure sore on their right hip and it states that in their care plan you would then not turn them onto the right but if you did it wouldn’t be for a long amount of time, you would just turn them onto their back and left regularly and this would all be stated in the individuals care plan.

Why do you need to check for any concerns with the agreed care plan before undertaking pressure area care? Because the individuals circumstances may have changed and their care plan may have not been updated so you would double check with the team leaders/seniors that what is written in the care plan about the individuals pressure area care is up to date and that there are no concerns before attending the individuals pressure area care.

Describe actions to take where any concerns with the agreed care plan are noted? You would discuss this with the team leaders/seniors, suggest anything that you think would be appropriate for the individuals care.

Identify the pressure area risk assessment tool which are used in own work area? Waterlow score – this will indicate whether people are at risk such as sitting in a chair all day, are bed bound or immobile etc but the outcomes will either be that they are low risk which will not need any action or medium to high risk which means they will need pressure area care intervention and also an assessment by the district nurse to provide pressure relieving equipment such as cushions and mattresses etc. Body charts – where staff write down whereabouts on the individuals body they have seen red areas, discolouration or breaking of the skin etc. Nutritional charts (food and fluids) – where staff write down what food and fluids the individual has had and to ensure that they get the appropriate nutrition and fluids.

Explain why it is important to use risk assessment tools?
To monitor and assess whether an individual needs pressure relieving equipment such as cushions and mattresses etc and to see if they are at a high risk of developing pressure sores. To provide a plan for the individual in their care plan to provide the best pressure area care for them if needed. To provide any treatment that may be needed for the individuals pressure area care. To assess whether they are consuming enough fluids and monitoring their nutrition and if not staff are encouraging more. It’s important that staff are regularly checking each individuals skin for signs of redness or breakage of the skin etc and recording it so treatment can be given. All this recording is to either prevent the risks of an individual developing pressure sores or if the individual already has pressure sores then to help treat them.

Identify a range of aids or equipment used to relieve pressure?
– Pressure cushions
– Pressure mattresses
-Sheep skin boots for comfort if they have sores on their feet/heels/ankles etc.

Describe safe use of aids and equipment?
To relieve pressure off of areas that are at risk of becoming sore or areas that are already sore. Make sure that there are two members of staff when using equipment and to make sure all staff have had the correct training to use all equipment and their training is up to date. Make sure that all equipment has been tested and is in full working order and is safe. That if they are using mattresses or cushions that need pumping up by hand that they have been done so and haven’t deflated. That electrical pressure mattresses are working correctly and are the correct pressure for the individual. Identify where up-to-date information and support can be obtained about

a) Materials

-District nurses
-Employers
-Senior staff
-Management
-Internet

b) Equipment

-District nurses
-Senior staff
-Management
-Employers
-Internet

c) Resources

-District nurses
-Employers
-Senior staff
-Management
-Internet