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1.1 Pressure sores also known as pressure ulcers are injuries to the skin and underlying tissue, they appear when an area is under too much pressure for long periods of time, due to this pressure the blood flow id disrupted, and the area doesnt get irrigated, therefore the nutrients and oxygen do not reach the skin cells, the skin then breaks and the pressure ulcers form. Epidermis – is waterproof has no blood supply(avascular), the epidermis is constantly changing the top layers are continually rubbed off through friction and washing, new cells are made at the bottom, these gradually make their way too the top to replace the lost cells, this takes approxiametly 35 days. the dead cells contain keratin, keratin is tough and waxt and helps to toughen the skin so that it can protect the body.

Dermis – This layer contains nerve endings(capillaries) blood vessels, oil glands(sebaceous glands) sweat glands, hair follicles. Sebaceous Glands make a substance called sebum, it rises up into the epidermis and keep the skin moist and waterproof to protect the body, the layer of fat under the dermis is called the subcutaneous layer, this layer helps to keep us warm and absorbs knocks and shocks, it also contains the hair follicles. the body also contains collagen and elastin, to make the skin tough and stretchy. The thickness of the epidermis and the dermis varies in different parts of the body. from about 2mm – 4mm. the skin on your back is thicker than the skin on your face.

1.2 Risk to individuals can be indentified by the following, Intrinsic factors- (internal forces)

Age, dereased or increased body weight, heat, temperature, dehydration, incontinence and excessive moisture, sensory loss, reduced mobility, malnutrition, poor diet, the presence or absence of pain, vascular problems, low resistance to infections, thinning dermis, concurring illnesses, diabetes, pyrexia(feverish conditions). Extrinsic factors (external forces)

hard support surfaces, wrinkled or patched sheets, poor hygiene, incorrect positioning, poor lifting techniques, long periods of sitting in bed or chair, misuse of aids, shearing force and friction. Overweight or underweight individuals, overweight clients could be at risk as fat has a pooreer blood supply than muscle or lean tissue, some overweight clients could have limited mobility due to their size and added pressure on their limbs, or may have difficulty turning when lying down, this in turn can lead to added pressure on internal organs, making these organs work harder, making breathing more difficult. Underweight, malnourished individuals suffer with depletion of fat and muscle and consequently a reduction of the padding between bone and skin. Common pressure points on the body include the tail bone (sacrum), hip, pressure sores also result from friction caused by your skin rubbing against another surface, or when two layers of skin slide on each other, moving in opposite directions and causing damage to the underlying tissue. This may happen if you are transferred from a bed to a stretcher, or if you slide down in a chair.

Individuals with neurological disease/disorders such as multiple scierosis or motor neurone disease may lose all sensation in the lower half of their body, as the condition advances movement and speech could become more and more difficult. Some medications can leave an individual confused, drowsy, therefore less aware of any pain or discomfort, also reducing their mobility. diabetic patients often suffer with poor circulation, and may develope loss of feeling in their feet, lower limbs and hands, this is known as (peripheeral neuropathy) it is hard for diabetics to heal from wounds. Paralysed or wheelchair bound individuals may not be able to feel anything, so therefore could be unaware of discomfort or pressure prone areas. Wheelchair-bound individuals may develop pressure ulcers where the legs rest on the lower portion of the wheelchair.

Not moving the legs for extended periods while in the wheelchair increases the risk of developing the sores on the legs. Individuals who are bed-bound may also develop bedsores on the lower extremities. Arms, Back and Shoulders Individuals confined to a wheelchair frequently experience pressure ulcers on the body where the chair causes constant pressure. These locations include the elbows and along the backs of the arms. These areas rub on the wheelchair armrest. The spine and shoulder blades may rub along the back of the chair and cause pressure ulcers due to the friction of the chair and pressing on it while rolling the wheelchair. The buttocks and the tailbone are at risk for pressure ulcers in wheelchair-bound individuals. Because of loss in sensation below the waist, paralyzed people or people with decreased sensation in the lower body do not feel the pain associated with the need to change positions. Wheelchair bound individuals may also lack the ability to shift positions to relieve the pressure on the buttocks and sacrum.

Areas at increased risk for developing the sores in individuals confined to bed include the sides of the knees, heels and the ankles because of the bony protrusions on the bed. For people with decreased mobility or individuals who are in a coma, the knees, ankles and heels also experience friction and sheer from sliding in the bed to change positions. ribs, and back of the head, bone areas, and the ankle and heel. Less common sites include the elbows,

1.3 By using incorrect manual handling techniques one might put an individual at risk, this can happen when an individual is moved into/out of a chair or bed. The chair surface,covering or padding may cause uneven distribution, wheelchairs which may be ill fitting, causing pressure. skin could get damaged on contact with protusions such as footplates. ill fitting slings or handling belts could rub, or cut up into skin. not staightening out slide sheets can lead to friction marks.

1.4 Mobility has a significant role to play in the prevention of pressure sores by assisting the individuals movement, repositioning regularly, using the 30 tilt method, keeping clean and dry, eating a well balanced diet, keeping hydrated, using supportuve aids, air mattresses, pillows, foam pads.

1.5 purplish or bluish patches on darker skinned people, red or white patches on fair skinned people, blisters, swelling, shiny areas, dry patches,  cracks and wrinkles.

2.1 The safe guarding of vulnerable adults looks at our responsibility and accountability of keeping people safe and would include risk assessments to identify the skin break down. The care standards act reinforces the importance of policies and procedures put in place by our organisations to protect the service users and this includes again skin care and prevention of pressure sores. The social care code of practice also identifies roles and responsibility of the care worker. Nhs guidelines on wound care, tissue viability, relevant protocols should be included in your organisations policies and procedures Duty of Care (Dealey 1997)

The National Institute for Health and Care Excellence (nice) Healthcare improvement scotland
European Pressure Ulcer Advisory Panel (EPUAP)
Manual Handling Policy
Health and Safety Act
Control of Substance Hazardous to Health(COSHH)
Human Rights Act
Service User Choice
norton scale
gosnell scale
braden scale
waterlow scale

2.2 Follow care plan, follow up with risk assessments, if you feel a new assessment should be made, then record and report. if when doing personal care with an individual you notice marks, get another care professional to double check, check to see if the area has been noted in care plan, if not monitor, record and report. turning and mobility will be essential to prevent from getting any worse.

2.3 If you do not communicate with each other the patients are at risk, giving precise, factual information reguarding the individual/s in your care to others professionals with a need to know basis.(i.e going to be looking after said individual/s) making sure everything is documented, in the correct way using precise, factual wording. sign, date and time.

3.1 following the agreed care plan is for the benefit for all concerned, the clients well being is of the upmost importance, and this care plan has been put into place to protect and assist them as much as possible, while still allowing them freedom of choice, dignity, and respect.

3.2 When meeting a new client for the first time you should always find out as much information about the person, i.e… history, medication, illnesses, mobility, what your tasks will be on entering/during your time with them, you need to know as much as you can so that you can assist the person as best as you can, so that you know their limitation and if there condition detiorates you can record and then report to the relevant persons.

4.1 Pressure relieving aids include, propad mattress/cushion or an airflow mattress/cushion can be used for individuals to sleep or sit on if they are not very mobile. For an individual with good mobility it is important that they move around often to help relieve pressure. For someone with poor mobility or bed bound it is important that they are repositioned regularly to relieve pressure to different parts of the body using a slide sheet if required or stated in the individuals care plan. soft form matresses

pro pad cushions/mattress
repose matress toppers, cusions, foot protectors, wedges
airflow matresses/cushion/leg supports
barrier creams (cavillon)
releiving dressing, ( alleyvin gental sacrum)
alleyvin gel heels, sacrum
also gel cushions,

4.2 Firstly the individuals care plan should be read in order to identify any risks and which equipment or aids are in use. If an individual sleeps or sits on an airflow mattress or cushion these would have been initially installed by a trained professional. It is important that these are kept at the correct pressure for each individual’s needs which can be easily adjusted. Using a slide sheet to help reposition someone should be done by 2 carers or more if stated in the individuals care plan.

4.3 Materials
Up to date information on materials can be found on the internet. A manager or senior member of staff, CQC or the provider/supplier of the material.
Up to date information on equipment can be found on the internet. A Manager or senior member of staff, CQC or the provider of the equipment. The use of equipment is covered by the Lifting Operations and Lifting Equipment Regulations (LOLER) 1998. Resources

Up to date information on resources can be obtained from the resources provider.

5.1  Make sure all equipment is clean and in good working order, before commencing any care. make sure the area is clear from obstacles, that could cause harm, i.e.tripping, make sure you have everything within reach before commencing any personal care, and pressure care procedure.

5.2 Make sure you speak clearly and respectful to the client explain everything you would like to do, to gain their consent before starting any procedure, let them know what you are doing every step of the way, and give them reassurance that at any stage that they feel uncomfortable or wish to stop you

6.1  Firstly make sure you get the individuals full consent before carrying out any personal care/ pressure area care, explain to them fully what you would like to do and that at any time they feel uncomfortable, or wish to stop that you will respect their wishes and do so. reassure them that you will continue to talk to them and explain what is happening every step of the way if that is their wish, or talk about any other topic they wish. close all doors, window dressings(blinds, curtains) pull round bed(hospital) screens or curtains, make sure you have everything needed at your disposal, and that you are wearing your ppe. make sure everything is disposed of correctly in the correct way. make sure as much dignity and respect is given to the patient as is possible.

Make sure the individual feels safe secure, is not too close to edge, if bed rails are available that they are up on side the patient is facing, all objects are within your reach and no sharp objects are left on the bed(scissors). Make sure throughout the procedure that the patient feels safe and secure, and that they know they have the choice to stop if they feel uncomfortable. talk and reassure the patient throughout, get them to talk to you, find out about them, make them feel more comfortable in this situation. talking to the patient throughout allows the patients to know you actually care, it reassures them, gives them comfort. lets them know that they have someone who supports them and their choices, and is looking out for their well being. it also gives you the chance to get to know them better and assess and monitor the pressure areas more closely.

6.2 Follow policy and procedures when disposing of waste, putting into correct bags. wear your ppe. disinfect spray/wipe the area used before and after. wash hands before and after. dispose of opened but not used dressing.

6.3 remove any bedding/clothing that could get in the way make sure you get full consent from patient first, make sure you have all materials for said task within your reach, clean, treat, dress, dispose of unused open and used materials in correct way, recover with clothing and bedding. make sure nothing is too tight.

6.4 moving a patient from bed to chair, chair to bed. you could use various aids to do so. stand aid, hoist, handling belt, make sure the aids used are the correct ones for the peerson size and weight. if turning the person in a bed, you can use slide sheets or if these are unavailable, use your manual handling training. patients opposite arm across and back of hand on check, opposite knee (to side you are standing) up foot flat, one of your hands on their opposite shoulder(furtherist away from you) your other hand on their knee and gentle roll them towards you, place a pillow behind them, and one between their legs to relieve pressure.

Slide sheets are better as you can move the patients up/down, side to side or roll on side. slide sheets can also be used on top of slide boards to pull across onto or off a stretcher, make sure you have enough staff to carry out this procedure, follow the policies and procedures and any care plan in place for the individual.

6.5 Using pressure aids helps prevent pressure sores and alievates pressure on areas that already has sores or the symptoms developing. monitoring and with the added help of aids has helped.

6.6 Always get consent from the individual or their advocate before commencing any procedure, give them reassurance throughout, explain to them what is happening or get them to talk to you. make sure you are respectful.

6.7 Record, report time date and sign all paperwork, using clear concise factual, legible to others, all in accordance with your companies policy and procedures, if body charts are available, mark down where the infected are is, what degree it is. what colour the discolouration is.

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