Undertake agreed pressure area care
Anatomy and physiology of the skin in relation to skin breakdown and development of pressure sores
• A pressure sore, also known as a bed sore is an injury to the skin and the tissue under it. A pressure sore develops when the blood supplying the tissue with oxygen and nutrients is unable to circulate, and the tissue no longer receiving oxygen and nutrients dies. The oxygen and nutrients are essential to maintain healthy tissue. Sitting in the same position for a prolonged period of time can start the process of tissue breakdown by excessively loading the skin and underlying tissue. Friction and shearing forces applied to the skin and increased moisture on the skin surface can also increase the incidence of pressure sore development. Shear stress occurs when a force is applied in the plane of the skin surface. Friction occurs when there is displacement between the skin and the supporting surface.
Identifying pressure sites of the body
• Skin is not broken but is red or discoloured. The redness or change in colour does not fade within 30 minutes after pressure is removed. There will be a hardness or firmness
Identifying factors which may put a patient at risk of skin breakdown or pressure sore
• Staying in the same position for a prolonged period of time
• Friction of sheets, slings or banana boards
• Not being able to move certain parts of the body
• Fragile skin
How incorrect handling and moving techniques can damage the skin
• Friction is caused when the skin is pulled across a surface such as bed linens, washcloths or incontinence pads. When friction is applied to the skin, the outer protective layer is rubbed away. The soft moist layers of skin are exposed which allow bacteria to enter.
• Shear: Occurs when surfaces slide across one another, when a patient slides down in bed or chair. The skin remains still against the bed linens while the underlying tissue shifts. This...