Outcome 1 understand the anatomy and physiology of the skin in relation to pressure area care 1.1 describe the anatomy and physiology of the skin in relation to skin breakdown and the development of pressure sores. The skin is the largest organ of the body, covering and protecting the entire surface of the body. The total surface area of the skin is around 3000sq inches depending on age, height and body size. As well as the nails, hair, sweat glands and the sebaceous glands, the skin forms the integumentary system. Besides oroviding protection to the body, the skin also helps regulate body temperature, helps your immune system, provides sensations of touch, heat, cold and pain throught the sensory nerve endings. The skin is primarily composed of three layers, the epidermis, the dermis and the subcutanious layer/the hyppodermis. Each layernhas its own function and its own role in maintaining the skin integrity. Pressure sores are the result of a constant deficiency of blood flow to the skin tissue. This is more common over a bony area such as a heel, which may have been in contact with a surface for an extended period of time.
1.2 identify pressure sites of the body
Common pressure points on the body can include the skin:
– over the buttocks
– the sacrum
– the ankles
– the hips
– the heels
– the back of the head
– the shoulder blades
– the elbows
– base of spine
– rib cage
1.3 idendify factors which might put an individual at risk of skin breakdown and pressure sores Factors that may put an individual at risk of skin breakdown and pressure sores can include:
– aging skin
– alcohol abuse
– drug abuse
– high exposure to UV rays
– poor or unhealthy diet
1.4 describe how incorrect moving and handling techniques can damage the skin It is important to recognise the effect on the skin caused by the forces of incorrect moving and handling. It is important to minimise frictionand shear forces by limiting the potential for rubbing or dragging an individuals skin during turning or rolling and repositioning,
Shear forces can occur when the skin is pulled sideways over muscle or bone when moving, as this can stretch and block the blood vessels which restricts blood flow to the skin. In addition to this, friction forces may be present when an individual is thought to be at rest. The best example of this is lying in bed with the back rest raised.As gravity acts on the individual the inertia force ( body at rest ), the friction forces on the skin surface attempts to slow the process of movement, which in turn means the underlying skin structures are affected by the high friction and shearing forces to a higher degree.
1.5 Identify a range of interventions that can reduce the risk of skin breakdown and pressure sores. Devices that can assist with manual handling can include
– sliding sheets
– turning and repositioning aids that enable independent movement and take into consideration the effect of gravity. These should be used wherever possible to reduce the potential of skin damage to an individual and any injury to carers.
1.6 Describe changes to an individuals skin condition that should be reported. Any open sores or areas of skin that have been red and non blanching for 24 hours plus should be reported to a healthcare proffessional such as a district nurse.
If you have noticed an individuals skin is slightly red in an isolated area it should be reported to a supervisor or manager and all the correct documentation should be completed ie; body mapping chart. Depending on the severity of the redness it may be possible to place the individual on a repositioning chart as this will help regulate pressure and decrease redness and soreness before it becomes bad enough to be seen by a district nurse. Other changes to skin that should be reported include blisters, patches of hot or cool skin, dry skin or swelling
Outcome 2 Understand good practice in relation to own role when undertaking pressure area care.
2.1 Identify legislation and national guidelines affecting pressure area care, Some of the legislation and national guidelines affecting pressure area care are: – Care standards act 2000
– Human rights act
– N.I.C.E guidelines
– European pressure ulcer advisory panel
– The national pressure ulcer advisory panel
– CQC essential standards of quality and safety.
2.2 Describe agreed ways of working relating to pressure area care. To maintain good pressure area care for individuals we as carers should always maintain good health and safety practices. This can be done by performing regular checks on individuals, and using turning charts to document the repositioning process and to make sure that all of their pressure areas are intact. We must always use the correct protocol and manual handling techniques to ensure skin safety at all times. We can do this by using slide sheets or other moving aids to help maintain an individuals skin integrity. Risk assessments should be
Unit 4222-229 Undertake agreed pressure area care ( HSC 2024 ) “cont” Karen Yardley
put in place if an individual is at risk of developing pressure sores. Skin should be checked reguarly in accordance to your establishments policies and procedures and any changes should be reported to the relevant places.
2.3 Describe why team work is important in relation to providing pressure area care. Team working is important because it provides consistency of care, everyone knows how things should be managed,everyone will be working exactly the same and this in turn will decrease mistreatment of pressure area care. If everybody worked on an individual basis then the lack of communication could result in the pressure area becoming worse due to neglet or wrong information. Each shift needs to be aware of the plan of care so that the individual receives adequate treatment around the clock.
Outcome 3 Be able to follow the agreed care plan.
3.1 Describe why it is important to follow the agreed care plan. It is important to follow the agreed care plan because it forms the basis of what is considered best interest for the individual, it is unique to them and details their needs and preferences. All care givers to the individual should check the care plan in order to know they are providing the correct care and support and following the individuals wishes. If any problems are recognised then the care plan can be updated to reflect these changes.
3.2 Ensure the agreed care plan has been checked prior to undertaking the pressure area care. It is important to ensure the agreed care plan has been checked prior to undertaking the pressure area care because the care plan reflects the individuals current health issues, and the agreed way of how to best care for them, it is important that everyone follows the plan to avoid any further health issues, it is also important to check the plan for any updates or changes.
3.3 Identify any concerns with the agreed care plan prior to undertaking pressure area care. It is important to identify any concerns with the agreed care plan before undertaking the pressure area care in order to complete a risk assessment, any new concerns should be noted and changed in order to best care for the individual.
3.4 Describe actions to take where any concerns with the agreed care plan are noted. Once a risk assessment has been completed, and concerns with the care plan have been found, it is important to address these issues with authorised staff so that the care plan can be updated to reflect these issues, so that changes can be made to maintain a high level of care for the individual. Any concerns should be verbally addressed, discussed and finally recorded in the written care plan.
3.5 Identify the pressure area risk assessment tools which are used in your own work area. The main pressure area risk assessment used in my work area is the walsall tool assessment, The primary aim of this tool is to assist you to assess risk of an individual developing a pressure ulcer, use this together with your own clinical judgment. The walsall tool consists of categories such as height, build/weight, visual assessment of the skin, continence, mobility, appetite and also any special risk factors.
Unit 4222-229 Undertake agreed pressure area care ( HSC 2024 ) Karen Yardley
3.6 Explain why it is important to use risk assessment tools. By using risk assessment tools you have early implementation of preventative or management strategies to prevent or minimise further pressure damage.
Outcome 4 Understand the use of materials, equiptment and resources available when undertaking pressure area care.
4.1 Identify a range of aids or equiptment used to relieve pressure. Aids and equiptment for relieving pressure can include:
– pressure cushions
– airwave mattresses
– slide sheets
– turning/ repositioning/ movement charts
4.2 Describe safe use of aids and equiptment.
When using aids or equiptment to relieve pressure you should always make sure you are doing so safely and appropriately. When using a slide sheet ensure that the individual is fully on the material before any force is applied as this can cause shearing or friction to the skin. Slide sheets must always be handled by a minimum of two people. Specialised mattresses and cushions should be checked reguarly to ensure they are still safe to use and in good working order. All charts should be filled in reguarly and stored in an appropriate manner to leave a paper trail to look back on. Carers must always ensure when using aids that policies and procedures are followed and that they are working in accordance to the relevant acts and legislations.
4.3 Identify where up to date information and support can be obtained about, Materials,
By checking the individuals care plan, the materials and equiptment to be used will be detailed, for further support and information you should refer to your line manager, District nurses, G.P or visit the National Institute for Clinical Excellence ( N.I.C.E. ) website www.nice.org.uk which issues guidelines and up to date information.