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1.2. Describe the changes that occur when damage caused by pressure develops
The damage that is caused when pressure develops can be termed as pressure ulcers, previously termed decubitus ulcers, are also commonly referred to as pressure sores and bed sores. Pressure sores are the result of a constant deficiency of blood to a localized area that creates damage to the skin and underlying tissue as a result of compression between a bony prominence and an external surface. Damage to the skin to create a pressure sore may be caused by forces of pressure, shear and friction acting individually or in combination with each other. The changes the occur when damage caused by pressure develops are as follows; the skin will become discoloured in a partial area – people with pale skin will tend to get red patches, while people with darker skin will tend to get blue or purple patches, these discoloured areas when pressed won’t turn white. The area of skin tends to feel warm, spongy or hard. The individual with the pressure sore will feel pain or itchiness in the affected area. As the pressure sore develops further an open wound may form in the shape of a blister this would be classed as a stage two pressure sore. The wound could develop further and become a deeper wound which reaches into the deeper layers of the skin known as a stage three pressure sore. The wound could even go so deep it may reach the individuals bone and muscle known as a stage four pressure sore.
1.3. Explain when an initial tissue viability risk assessment may be required
Whenever a new individual enters a care setting it is incredibly important to do an assessment of how likely an individual is to get a pressure sore. This will be done through a score sheet which will take into account any previous history the individual has of pressure sores, also their age and any medication that they are taking. If individual’s score highly in the assessment, then it is incredibly important to put in measures such as turning charts immediately so that the risk of pressure sores is reduced. The initial assessment needs to be done as soon as possible as pressure sores can develop very quickly. It is also important to take into account any changes to an individual’s condition because this could result in a change to their pressure ulcer risk, the individual must be re-assessed as soon as their condition changes. The best way to quickly identify a change in a person’s pressure ulcer risk, you should undertake an assessment of pressure ulcer risk on a daily basis when working in hospitals and monthly in care settings or more frequently if required.
1.4. Describe what to look for when assessing the skin
When you are assessing an individual’s skin you must look for at the locations on an individual’s skin which are most likely to be prone to skin breakdown such as the back of the head, sacrum, heels, spine, elbows and anywhere else on an individual’s body that has a bony prominence. You must always state the location of the pressure ulcer in the correct paperwork such as daily notes, body map etc. stating the staging of the ulcer, including the depth, width and length in centimetres. You should also note the presence of undermining, tunnelling, sinus tracts and any exudate (if present, the colour and amount). You should also look at the wound bed checking the appearance and the type of tissue visible (layers of skin, muscle, bone and any necrotic tissue) and the wound edges looking carefully for evidence of induration(hardness), maceration(moisture), rolling edges and any redness. You should also take into account the presence or absence of pain and the presence or absence of odour as these can be indicators of the severity of the pressure ulcer.
1.5. Describe pre-disposing factors which may exacerbate risk of impaired tissue viability and skin breakdown
There are many pre-disposing factors that contribute to skin breakdown and the likelihood of pressure sores the primary one being age related. If an individual is aged 70 and older the individuals skin density weakens. The individual will experience a decrease in the subcutaneous tissue (decreasing the body’s natural padding and insulation); a flattening of the epidermal-dermal junction which decreases the overall strength of skin (increasing the risk of skin tears or blistering); a decrease in the Langerhans cells and melanocytes (increasing the risk for allergic reactions and sensitivity to light); a decrease in fibroblast function (which increases the time required to synthesize collagen, slowing the healing process); a decrease in blood flow (which decreases skin temperature and delays healing); a decrease in oil and sweat production (contributes to dryness and flaking); a decline in the reproduction of the outermost layer of the epidermis may lead to the skins inability to absorb topical medications. All of these factors contribute as to why an elderly individual is more likely to be at risk of pressure ulcers other factors that aren’t related to age include: dehydration and malnutrition (as skin can become fragile); obesity; paralysis or impaired sensation; being confined to bed because of surgery or undergoing surgery longer than four hours; urinary and bowel incontinence; smoking; significant weight loss; Edema (swelling); prolonged time on a stretcher in an emergency room or in ICU; any history of previous skin ulcers (as scar tissue is weaker than the skin it replaced and will break down easier than intact skin); medications (sedatives, analgesics and nonsteroidal anti-inflammatory drugs); medical equipment (catheters, peg/rig sights and mechanical ventilation such as oxygen pipes and CPAP’s); medical conditions that affect blood supply, make skin more fragile or cause movement problems (diabetes, kidney failure, heart failure, multiple sclerosis, Parkinson’s disease, strokes, cancer etc); and an individual’s choice to refuse care despite being educated about the subject.