Skin Management & Wound Prevention

Pressure ulcers can present a significant challenge, resulting in increased morbidity, mortality and cost of care. There are multiple therapies and technologies designed to protect patients’ skin.

Skin Moisture

Skin Moisture

Skin moisture is a key extrinsic factor in pressure ulcer development. The sources of skin moisture that may predispose the skin to breakdown include perspiration, urine, feces and fistula or wound drainage.
Excessive moisture may lead to maceration. Increases may be due to the slight increase in friction that occurs with light sweating or to the increase in bacterial load resulting when alkaline sources of moisture neutralise the protection provided by the normal acid mantle of the skin.

Reference: Brienza DM, Geyer MJ, Sprigle S. Seating, positioning, and support services. In: Baranoski S, Ayello EA. Wound Care Essentials: Practice Principles.


Skin Temperature

Skin Temperature
The role of temperature in pressure ulcer formation hasn’t been definitively investigated. However, higher ambient temperatures have been shown to cause an increase in tissue metabolism and oxygen consumption. Thus, patients with compromised tissue already at risk for pressure ulcers may have increased demands for oxygen in excess of their metabolic capabilities.
Any increase in temperature, in combination with pressure, is believed to increase susceptibility of the tissue to either ischemia or reperfusion injury when the pressure is relieved.

Reference: Brienza DM, Geyer MJ, Sprigle S. Seating, positioning, and support services. In: Baranoski S, Ayello EA. Wound Care Essentials: Practice Principles


Skin Pressure

Skin Pressure
A skin or pressure sore develops when the blood supply to an area of the body stops and the skin in that area dies. A person who is bedridden or always in a wheelchair puts pressure on the same areas much of the time. This reduces the blood flow to these areas, making them more likely to develop open sores. These areas are made worse when the patient rubs against his or her sheets or is roughly pulled up in the bed or chair.

What to look for:

  • Red areas on the skin that do not go away even after the pressure is removed
  • Cracked, blistered, scaly, broken skin
  • An open sore involving the skin surface or tissue under the skin
  • Yellowish stains on clothing, sheets or chair (may be tinged with blood)
  • Painful or tender "pressure points" (back of head, ears, back of shoulders, elbows, buttocks, hips, heels and any place a bony part rests on the bed surface)

Reference: American Cancer Society. Skin (pressure) sores.


Skin Friction

Skin Friction
Skin shear is an internal force caused when adjacent surfaces slide across each other, which results in twisting and tearing of the underlying blood vessels and leads to tissue ischemia and localized tissue death.
Shear commonly occurs when patients are semi-recumbent in bed. The body begins to slide and, before the frictional force of the skin on the bedclothes is overcome, the internal parts of the body, such as the skeleton, move down the bed. As the skin does not move, there is a stretching or tearing of the blood vessles.

Source: Flanagan, Fletcher. Tissue viability: managing chronic wounds. In: Brooker C, Nicol M, eds. Nursing Adults: The Practice of Caring


Skin Shear Stress

Skin Shear
Skin shear is an internal force caused when adjacent surfaces slide across each other, which results in twisting and tearing of the underlying blood vessels and leads to tissue ischemia and localized tissue death.

Shear stresses commonly occur when patients are semi-recumbent in bed. The body begins to slide and, before the frictional force of the skin on the bedclothes is overcome, the internal parts of the body, such as the skeleton, move down the bed. As the skin does not move, there is a stretching or tearing of the blood vessels.

Reference:   Flanagan, Fletcher. Tissue viability: managing chronic wounds. In: Brooker C, Nicol M, eds. Nursing Adults: The Practice of Caring

 


Edema

EdemaEdema (swelling) is the enlargement of organs, skin or other body parts. It is caused by a build-up of fluid in the tissues. The extra fluid can lead to a rapid increase in weight over a short period of time (days to weeks).
Edema can occur throughout the body (generalised) or only in a specific part of the body (localised). Slight edema of the lower legs commonly occurs in warm summer months, especially if a person has been standing or walking a lot.

Generalised swelling, or gross edema (also called anasarca), is a common sign in severely ill people. Although slight edema may be difficult to detect, especially in an overweight person, gross edema is very obvious.

Reference: MedlinePlus. MedlinePlus, a service of the US National Library of Medicine and the National Institutes of Health

 

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