identify a range of interventions that can reduce the risk of skin breakdown and pressure sores
With a concerted effort, skin breakdown is, for the most part, preventable. It can occur, however, even in people who maintain the most diligent care and use the proper equipment. [ If skin breakdown is identified early, when still in the minor stages, and if the cause of the breakdown can be identified and eliminated, healing should occur fairly quickly. If it is not identified in its early
stages, skin breakdown can rapidly progress from minor to serious.
Skin breakdown is caused in several different ways, including friction, shear, moisture and pressure. These causes can occur individually or in combination. Friction, moisture and sheer are identified as contributing factors to pressure ulcers (5). A friction injury occurs when the skin rubs on surfaces, such as a bed sheet, arm rest or brace and has the appearance of a scrape, abrasion or blister. This type of injury is typically seen on the heels and elbows and may result from repositioning, propping or rubbing due to increased spasticity.
A shearing injury occurs with dragging or sliding of a body part across a surface and has the appearance of a cut or tear. This type of injury can occur from dragging your bottom during a transfer or sliding down in bed when the head of the bed is elevated. With the sliding force, bone is moved against the subcutaneous tissue while the epidermis and dermis remains essentially in the same position; against the supporting surface such as a wheelchair or bed. This action causes occlusion of the blood vessels, decreasing blood flow, oxygen and nourishment to the skin, which eventually leads to breakdown. Sometimes a shear injury will actually tear the tissue over the tailbone and with unrelieved pressure will become a pressure ulcer.
Too much moisture over-hydrates the skin, making it weak and more sensitive to friction, shear and breakdown (think about being in the tub or pool for a long time). Primary sources of excess skin moisture include sweating, bowel and bladder accidents, and drainage from wounds. ]
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