Download Protect Your Skin

Protect
Your Skin
It’s one of the most important
things you can do!
What is the skin?
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It’s the largest organ in the body
It protects you from the outside
world
It houses your sensory nerve
endings
It senses everything you touch
It tells you when to change
positions
It tells you when something is
hot or cold
How do you normally keep
your skin healthy?
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Your skin needs oxygen and
nutrients to live, just like the rest of
your body
These are delivered to your skin
by small blood vessels called
capillaries
Your nerves tell you when to
change position
You eat healthy
You don’t smoke
You take care of cuts and bruises
What happens to your skin
after a spinal cord injury?
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The sensory nerves no longer work
properly
The circulatory system to your skin may
not be working effectively to bring
oxygen and nutrients to the skin
How your skin feels and its elasticity may
change after a spinal cord injury
Pressure over bony points is increased
due to a decrease in muscle and
imbalances in posture
You may not feel light touch
You may not feel pressure
You may not feel hot or cold
You may not know when to change
position
What is a pressure ulcer?
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Also known as pressure sores,
decubitus, or skin breakdown
A localized area of tissue necrosis
(dead tissue) that can occur when soft
tissues are subjected to prolonged
unrelieved pressure
A common complication and lifelong
risk of people with spinal cord injury
Can lead to serious infection and even
death
It can affect health and well being
A pressure ulcer can make your life
miserable
They can confine you to bed for
weeks and months
They can be prevented
The earlier they are found, the more
easily they are treated
Stages of Pressure Ulcers
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Pressure ulcers are graded in
stages I-IV, getting
progressively worse with each
stage
Stage I: skin redness or
discoloration, warmth, edema,
hardness
Stage II: skin and tissues
underneath are compromised,
can look like an abrasion or a
shallow crater
Stage III: Wound goes all
the way through the skin layers
to the muscle
Stage IV: Wound goes down
to the bone and may have
tunnels under the skin
What causes or puts you at
greater risk for pressure sores?
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Sensory or motor impairments that affect how you move
Not performing pressure reliefs or position changes and
thus prolonged unrelieved pressure which compromises
blood flow
Shear forces or trauma
Excessive moisture to the skin (urine, feces, sweat)
Changes in skin make-up
Nutrition deficiencies (protein, iron, zinc) result in poor
skin condition
Poor general skin condition before the injury
What causes or puts you at
greater risk for pressure sores?
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Secondary infections (colds, flu, urinary tract infections)
Smoking – (nicotine decreases capillary size and thus
decreases blood flow)
Increased age. As you get older, skin is more sensitive
to tears and shear trauma
Other health problems such as diabetes, heart disease,
kidney disease, lung disease
Severity, completeness and level of injury
Decreased activity level
The use of alcohol or drugs
Worn out or broken equipment
Mental stress or depression
Aging and Skin
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Age also affects skin; it becomes thinner and
less elastic
As you get older, skin may become more
susceptible to tears and shear trauma
Decreased circulation as you get older affects
skin health
What areas are susceptible to
pressure sores?
Laying on your back
Back of your head, shoulder blades, sacrum (area about
butt crack), and heels
How do you position yourself
in bed?
ON BACK
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Only one pillow under head
Arms supported with elbows straight and hands facing up
Pillow/s under calves to float heels off of mattress
Head of bed should not be raised more than 30º without
trying to reduce the amount of force at your tailbone and
sacrum
What areas are susceptible to
pressure sores?
Laying on Side
Shoulder, hips, knees (inside and outside bones), and
ankles (inside and outside bones)
How do you position yourself
in bed?
ON SIDE
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Pillow under head
Arm you are laying on pulled out from underneath so you
are laying on your shoulder blade
Pillow behind back (not bottom)
Pillow between knees
What areas are susceptible to
pressure sores?
Laying on Stomach
Front bones of hips, knee caps, top of feet
How do you position yourself
in bed?
ON STOMACH
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Pillow under head
Pillow under ankles
Can also place a pillow under chest or stomach
What areas are susceptible to
pressure sores?
Sitting
Ischiums (the bones you sit on), tailbone, any body
part that has continuous pressure on wheelchair
How do you position yourself
in a wheelchair?
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Hips all the way back in the wheelchair
Sitting up tall – No slouching
Proper cushion in good condition and position
Legs properly supported
on cushion
No areas of pressure on
body from wheelchair
parts
How can you prevent pressure
sores?
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Proper positioning in bed and wheelchair
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Turning every two hours in bed
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Performing pressure reliefs in wheelchair every
20 minutes
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Maintaining a proper diet
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Proper bowel and bladder management
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Avoid damaging forces to the skin (trauma,
shear)
How can you prevent pressure
sores?
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Daily skin checks (Check for redness or
darkening and for warmth to the touch)
z Skin checks are a vital lifelong component of
your daily routine
z Either it is done by you or a caregiver
z Self skin checks require a long handled mirror
to check your gluts and tailbone
z If someone else is performing the checks, you
need to take responsibility for instructing them
in what to look for
CHANGE YOUR
POSITION IN BED
EVERY 2 HOURS!!
How do you do a pressure
relief in a wheelchair?
If you are unable to perform one yourself:
z You may have a power wheelchair that can
place you in a tilt
z You may have recliner wheelchair that
someone can recline and elevate your legs
z Need to perform for at least 5 minutes
z Or you may have someone assist you to
perform the ones below
How do you do a pressure
relief in a wheelchair?
If you are able to perform a pressure
relief:
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You may do a wheelchair push-up;
requires the most strength but give
the best pressure relief. Do it for 3060 sec 2-3 times.
You can lean forward in your chair to
take the pressure off your tailbone.
Do for 30-60 sec 2-3 times.
You can leaven side to side in your
chair to take the pressure off of the
sitting bones. Do for 30-60 sec 2-3
times.
PRESSURE RELIEFS
IN WHEELCHAIR
SHOULD BE DONE
EVERY 20
MINUTES!!!
What do you do if you see a
pressure sore?
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Get off the area immediately
Stay off until redness and warmth go
away
Figure out what caused the pressure
Problem solve to keep it from
happening again
If it is a Stage II or worse, contact
your doctor
If there is black, dead tissue, call your doctor
It is important to stop skin problems before they
become major problems
You, and only you, are
responsible for your
body!