Protect Your Skin It s one of the most important things you can do!
What is the skin? 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? 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? 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? 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 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? 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? 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 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? Only one pillow under head ON BACK 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? Pillow under head ON SIDE 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 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? 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? Proper positioning in bed and wheelchair Turning every two hours in bed Performing pressure reliefs in wheelchair every 20 minutes Maintaining a proper diet Proper bowel and bladder management Avoid damaging forces to the skin (trauma, shear)
How can you prevent pressure sores? Daily skin checks (Check for redness or darkening and for warmth to the touch) Skin checks are a vital lifelong component of your daily routine Either it is done by you or a caregiver Self skin checks require a long handled mirror to check your gluts and tailbone 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: You may have a power wheelchair that can place you in a tilt You may have recliner wheelchair that someone can recline and elevate your legs Need to perform for at least 5 minutes 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: You may do a wheelchair push-up; requires the most strength but give the best pressure relief. Do it for 30-60 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? 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!