Pressure Sores 101

One of the most common nursing buzzwords- pressure sores (AKA pressure ulcers). They can be developed by anyone, and in a wide range of places on the body. As nurses (student or not!) it is our responsibility to report, treat and prevent them.

What is a pressure sore?

A pressure sore is an area of skin that has been deprived of oxygen, due to continuous pressure. This prevents the area of skin getting enough blood, causing the skin to “blanch” (become white due to lack of blood flow). This can then develop into varying degrees of tissue damage; ranging from grade 1 to 4 depending on the severity (NHS Stop the Pressure, 2009).

Grade 1-  skin is intact but blanching, may be some heat/oedema as well 

Grade 2- partial thickness skin loss, looks like an abrasion or a blister. 

Grade 3- full thickness skin loss, some fat may be visible. Possible ‘undermining’ or ‘tracking’ as there is usually depth, depending on the location. This depth can sometimes be covered by slough, which needs to be removed before proper grading can take place. 

Grade 4- full thickness tissue loss, with exposed bone or tendon. There tends to be undermining or tracking, depending on the location. 

Where do they crop up?

Areas that have a hard bony prominence are at risk of pressure sores. This is because they have the least amount of skin protecting itself.

What factors lead to a higher risk of pressure sores?

There are many factors that increase the risk of pressure sores:

  • poor circulation – this could be caused by kidney problems, heart diseases or diabetes.
  • reduced/no mobility- it doesn’t have to be long term! even short term loss of mobility (e.g. after an operation) leads to a pressure ulcer risk.
  • friction- this is where good practice comes in. People who transfer frequently between bed-hoist-chair or just bed-chair, and being moved up/down a bed are at risk. This is why we use slide sheets!

How can they be treated?

  • regular re-positioning/ turns are vital! This helps distribute the pressure, and reduce the risk of the pressure sore from getting worse. You must assess whether the patient is able to do this themselves, or if they require help. Asking the patient (if they have capacity) is always best.
  • pressure relieving devices such as airflow mattresses or pressure cushions can be obtained through physiotherapists, occupational therapists, some trusts require nurses to send the referrals (depends on the area).

  • regular cleaning of the area. Special washes can be used such barrier creams or sprays like ‘Sorbaderm’. This is especially useful for pressure sores on the buttocks/sacrum as they are subjected to lots of moisture.
  • dressings! There are a wide range of dressings which can be used on pressure sores, those that have foam are good for extra protection.

 

How can they be prevented?

Similar to the above treatment! Encourage your patient to mobilize frequently (if possible) and explain the reasons why. Those who are at risk will be identified by their Waterlow Score (10+). If in the community and the patient has carers/relatives helping with their care, speak to them and ask them to update you on any concerns re: pressure sores. Completing bodymaps whenever a new patient arrives and update it regularly is also important. This allows you to assess the patient’s skin integrity, and keep an eye on any possible developments.

 

If you have any ideas for another ‘101 guide’, please get in contact via facebook, twitter or email us on enhancingplacement@gmail.com.

 

 

Advice from a Newly Qualified Nurse

Today I am delighted to bring you some advice from a newly qualified nurse, who also graduated from The University of Manchester

To all my fellow nursing students… the toughest students around! I have recently qualified as a staff nurse in October (scary right ) and currently work on a diabetic specialist ward- the first job I applied for as I went through general trust recruitment and would recommend this to any of you who aren’t sure what area you would like to work I in yet. I thought I would pass on my experience as a Manchester student and as a newly qualified staff nurse 🙂

First of all I am going to bullet point any learning experiences or notes I have for all of you rather than put it in a long winded paragraph as frankly we all have to read enough rambling on of other people whilst at uni, especially if you are currently writing your dissertation, you may never want to read again!

Student Life: -Don’t give up!

1-It is a very hard but very rewarding career. At times I felt like quitting with the stress of placement, uni work and trying to hold down a part time job. You are all doing so well to have made it this far, and we are all here to help and support you. On a side note please ignore all the nurses on placement who say:”why on earth have you picked to do nursing ” or my favourite ” oo you should have been a doctor, that’s much better money”.

2-In reference to part time work – I worked at a roster aunt long hours at weekend for my first and second years and it was just too much ! I would advise to join nhsp as a HCA as soon as you have done 6 weeks in a hospital setting . If like me nhsp keeps crashing for you and is taking 6 months to get an interview consider agency HCA who I joined with for my last year – if anyone wants any information on that I will leave my email 🙂

3-Do your work in plenty of time ! Especially your dissertation, I left mine till the last minute and boy was it stressful . Also a tip for assignments, the reference app thing on Microsoft word is very good.

4-If you are a complete newbie, invest in comfy shoes,your feet will ache after long shifts on your feet all day and please don’t wash your tunic and pants together, they go a very odd colour haha.

5- whilst on placement attend all of the training sessions you can by booking onto them at the education centre, they make up your hours which is good, especially if you aren’t to keen on your placement. I also found it handy to carry a small notepad in my pocket to jot useful things down whilst on placement.

Moving on… Newly qualified:

1- I am not going to lie, it is scary as anything when you first qualify, when someone shouts nurse, you look down and it’s you ! It is normal to doubt your capabilities, question if your cut out for this or why on earth have I decided to do this? ITS OK & VERY VERY NORMAL. Every nurse you see on the ward has all been there , you are going from little to full blown responsibly and that’s scary however the nurses in my experience are all so supportive and understanding. They know you are new to the job and don’t expect as soon as your graduation cap comes off , super nurse to bound through the doors, and any nurse who tries to put you down for not knowing something because your newly qualified, shame on them , no one knows everything there ever is to know about nursing and on a side note, revaluation is coming around, we have had 3 years worth of cross referencing and reflection for our portfolios, so the tables will soon turn 🙂 I would recommend getting a job where there is a preceptorship programme as that’s what I wish I had done differently.

2- Stand your ground: if there is something you are not sure of or not happy with, just ask or even question a doctor as to why he’s doing such a thing, no one is going to think your stupid and you would rather be safe than sorry (we all make mistakes, even doctors!) At the end of the day no one can make you do anything you don’t want to, it’s your pin on the line. Have confidence in your own judgement , most of the time you will be right 🙂

Good luck in your training , which ever stage you may be in, you will all make fantastic nurses and hope to work with you in the future.

If anyone has any questions they would like to ask about anything this is my emailracheljanemoore@hotmail.com

All the best , keep up the good work:)

Rach