Risks for impaired skin integrity.

Hello, my name is Cindy Braz. I'm the Executive Director of the National Alliance of Wound Care and Osteomy. Our organization works with our sister foundation, the International Alliance of Wound Care Scholarship Foundation, to promote and enhance education and certification in wound care. Our health-shared community will provide education and information that is specific to wound care for both clinicians and patients. Thank you for viewing this video and visiting our community. In this video, we will be looking at a special population of patients and discuss what puts them at risk for impaired skin integrity. Skin is our first line of defense against organisms, water loss, and external agents. Taking care of the skin is an integral component of any skin management program. You see, when the skin is compromised, the patient's overall health is compromised as well. and protecting the skin really requires a basic knowledge of the skin and frequent skin assessments. All patients should be assessed for risk of pressure injury development. The risk assessment helps to identify patients who are at risk for developing pressure injuries and it's essential for prevention and treatment. An appropriate individualized plan cannot be developed until the risks have been identified. The risk assessment tool will be completed by a trained clinician. Most often used tools include the Brayden scale for pressure sore risk, there's the Norton scale, and the Water loan. While we have these risk tools, remember, the risk level should not be based on the score alone, but should also include clinical judgment, patient observations, and input from all staff involved with the patient's care. Incomplete data will lead to inaccurate treatment plans. Now risk assessments are often completed on admission within eight hours. When there is a change in the patient's condition, infer the facility protocol or as needed. A risk assessment will help to establish an individualized plan of care for your patients. Remember, not all patients will have the same risks, and not all risks are the same for all patients. According to the Prevention and Treatment of Pressure Ulcers Injuries Clinical Practice Guidelines, there are special populations of individuals who have specific pressure injury-related needs. So let's take a look at a few. First on the list are the critically ill patients. These are the sickest patients in our health care system. Interventions must be individualized to the specific needs of these patients. They can become nutritionally compromised. They're typically immobile, requiring total assistance from the staff to turn a reposition. And remember, these patients may require more frequent small changes in positioning. The next group on our list are spinal cord injury patients. They have an increased risk due to immobility, decreased sensation, and altered pathophysiology. New spinal cord injury patients have an increased risk for development of pressure injuries. However, the risk is still present at every stage of their care. The risk for pressure injury is present throughout their life. Appropriate support services, turning and repositioning, and education is a crucial part of their plan of care. Our next group are our palliative care patients. Palliative care patients have a high risk for pressure injury development due to organ failure. Remember, skin is the largest organ of the body, it can fail just like any organ. These patients typically require the caregiver to turn and reposition, keep them clean and dry, feed them, and assist with personal hygiene needs. Immobility, incontinence, and inadequate nutrition can contribute to pressure injury development. The focus is on comfort and quality of life for these patients who are receiving hospice care. Our next group are neonates and children. Neonates have immature skin, which increases the risk for skin breakdown. Medical devices are often used with these patients, increasing their risk for pressure injury development. Neonates are not able to reposition themselves in order to redistribute the pressure. So frequent monitoring and assessment should be conducted to prevent development and identify risks for pressure injuries. Our next group are obese patients. Obese patients are more likely to develop injuries caused by pressure because of incontinence, decreased mobility, compromised nutritional status, and decreased oxygenation. Shear, friction, stress incontinence, and sweating are also increased in obese patients, all of which can contribute to pressure injury development. Obese patients will require appropriate equipment and assistance in repositioning. Equipment availability may also be limited, which can further increase their risk. Our next group of patients that are at high risk are those that are receiving community care. These higher risk patients include those that are aged, spinal cord injury patients, and patients that are physically or intellectually disabled. Some contributing factors can include a lack of access to equipment and care, caregiver knowledge, and cost. Patients do not always follow the plan of care, which can result in worsening of an existing wound or the development of a new one. Our next group are those patients who are surgical patients or have been in the OR. These patients are placed on hard surfaces, they're immobile, they're unable to feel pain, and they're unable to reposition themselves. A patient may be positioned in the same position for long periods of time prior to the surgery, during the surgery, and oftentimes after the surgery, which can lead to the development of a pressure injury. Skin checks after these procedures are necessary to identify early signs of pressure injury development. And finally, our last group are patients in transit. Transporting patients in an ambulance or facility transportation vehicle requires the patient to be in one position for what can be very long periods of time. Immobility and oftentimes the underlying comorbidity can increase their risk for pressure injury development. Patients transported within a facility setting are also at risk. For instance, when patients are taken for an x-ray or an MRI, the waiting time and procedure time can be lengthy. Sitting or lying on a hard surface for prolonged periods can increase the risk for pressure injury development. Once a patient has returned, a thorough skin check should be conducted. This will help to identify early signs of skin disturbances. The more you know about identifying those who are at risk, the better equipped you will be when it comes to initiating a plan of care to prevent skin integrity issues. Thank you for viewing this video. We hope you found it to be informative and helpful.