Managing the Prevention of Skin Breakdown

Abstract

This chapter addresses the fundamental role of nurses in the prevention of skin breakdown. Every nurse should possess the knowledge and skills to identify people at risk of skin breakdown, to select and implement strategies to maintain skin integrity, and to review the effectiveness of these to inform any necessary changes in care. Skin breakdown is associated with long-term conditions such as diabetes, cardiovascular disease, and spinal cord injury, and with acute illnesses that cause mobility restriction such as surgery and severe illness. Diabetes is associated with foot ulcers, cardiovascular disease with leg ulcers, and acute or long-term mobility restriction is associated with pressure ulcers. This chapter focuses on these three categories of skin breakdown and illuminates the key responsibilities carried by nurses in each of these areas. The first section of this chapter provides detailed guidance on the nursing management of pressure ulcer prevention. This is followed by a subsidiary section on the prevention of diabetic foot ulcers. The final section provides a short overview of the nursing role in preventing or managing venous ulceration. Pressure ulcers, which are also called pressure sores, bed sores, and decubitus ulcers, have been defined as:…localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. (European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel, 2010)…Pressure ulcers may present as persistent redness (where the skin is damaged, but not yet broken), blisters, shallow sores, or necrotic wounds extending to the muscle and bone. An ‘avoidable pressure ulcer’ is one that developed and the provider of care did not do one of the following:…● evaluate the person’s clinical condition and pressure ulcer risk factors; ● plan and implement interventions consistent with the person’s needs and goals, and recognize standards of practice; ● monitor and evaluate the impact of the interventions; or ● revise the interventions as appropriate….