B2131 - Care of the Older Person: Preventing Pressure Sore Development

This report delves into the critical issue of pressure sore prevention in clients experiencing reduced mobility, a common concern in healthcare settings, particularly among the elderly. It begins by defining pressure ulcers, also known as bedsores, and explaining the underlying causes, which include prolonged pressure, friction, and shear forces. The report then explores the concept of reduced mobility, outlining various factors contributing to it, such as osteoporosis, Parkinson's disease, cognitive decline, neuromuscular disorders, osteoarthritis, excess weight, heart problems, and falls. It provides detailed insights into the signs and symptoms of pressure sores, emphasizing the importance of early detection. The report also highlights the specific needs of clients prone to pressure sores, encompassing physical aspects like hygiene, skin care, nutrition, and mobility, alongside social, emotional, and spiritual considerations. It proposes a comprehensive care plan that addresses these needs, offering practical guidance for healthcare professionals to improve patient outcomes and prevent the development of these debilitating ulcers. The report is designed to be a valuable resource for students and healthcare professionals seeking to enhance their understanding of pressure sore prevention.

B2131 – CARE SKILLS/CARE OF THE THE
OLDER PERSON
THE PREVENTION OF PRESSURE SORE
DEVELOPMENT IN A CLIENT WITH REDUCED
MOBILITY.

B2131 – CARE SKILLS/CARE OF THE OLDER PERSON
INTRODUCTION: Pressure ulcers (Pressure Sore) are caused when an
area of skin and the tissues below are damaged as a result of being
placed under pressure sufficient to impair its blood supply. Typically,
they occur in a person confined to bed or a chair by an illness and as a
result they are sometimes referred to as 'bedsores', or 'pressure sores'.
Pressure ulcers are often preventable. Recommendations for prevention
include methods for identification and risk assessment and the
preventive measures that should be applied. Treatment of pressure
ulcers includes recommendations on wound care, adjunctive therapies
and support surfaces.
DEFINITION OF REDUCED MOBILITY: A term defined by the EU to
describe a ‘disabled person’ or ‘person with reduced mobility’ whose
mobility when using transport is reduced due to any physical disability
(sensory or locomotor, permanent or temporary), intellectual disability or
impairment.
THE CAUSES OF REDUCED MOBILITY:
Osteoporosis
Osteoporosis causes bones to become so weak and degraded that they
can break in even minor accidents. Even seniors with osteoporosis who
don’t have broken bones tend to shuffle or hunch because deteriorating
spine bones make it difficult to remain upright. Osteoporosis is most
common in postmenopausal women, so doctors may recommend
hormonal treatments that reduce bone density loss. It’s also important
for seniors to consume enough calcium and vitamin D to keep the bones
strong.
Parkinson’s Disease
Parkinson’s is a type of central nervous system disorder that makes it
difficult for the body to control muscles. Seniors often experience
tremors or muscular stiffness that affects the way they walk, talk, or
perform other daily activities. Parkinson’s disease cannot be cured, but
medications that increase dopamine concentrations in the brain may
ease the symptoms.

Cognitive Decline
Conditions like dementia and Alzheimer’s typically leave a senior’s
physical health intact, but they can still cause many challenges with
mobility. Seniors often get disoriented and experience issues with visual-
spatial awareness. They might lose the ability to navigate stairs, avoid
tripping hazards, and perform fine motor skills like eating or writing.
Managing these issues requires caregivers to take preventative steps
that keep seniors from hurting themselves.
Neuromuscular Disorders
Neuromuscular disorders can result in degenerating muscles and nerve
tissues that leave seniors unable to move normally. With conditions like
multiple sclerosis and ataxia, seniors often experience sudden feelings
of weakness and an inability to move as desired. Treatments for these
disorders might include reducing stress and taking medications to slow
the progression of the disease. Walkers, canes, or braces can further
increase mobility
Osteoarthritis
Osteoarthritis is a type of joint inflammation that occurs when the
protective cartilage at the ends of bones reduces. It makes joints swell,
stiffen, hurt, or lock into place. There are many methods for managing
joint pain and immobility related to osteoarthritis. Make sure to talk to
your loved one’s doctor about potential physical therapies, medications,
or surgeries. Your loved one can also use home remedies and embrace
lifestyle changes, including losing weight, applying warm compresses,
and wearing braces, to increase mobility.
Excess Weight
The ability to transfer body weight is limited when your loved one is
overweight. Therefore, he or she may have difficulty going up and down
stairs and find it challenging to walk from room to room. Instead of being
able to move around independently, your loved one may rely on you and
other caregivers to navigate his or her environment, which could cause
isolation and prevent him or her from going to social gatherings in the
community. Seniors can avoid being overweight by remaining physically
active and burning excess calories. Staying in good physical shape
could increase your loved one’s mobility and independence.
Heart Problems
Older adults with cardiovascular issues such as high blood pressure and
poor circulation often become dizzy and have difficulty moving around or
standing for long periods. Heart problems can also lead to difficulty
breathing when moving. These issues can cause limited mobility and

increase the risk that older adults will adopt sedentary lifestyles. Seniors
can prevent cardiovascular problems by developing healthy habits such
as abstaining from smoking, limiting alcohol consumption, eating more
fruits and vegetables, staying physically active, and getting plenty of rest
each night.
Falls
Falls can lead to strained connective tissues that negatively affect
balance, flexibility, and posture. The fractures and broken bones many
seniors experience after falling could have permanent side effects that
prevent them from moving around without using canes, walkers,
wheelchairs, or other assistive devices. The long-term results of falls
could also require families to make extensive changes to their loved
ones’ homes, such as installing grab bars and wheelchair ramps,
rearranging furniture, and lowering sinks, counters, and cabinets.
DEFINITION OF PRESSURE SORES: Pressure ulcers, also known as
pressures sores or bedsores are injuries to the skin and underlying
tissue. They are caused by prolonged pressure on the skin. They can
happen to anyone, but usually affect people who have to stay in bed or
who sit for long periods of time.
CAUSES OF PRESSURE SORES:
• Bedsores are caused by pressure against the skin that limits blood
flow to the skin. Limited movement can make skin vulnerable to
damage and lead to development of bedsores.Three primary
contributing factors for bedsores are:
• Pressure. Constant pressure on any part of your body can lessen
the blood flow to tissues. Blood flow is essential for delivering
oxygen and other nutrients to tissues. Without these essential
nutrients, skin and nearby tissues are damaged and might
eventually die.
• For people with limited mobility, this kind of pressure tends to
happen in areas that aren't well padded with muscle or fat and that
lie over a bone, such as the spine, tailbone, shoulder blades, hips,
heels and elbows.
• Friction. Friction occurs when the skin rubs against clothing or
bedding. It can make fragile skin more vulnerable to injury,
especially if the skin is also moist.

• Shear. Shear occurs when two surfaces move in the opposite
direction. For example, when a bed is elevated at the head, you
can slide down in bed. As the tailbone moves down, the skin over
the bone might stay in place — essentially pulling in the opposite
direction.
SIGNS AND SYMPTOMS OF PRESSURE SORE:
Warning signs of bedsores or pressure ulcers are:
• Unusual changes in skin color or texture
• Swelling
• Pus-like draining
• An area of skin that feels cooler or warmer to the touch than other
areas
• Tender areas
Bedsores fall into one of several stages based on their depth, severity
and other characteristics. The degree of skin and tissue damage ranges
from red, unbroken skin to a deep injury involving muscle and bone.
Common sites of pressure ulcers
For people who use wheelchairs, bedsores often occur on skin over the
following sites:
• Tailbone or buttocks
• Shoulder blades and spine
• Backs of arms and legs where they rest against the chair
For people who need to stay in bed, bedsores may happen on:
• The back or sides of the head
• The shoulder blades
• The hip, lower back or tailbone
• The heels, ankles and skin behind the knees
NEEDS OF CLIENTS PRONE TO PRESSURE SORES (CARE PLAN)
PHYSICAL: Hygiene and skin care: Proper skin care plays crucial role
where daily inspection of skin is recommended. Skin care includes
washing with gentle nature cleansing products, using emollients on skin,

and avoiding use of any kind of adhesive products on skin. The patient
also needs to ensure that skin is properly hydrated and nutrition in order
to avoid any kind of skin infection (Nursing Times, 2013).
Eating and drinking: Poor diet is found as major reason increasing
intensity of pressure ulcers, especially diet with lack of protein, vitamin C
and zinc. It is necessary to maintain good nutrition for enhancing overall
health and improving speed of wound healing and recovery. People are
advised to take diet with enough fluids, calories, protein, vitamins and
minerals in order to develop and maintain healthy skin, and, reducing
any kind of breakdown of tissues. Dietary deficiencies can increase
chances of health problems such as diabetes and vascular diseases,
which, in turn, results in tissue damage (Mooney, Knox and Schacht,
2012).
Mobility and toileting: An individualised bathing schedule with warm
water and mild soap is suggested. It is asked to avoid any kind of
massage over bony prominences and lubricants over genitals. With
respect to mobility, it is asked to provide appropriate support surface to
the patient, the body should be repositioned in every two hours in bed. In
case of sitting in a chair, reposition should be done in every hour, and,
using pillows between legs for side lying. The patient should be moved in
every 15 minutes in case of wheelchair and in every 2 hours in case of
people in bed. As a part of it, physical exercises, even in bed with some
assistance are also suggested as it improves blood circulation (Mason,
Gardner, Outlaw and O'Grady, 2015).
In any of mobility, friction and shear is strictly asked to be reduced.
Friction is a kind of mechanical force used in case skin is dragged
against a coarse surface while any kind of interplay of gravity and friction
give rise to mechanical force. Friction and shear is asked to be avoided
as it exerts a kind of force parallel to the skin resulting in the stretching of
blood vessels (Siegel, 2019).
SOCIAL: Pressure ulcers create physical restrictions for patients which
impose lifestyle changes as well. For example, one’s living
arrangements must be altered to accommodate the presence of a
pressure ulcer. As a result of these restrictions, social and psychological
implications arise. Research has found that physical limitations may
severely restrict an individual’s social life, sometimes resulting in social
isolation. Some have expressed that their relationships have been
impacted. Those with pressure ulcers are often very dependent on
others for care, and are affected by the perceived impact these pressure
sores impose on others. For example, sufferers develop a fear of
becoming a burden upon others, and develop preoccupations regarding

the financial impact the pressure ulcer may have on their families. Many
have expressed that they have been emotionally or psychologically
embarrassed to due odors which stem from the wound, and this has also
led to social isolation as a result. In addition, many have felt
embarrassed requiring assistance in changing of dressings, and this has
impacted relationships and quality of life as well.
EMOTIONAL: Psychological implications also arise when individuals
develop a preoccupation with the presence and healing of the sore. This,
in turn, may impact an individual’s own perception of their body image.
When one sustains an injury or wound, particularly one that is visible, it
can result in emotional and psychological trauma, including feelings of
shame and embarrassment. This is particularly likely in cases of patients
suffering from stage IV pressure ulcers, which not only cause pain, but
usually also expose muscle and bone.
SPIRITUAL: Respond to spiritual needs as they arise
A patient with a spiritual concern might not want to wait for an
appointment with a chaplain, so be ready to recognize and respond to
spiritual concerns as they arise. You can provide spiritual care at virtually
any place or time—for instance, you can discuss spiritual matters while
ambulating the patient.
Nine simple spiritual interventions
You can meet many spiritual needs through simple interventions. One
nurse colleague, whom I’ll call Julia, found this out when she was
hospitalized with a difficult pregnancy. Afterward, she told me, “My
understanding of what we as nurses do to give spiritual care changed.
The simplest things made an enormous difference to me.”
The nine simple interventions below will help you care for your patients’
spiritual needs.
1 Be there
Your mere presence is meaningful when you intentionally focus on the
patient. You don’t even have to say anything; you can connect with the
patient by being silent and trying to understand what he or she is
experiencing. Concentrate on valuing, accepting, and empathizing. By
giving your time in silent companionship and establishing an atmosphere
of empathy and serenity, you can soothe deep spiritual pain.
2 Listen actively
Encourage the patient to talk by affirming what he or she says, asking
open-ended questions, and offering reflective comments. When a patient
expresses a spiritual concern, acknowledge this by saying, “That sounds
troubling. Help me understand what you mean.” Maintain a matter-of-fact

manner.
Reflect your understanding of the patient’s concerns by stating, “It
sounds like you’re thinking a lot about what lies ahead.” On the day Julia
realized she was facing 16 weeks of hospitalized bed rest, one nurse
“took the time to listen to all my fears. She told me she didn’t have the
answers to my questions, but she helped me remember my faith and
think about how to leave my fears in God’s hands.”
Listening to patients doesn’t require much response on your part. Simply
encouraging the patient to talk may be an effective spiritual intervention.
3 Use touch
Gentle touch is reassuring and comforting. When you touch your patient,
you provide comfort, warmth, and connection. But first make sure the
patient is open to physical touch. Ask, “Do you mind if I take your hand?”
Besides holding the patient’s hand, you might touch the arm or place
your hand on the shoulder to show concern and caring. Even the touch
you provide when performing a procedure can be a spiritual intervention
if you intentionally focus on the patient and think about conveying
comfort through your touch.
4 Reflect and remember
Help your patient think about previous experiences. Ask “What types of
things have comforted you in past situations like this?” Help the patient
remember the support he or she has received in the past from family,
friends, or spiritual beliefs.
5 Laugh
Talk with clients about things other than their condition. Engage
family`s client and the client in planning a “party”. Make the days go by
fast.” Create happy experiences.
6 Share the experience
Join the patient in questioning the meaning and difficulties of life.
Acknowledge that much about life’s purpose and why people suffer is
beyond your understanding. As you explore such issues together, follow
the patient’s lead. Learn to be comfortable with the patient’s tears and
accept crying and other emotional expressions (including your own)
calmly.
7 Pray or encourage the patient to pray
Prayer is one of the spiritual interventions patients request most often. It
helps us connect with the spiritual dimension. If your patient asks you to
pray, adapt your prayer to the patient’s beliefs and needs. Ask “What
would you like me to pray for?” Use everyday language, and keep your
prayer simple and short. Pray for the patient’s concerns. If you don’t

believe in prayer or for some other reason don’t wish to pray with the
patient, ask a coworker to do this.
8 Use inspirational words and music
Many people find comfort in reading sacred texts or inspirational
materials. Offer to read from a book of the patient’s choice, or have a
volunteer read to the patient. If desired, arrange for the patient to listen
to music of his or her choosing; perhaps family members could bring in a
CD player with a selection of comforting music.
9 Evaluate spiritual needs
Performing a simple spiritual-needs assessment can be an effective
nursing intervention in itself. It gives the patient permission to express
these needs and reveals what kind of language to use when providing
spiritual care. If the patient tells you praying to Buddha provides comfort,
you’ll know what name to use when talking about a higher spiritual
power. (See Assessing your patient’s spiritual needs.)
What not to do
When providing spiritual care, be careful not to inflict additional suffering.
Follow these guidelines:
• Don’t try to be something you’re not or to know something you don’t.
• Don’t give empty reassurances, such as “Everything will be all right.”
You don’t know if everything will be all right.
• Don’t debate religion or try to impose your own religious or spiritual
views on the patient.
• Don’t try to “fix” your patient’s spiritual problems or answer
unanswerable questions. It’s fine to explore difficult questions with the
patient. But if you offer pat answers, you’ll only belittle the patient’s
concerns and may increase feelings of isolation.
ENVIRONMENTAL: Moving and regularly changing your position helps
to relieve the pressure on ulcers that have already developed. It also
helps prevent pressure ulcers form.
If the client are at risk of getting pressure ulcers or have a minor ulcer,
the care team have to recommend a specially designed static foam or
dynamic mattress.
If more serious ulcer, the client will need a more sophisticated mattress
or bed system, such as a mattress connected to a pump that delivers a
constant flow of air into the mattress.
Specially designed dressings can be used to protect pressure ulcers and
speed up the healing process.
These include:

• alginate dressings – these are made from seaweed and contain
sodium and calcium, which are known to speed up the healing
process
• hydrocolloid dressings – contain a gel that encourages the
growth of new skin cells in the ulcer, while keeping the surrounding
healthy skin dry
• other dressing types – such as foams, films, hydrofibres/gelling
fibres, gels and antimicrobial (antibiotic) dressings may also be
used
Creams and ointments
Topical antiseptic or antimicrobial (antibiotic) creams and ointments are
not usually recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged
or irritated by incontinence.
Maintain a clean and healthy environment:
• Hand hygiene – demonstrating proper hand washing techniques
• Protective barriers – including gloves, gown, mask, eye protection,
or face shield.
• Dispose of laundry and hazardous waste properly – use towels
only once after contact, and wash linens routinely and when soiled.
• Proper handling of contaminated areas and devices – clean the
client’s environment routinely and when soiled with body fluids.
Prevention 0f Pressure Sore Development
• The majority of pressure ulcers can be prevented.
• Skin injury due to friction and shear forces should be minimised
through correct positioning, transferring and repositioning
techniques.
• Pressure redistributing equipment should be used.
• Eliminate any source of excess moisture due to incontinence,
perspiration or wound drainage.
• Reduce underlying risk factors such as poor nutrition.

• Education and training - eg, mobility, positioning, skin care, use of
equipment - for patients and their carers.
• Consider the use of emollients if the skin is dry or barrier products
if the skin is excessively moist.
• People at high risk of developing pressure ulcers should use
higher-specification foam mattresses rather than standard hospital
foam mattresses.
• Medical grade sheepskins are associated with a decrease in
pressure ulcer development.
• A polyurethane foam dressing can be applied to bony prominences
(eg, heels, sacrum) for the prevention of pressure ulcers in
anatomical areas frequently subjected to friction and shear.
• A barrier preparation can be used to prevent skin damage in adults
who are at high risk of developing a moisture lesion or
incontinence-associated dermatitis, as identified by skin
assessment.
PROCEDURES RELATING TO THE SAFETY AND SECURITY OS CLIENTS.
Security Procedures means any instructions, recommendations,
measures and procedures concerning security or authentication issued
or made available to You.
Privacy and Security Laws means Laws regarding collecting, accessing,
using, disclosing, electronically transmitting, securing, sharing,
transferring and storing personally identifiable data, including federal,
state or foreign laws or regulations regarding (i) data privacy and
information security, (ii) data breach notification (as applicable), and/or
(iii) trespass, computer crime and other laws governing unauthorized
access to or use of electronic data.
Environmental, Health, and Safety Requirements means all federal,
state, local and foreign statutes, regulations, ordinances and other
provisions having the force or effect of law, all judicial and administrative
orders and determinations, all contractual obligations and all common
law concerning public health and safety, worker health and safety, and
pollution or protection of the environment, including without limitation all
those relating to the presence, use, production, generation, handling,
transportation, treatment, storage, disposal, distribution, labeling, testing,
processing, discharge, release, threatened release, control, or cleanup
of any hazardous materials, substances or wastes, chemical substances

or mixtures, pesticides, pollutants, contaminants, toxic chemicals,
petroleum products or byproducts, asbestos, polychlorinated biphenyls,
noise or radiation, each as amended and as now or hereafter in effect.
Policies and Procedures means the written policies and procedures of
the Client in any way related to the Services, including any such policies
and procedures contained in the Organic Documents and the Offering
Documents.
IMPORTANCE OF SAFE AND HYGIENIC WORK PRACTICES.
The best safety and health management practices involve not only the
employer, but the individuals in the company buying into the health and
safety culture.
Smoke, eat, and drink only in designated areas away from areas
where hazardous materials are used or stored. Small amounts of the
substances may be present in the area, and smoking, eating, and
drinking nearby will cause you to inhale or ingest the hazardous material.
Keep work clothes clean and in good condition. Holes or tears will
allow hazardous materials to get on your clothes or skin, increasing the
likelihood that you will be exposed to the substance.
Do not mix contaminated clothing with your home laundry. Not only
will cross-contamination occur, but it is possible to cause a fire if these
clothes are laundered. Find out what to do with your contaminated
clothing before you leave work. Many companies have an industrial
laundry facility specifically for contaminated clothing.
Always wash before you apply makeup, lotion, lip balm, or gloves.
Applying these to contaminated skin is likely to cause an accidental
exposure.
Remove contact lenses when working in an area where vapors are
present. Contact lenses absorb substances from the air, causing eye
irritation and other potentially serious conditions.
Keep hazardous material storage areas clean. In case of a spill, the
area should be cleaned according to proper spill control and clean-up
procedures. Materials used to clean up the spill must also be disposed of
properly.
KEY POINT THAT WILL CONTRIBUTE TO AN ENHANCED QUALITY
OF LIFE FOR THE CLIENT/CLIENT`S.