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

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