Observe skin, monitor mobility and continence.

Assess state of wound to prescribe appropriate treatment supported by skin integrity assessment.

Skin integrity assessment (body mapping) undertaken.

Ensuring the accuracy and precision required in recording and interpreting skin integrity assessments.

Use appropriate technical terms.

Apply knowledge of skin function and structure to objectively assess skin conditions.

Dressings, ointments or simple wound dressings applied as prescribed/needed.

Applying and removing dressings where directed.

Taking swabs when indicated.

Pathophysiology of skin ageing and factors affecting skin integrity ie lifestyle, environmental, medical.

Pain assessment - assesses pain levels to diagnose and determine suitable treatment, supported by a range of pain assessment tools.

Bed comfort/specialist mattresses/ seating cushions.

Preventative measures for pressure injuries.

Types of treatment used for skin care and prevent or treat skin conditions eg phototherapy, hydrocolloid dressings, oral treatments, topical treatments, massage.

Communicate effectively - how to prevent pressure injuries to individuals and carers.

It uses a scoring system to predict the likelihood of a patient developing a pressure injury.

Should be completed within 6 hours of an admission and then at regular planned intervals.

• Moisturise regularly: Apply emollients (moisturising creams or ointments) at least twice daily, even when the skin appears healthy. This helps maintain and restore the skin’s protective barrier.

• Use gentle cleansers: Replace soaps, shower gels, and bubble baths with an emollient cleanser or mild, non-soap alternative to avoid irritation.

• Dry skin carefully: After washing, gently pat the skin dry with a soft towel rather than rubbing, which can cause friction and irritation.

• Avoid very hot water: Use lukewarm water for bathing or showering, as hot water can dry and irritate the skin.

• Apply creams in the direction of the hairs to stop build up and potentially blocking the hair follicles.

• Health professionals applying for a patient - PPE gloves and apron.

Managing Flare-Ups

• Begin treatment as soon as signs of a flare-up appear to help reduce severity and discomfort.

• Apply topical corticosteroids: Use prescribed steroid creams or ointments sparingly on affected areas to reduce inflammation and itching. Follow the guidance provided by a healthcare professional. If applying this for someone else then use gloves.

• Use “wet wrap” therapy (if advised): In more severe cases, healthcare providers may recommend applying emollient and steroid treatments under damp bandages to increase skin hydration and absorption.

Avoiding Triggers

• Choose appropriate fabrics: Wear loose-fitting, breathable clothing made from soft materials such as cotton. Avoid synthetic fibres like polyester or spandex, which may irritate the skin.

• Avoid fragranced products: Use fragrance-free soaps, detergents, and cosmetics to prevent irritation from perfumes and additives.

• Keep body temperature stable: Avoid overheating, as heat can make itching worse.

• Reduce scratching: Keep nails short and clean. If itching occurs, tap or press the area gently rather than scratching. For infants, mittens may help prevent skin damage.

• Protect hands: Wear gloves when using cleaning products or doing housework to reduce contact with irritants.

Additional Considerations

• Prevent contamination: Use a clean spoon, spatula, or pump dispenser when applying emollients from a tub to avoid introducing bacteria.

• Manage stress: Emotional stress can make eczema symptoms worse, so relaxation and stress management techniques may help.

• Fire safety: Emollients can be highly flammable, especially when absorbed into fabrics. Avoid smoking or being near open flames after applying these products.

-radiation

-electricity

-friction

-contact with chemicals

Burns are measured in degrees. The degrees relate to how many skin layers have been damaged.

Prepare the environment.

Free of hazards.

Gather equipment needed. Ensure it is in good working order. Report any concerns about worn or faulty equipment.

Think about the process before beginning any movement. Encourage active participation.

At least 2 members of staff required.

Assess the task.

POSITION -

Stable base * stay as close to the load as possible *feet usually hip width apart *feet usually pointing in the direction of travel.

PICK -

Bend your knees

Keep your back straight

Maintain a firm grip

Keep the load close

PROCEED -

Agreed countdown between all people.

Move smoothly in the direction of the destination.

Do not twist your body.

Turn your feet to change direction.

PLACE -

Lower with control. Use your leg muscles to lower the load gently.

Bend your knees when placing the object. Keep your back straight.

Allergic reaction causing an area of skin swelling. Body produces histamine.

Psoriasis is more common between the ages of 15 and 25 years.

Stress may cause “flare ups”.

Common sites - knees, elbows creases, lower back, scalp.

Generally less itchy than eczema, but can cause a burning, itching sensation. Itchiness can cause the person to scratch and then subsequent bleeding, with potential for infection.

Can often cause patients to remain in hospital longer than their condition would dictate.

Reduced mobility, or particular health conditions that prevent a person from moving independently are at greater risk of developing pressure injuries.

Also look at ageing and other factors discussed during our class discussion and refresher on the structure and function of skin.

Pseudomonas Aeruginosa is a type of germ that can cause skin infections.

It is a common hospital pathogen.

Transmission is reduced by standard infection control precautions such as frequent handwashing, using hand sanitiser and PPE.

BMI is a calculation using weight and height:

in metric terms, BMI = kg/m2, where kg is a

person's weight in kilograms and m2 is their height in metres

alternatively, in non-metric format the formula

for BMI = weight in pounds divided by a person's

height in inches, squared and then multiplied by 703.

1. Haemostasis phase: starts at the onset of the injury, for example a deep cut, when the body initiates its emergency repair system starting with the blood's clotting process. The location, depth and size of the wound affect which blood vessels are damaged and the hole that needs to be plugged. Platelets, collagen and an enzyme called thrombin initiate the formation of a fibrin mesh, the clot. This will begin the tissue repair process. The injured vessel such as a vein will constrict to prevent any further blood loss. Blood loss which collects under the skin is known as a haematoma - or bruise. A patient's overall health, such as nutrition level, blood thinning medication and medical condition (for example haemophilia), can slow down the initial response, causing a greater amount of blood to be lost.

   
   

2. Inflammatory phase: this starts the defence mechanism to expel debris and destroy bacteria.

Neutrophil cells peak between 24 and 48 hours after the injury occurs but are not always able to dear the site of pathogens. Macrophage cells are increased at the cut and secrete proteins to increase the immune reaction and facilitate skin and tissue repair. The characteristics of this phase are oedema, fluid swelling, erythema (visible redness), pain and generation of heat.

3. Proliferative phase: contraction of the wound's skin and tissue edges begin to come together following the formation of a scab, which protects the surface and prevents contamination. New blood cells are made to replace those lost, granulation tissue fills the wound bed from the bottom up; this prevents the formation of an abscess. Factors such as depth and location of the wound will have an impact on the length of time it takes to fully heal.

4. Remodelling (maturation) phase: new tissue progressively gains strength and flexibility, although scarred skin is thicker and less flexible. The skin's strength following repair may be limited and may not return to the pre-injury level.

Figure above shows the risk factors that influence the rate of the healing process.

a - assess risk

S - SKIN INSPECTION - can use the Braden II and Waterlow tool to support assessing and documentation.

S - SURFACE - Consider patient’s positioning (for example, sitting and lying down) and current preventative measures.

K - KEEP MOVING - consider the patient’s mobility and ability to reposition themselves.

I - INCONTINENCE - status of urine and faeces control and/or retention.

N - NUTRITION - MST assessment. Nutrition and fluids monitoring.

g - GIVING INFORMATION - giving information to patients and carers.

Tasks you will demonstrate:

*Carry out a Braden Scale assessment on a

70-year-old male patient who is sedated, ventilated and in the intensive care unit (ICU).

He is malnourished and has open wounds on the tailbone area, elbow and the back of the head.

Dress the three areas of open pressure injury wound. Describe interventions to protect heels and further pressure injuries, and describe the importance of good nutrition and continence care.

*Carry out a Waterlow assessment for a 42-year-old female patient with an estimated BMI of 34.

Her diet is high in fats and sugars, and she tends to overeat. She has been diagnosed with type 2 diabetes, has stress incontinence when getting up, and has restricted movement due to her weight and oedema in the lower leg, wrists and hands. Inform the dermatologist of risk rating and make suggestions of how to support the patient to improve her situation.

*Describe how the following skin conditions present in the different parts of the body listed, and explain the potential causes of these conditions:

~psoriasis observed on the torso and scalp ~eczema in elbow creases and on the back of knees

~contact dermatitis around the neck and wrist

~hives on the throat, upper arms and legs.

*Describe the purpose of steroid creams, moisturisers and barrier creams.

Psoriasis: Treatment Overview

• No cure – psoriasis is a chronic skin condition that can be treated and managed.

• Individualised condition – symptoms and effective treatments vary between individuals.

• Trial and error process – treatment effectiveness differs; finding the right one may take time.

• Emotional impact – can affect motivation and wellbeing; ongoing support is important.

• Person-centred care – regular reviews with a GP are essential to adjust treatments and maintain communication.

Role of the GP

• First point of contact for most patients.

• Initial management through topical treatments (applied to skin).

• Treatment options include:
  

  • Moisturisers and emollients – soothe and protect the skin.

  • Vitamin D–based treatments – slow skin cell growth.

  • Topical steroids – reduce inflammation and redness.

  • Coal tar preparations – reduce scaling and itching.

  • Dithranol – slows down skin cell production.

  • Calcineurin inhibitors – suppress immune response in the skin.

  
  

• Monitoring and review – GPs evaluate response and adjust treatment accordingly.

• Referral – if psoriasis is severe or unresponsive to topical treatments.

Role of the Dermatologist (Specialist Care)

• Referral pathway – patients with severe or resistant psoriasis are referred to dermatology.

• Advanced treatments include:
  

  • Ultraviolet (UV) light therapy – controlled light exposure to slow cell growth.

  • Systemic treatments – oral or injected medicines affecting the whole body (e.g. methotrexate).

  • Biologic treatments – target specific parts of the immune system.

    
    

• Ongoing specialist monitoring – ensures effectiveness and minimises side effects.

• Extra support for that patient?

• Safeguarding?

• Do professionals treat lack of cream application as seriously as not giving tablets/injections etc?

Types of emollient

• Creams:

  Lighter and cooler on the skin, often preferred for daytime use or for mild to moderate dryness. 

• Lotions:

  Contain a lower lipid (oil) content than creams. 

• Gels:

  Tend to be better at moisturizing than creams, though they may take longer to absorb. 

• Ointments:

  Greasier and stickier, with a higher lipid content, which makes them good for very dry skin and overnight use. 

These maps are often part of a Topical Medication Administration Record (TMAR) in care settings, highlighting specific areas like limbs, torso, or face for, for example, emollients, steroids, or patches. 

Key Components of a Body Map Application

• Visual Representation: A diagram of the human body (front and back) is used to mark the specific site of application.

• Direction of Application: Creams and ointments should generally be applied in the direction of hair growth to prevent folliculitis.

• Site Specificity: The map helps track where creams are applied, which is critical for ensuring they are not applied to the same spot repeatedly, especially for medicated patches or potent steroids.

• Dosage Tracking: The map is often used alongside "fingertip units" to measure the correct amount of cream for the designated area. 

Best Practices

• Clean and Dry: Ensure the skin is clean, dry, and not broken, unless the medication is designed for wounds.

• Documenting: After application, document that treatment was applied and any updates on skin (improvements, integrity etc).

• Frequency: The map should clearly state how often the cream should be applied (e.g., daily, after washing).

• Safety: Always use gloves when applying creams when treating someone else to avoid self-exposure. 

Body maps are essential for monitoring skin conditions and ensuring that treatments are being applied in accordance with a treatment plan and/or prescription.

Definition

Sterile swabs are commonly used in clinical practice to obtain samples of material from skin and mucous membranes. They are utilized to identify micro-organisms in suspected infection or as part of a screening programme to identify patients who may be carrying pathogens without displaying clinical signs or symptoms. Swab cultures provide useful data that can be used to augment diagnostic and therapeutic decision making (Bonham 2009, Panpradist et al. 2014).

Swabbing is aimed at collection of body fluid or cutaneous material for the purpose of obtaining a specimen for microbiological analysis; when properly performed, a swab is a simple, non-invasive and cost-effective method of culturing in clinical practice (Bonham 2009, Panpradist et al. 2014). Samples of infected material can be obtained from any accessible part of the body by using a sterile swab tipped with cotton wool or synthetic material (Chernecky and Berger 2013, Huddleston Cross 2014, Pagana and Pagana 2017).

Evidence-based approaches

Indications

Taking a swab is indicated:

• if there are clinical signs of infection, which may manifest as symptoms such as pain, redness, inflammation, heat, pus or odour

• if a patient shows signs of systemic infection or has a pyrexia of unknown origin

• as part of a screening programme.

• 
  

Contraindications

Taking a swab is not indicated:

• as routine use (unless part of a screening regimen)

• on chronic wounds, which will be colonized with skin flora.