Identify the Individual at Risk of Skin Breakdown and Undertake the Appropriate Risk Assessment Essay
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Upon arriving at the care home, I shut the door behind me, clocked in using my time card and signed the staff log book which is a requirement of the fire safety policy. Prior to starting my shift, I attended the hand over held in the staff office with closed doors to maintain confidentiality and privacy of the residents. The hand over gives me important changes in the resident’s health and social care needs, requirements and procedures that need implementing during the shift.
One of the residents I usually care for is Mrs H who has just come back from a hospital admission. According to her care plan Mrs H was diagnosed with Type 2 Diabetes Mellitus and Chronic Kidney Disease Stage 4 which are predisposing factors for pressure sores. She is bed bound, cannot weight bear and had just undergone Open Reduction and Internal Fixation (ORIF) for fracture on her left tibia fibula which left her immobilised. She is also incontinent of urine and faeces which are all predisposing factors to sore development.
As one of her primary carer, I was assigned to carry out a risk assessment for skin breakdown with the use of the Waterlow Scale. I knocked on Mrs H’s room before entering as a sign of respect for her privacy and greeted her good morning. I asked how she is and she smiled which means she is fine as she has difficulty speaking. I asked her if she would like to have her bed bath and she said “yes please”. I informed her that I also need to carry out a risk assessment for skin breakdown to identify if she is at risk of developing a pressure sore.
I explained the procedures that she will expect, the reasons behind these and I asked for her permission to carry on. She obliged by softly saying “ok” in a very low voice. Before starting the assessment, I gathered all the things that I need. I observed standard precautions for infection control by washing my hands with soap and water and drying them with disposable paper towels. I wore a disposable plastic apron and donned a pair of disposable gloves to prevent the spread and transfer of infection from one person to another.
With the help of my colleague, I gently and carefully took off Mrs H’s night dress informing her every step that I make to make her aware and to encourage her cooperation. I kept it in yellow laundry bag as per organisational policy on infection control and prevention. I covered her body with bath towels to maintain her privacy and keep her warm. I washed her face and body with the use of disposable Mediwipes with soap and warm water. I dried her up using the towel to keep her from freezing. I took off her nappy pad and washed her private front part properly and dried her afterwards.
Then I informed Mrs H that I need to turn her on her side so that I can wash and examine her back. With coordinated movements from my colleague, we gently and carefully turned her on her side, taking special care not to put any undue pressure on her bad leg to prevent any further injury. I examined her back side taking note of pressure points or bony prominences on her shoulders, sacrum, elbows, ankles and heels. Her skin on her shoulders, spine, elbows and heels look fine but there is a redness on her sacral area which feels hotter than other areas of her skin.
I asked Mrs H if she feels any pain in her bottom and she said “yes” in a very low voice. On her left heel is an abrasion which she developed while she was in the hospital. I washed her back and her bottom gently and dried them up properly as excess moisture can aggravate her skin condition. I put her soiled nappy pad in a plastic bag to be disposed of in the clinical waste bag. I applied aqueous creme on her skin especially on bony prominences to prevent drying. I applied sudocrem on her sacral area to soothe and to protect and help heal her skin.
I put on a clean nappy pad on her, put on clean clothes and positioned her on her right side to relieve the pressure on her sacral area, using cushions to make her comfortable. The nurse-in-charge came inside the room to check on her left heel wound and I asked her how to clean it and what dressing should I use for it. She said I can clean it with sterile water and sterile gauze, dry it up and apply Versiva dressing for protection as advised by the tissue viability nurse. I disposed of my gloves and donned on a clean pair.
I washed Mrs H wound on her heel with sterile water and sterile gauze, dried it up and applied Versiva dressing. I put on a pressure relief cushion on her left foot to relieve pressure, kept it supported and in a comfortable position. I thanked Mrs H for her cooperation during the procedure. I informed her about the condition of her skin and reassured her that it is well taken care of. I disposed of my apron, gloves and soiled dressings in the plastic bag, tied it and disposed it in a clinical waste bag. I washed my hands with soap and water again and dried it up to prevent the spread of infection.