Skin Breakdown Caused by Mechanical Factors

Question 1

Characteristics and etiologic factor for friction damage/maceration damage;skin tears - also prevention and management strategies

Answer 1

friction damage (abrasions, friction rubs, blisters)
repetitive cleansing, exposure to friction - fragile/macerated skin, road rash

soft cloths, gentle skin care, heel elevation, prevent further trauma

maceration damage
moisture associated skin damage (MASD) = waterproof skin against urine/stool
zinc oxide/petrolatum/dimethicone, calivon (copolymer)

skin tears superficial skin layers slide against each other, ecchymosis 
avoid tape on fragile skin (moisturize)
protect arms (tubigrip, ace wrap), gentle skin care

silicone adhesive foam
nonadherent drsg
absorb excess exudate

Question 2

Know 3 main factors contributing to pressure ulcer formation

Answer 2

1. prolonged or intense pressure/pressure gradients
2. shear force
3. reduce/compromised tissue tolerance (pts cannot feel or move)

Question 3

Explain the relationships between intensity of pressure and time tolerance, and implications for preventions

Answer 3

Intensity of pressure reduced = time tolerance increased 
redistribute pressures surfaces, routine positioning (time)
pressure relief (offload)
pressure reduction (redistribution)

Question 4

Know strategies for reducing shear

Answer 4

r/t friction (stick) & gravity (slide down)
blood vessels stretched when tissue layers slide
Shear Damage: Irregular deep lesions, undermining, tunneling

Prevention:

a. limit HOB, gatch knees when HOB elevated
b. lift sheet for repositioning (eliminate drag/shear)
c. support surfaces to reduce friction & shear
d. sitting in chair (feet flat on floor)
e. wheelchair/chair cushion elevated in front (reduces slide)

Question 5

Recognize/know how to reasons to the following:

a. reactive hyperemia
b. inflammatory response
c. signs of impending breakdown (DTI)

Answer 5

a. reactive hyperemia (normal response, resolves < 1 hour) is blanchable
b. inflammatory response (persistent hyperemia d/t to inflammatory response STAGE I) - cellular damage/death, tissue recover w/o ulceration if P/S relieved

c. signs of impending breakdown (DTI)
irreversible damage to deep tissue (SQ/muscle)
non-blanching erythema, mottling, dark red/purple color r/t ischemia

Question 6

Understand concept of capillary closing pressure and why 28-32 mm Hg cannot be accepted as “standard capillary closing pressure”

Answer 6

capillary pressures vary from pt to pt