BACK CARE

PRESENTED BY:PRESENTEDBY:GURINDER KAUR GURINDERKAUR M.Sc.(N)- FINAL YR. (N)- FINAL YR. M.Sc.

DEFINITION

Pressure points- pressure points are the prominent bony areas of the body where there is no rich blood supply or nourishment and also the skin layer is too thin.

Pressure sore or decubitus ulcer- the pressure sore is a localized area of tissue necrosis that tends to develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period. These are called bed sores.

RISK FACTORS FOR PRESSURE SORES

Infection and Fever Moisture Shearing Force

Edema

Contributing factors

Poor Nutrition

Cachexia Obesity

Anaemia Old Age

Infection and Fever

Shearing Force

Poor Nutrition

Anaemia

Old Age

Obesity

Cachexia

Edema

Moisture

COMMON SITES OF PRESSURE ULCERS

1.Occiput 2.Scapula 3.Sacral region 4.heels

Contd

1. Ears 2. Acromian process of shoulder 3. Elbow 4. Greater trochanter of hip

5. Medial and lateral condyles of the knee

6. Malleolus of the ankle joint 7. Heel

Contd

1. Elbow 2. Ears 3. Breast

4. Greater trochanter
5. Genitalia 6. Knees 7. Toes

WHAT ARE THE SIGNS TO DETECT?

Signs of skin damage may include:

Skin color changes, such as areas of redness, or purple or blue areas.

Skin over a bony area that feels firmer, warmer, or colder than the skin around it.
Calluses, cracked skin, or dry areas. Skin that caves inward, begins to swell, or has a blister. The skin may have a new shiny appearance.

What are the stages of pressure sores?

Stage 1 - The skin is not broken but the color of the skin changes.

The skin may turn purple, red, or darker than normal. The redness of a Stage 1 pressure sore is non-blanchable.

You may feel pain or itching in the area. At this stage, protecting the area from further pressure may treat the pressure sore.

Contd
Stage 2 - The top layer of the skin and the skin just below it are damaged. The skin may be broken (like a scrape), have a blister, or cave inward.

Contd
Stage 3 - The damage to the tissue has gone all the way into the fatty layer, and looks like a deep crater. The crater under the skin may be wider than the hole you see at the top of the skin.

Contd
Stage 4 - The pressure sore is a very deep wound that goes all of the way down into muscle, or to the bone.

PREVENTION OF PRESSURE SORES

Back care

Massaging

Positioning

Use of therapeutic beds and mattresses

BACK CARE

DEFINITION

Back care means cleaning and messaging an individuals back as a therapeutic and comfort measure.

PURPOSES

To prevent bed sore. To stimulate circulation. To detect early signs of bed sores. To relieve pressure from pressure points and to change positions. To keep the skin clean and dry. To refresh the patient and relieve fatigue.

ARTICLES REQUIRED
1.Screen
To provide privacy

2. Mackintosh To protect bed linen with cover 3. Bed linen and the pateints To change, if required clothes

A tray containing:

To take warm water

A small basin To wash with soap and Sponge cloth water

Spirit / oil
Powder A towel

To apply after drying the skin To prevent the friction

To dry the skin

PREPARATION OF THE PATIENT

Assess the need for back care in the patient.

Explain the procedure to the patient. Provide privacy by placing a screen.

PROCEDURE
Steps I

Rationale

Scientific Principles

Put the patient in lateral or prone position

For easy access to back

Anatomy and phsiology

PROCEDURE
Steps II
Expose the patients back, shoulder, upper arm and buttocks. Cover the remainder of the body with bath blanket.

Rationale
To prevent unneccessary exposure of body parts.

Scientific Principles

Privacy

Behavioral sciences.

PROCEDURE

Steps III

Rationale

Scientific Principles

Wash hands in warm water

To make the touch comforatble for the patient as cold causes muscle tension

Physics

PROCEDURE
Steps IV
Wash back with mild soap thoroughly from cervical spine to the coccyx, wash off the soap and dry

Rationale
To clean the back and to remove oil accmulation. To stimulate blood circulation and relieve muscle tension

Scientific Principles

Anatomy and phsiology

PROCEDURE
Steps V
Take spirit on the palm and apply it all over the back in a circular motion, massage till the spirit is evaporated and the skin is dry,

Rationale
Spirit keeps the skin dry.
Spirit hardens the skin and lessens the chances of bed sore.

Scientific Principles

Chemistry

PROCEDURE

Steps VI

Rationale

Scientific Principles

Apply talcum powder on the back

Keeps the skin dry. It reduces the friction

Chemistry

Back Massage Techniques

Effleurage

Definition - smooth rhythmic stroking Warm the massage oil in your hands, and apply a modest amount with whole hand "effleurage" . Use the whole surface of both hands. Stroke reasonably firmly upwards from the lower back all the way up to the neck, then (gentler pressure), circle around and back to the lower back region (5 to 10 minutes).

Benefits

The receiver experiences an immediate sense of well-being and relaxation.

Effleurage, when performed slowly, has a sedative action and is particularly beneficial for soothing the nerves. Stress and strain may be relieved, tension headaches dispelled and patterns of insomnia broken.
The tissues will warm up as you stroke the body, improving the circulation. The flow of lymph is increased, helping to get rid of waste and poisonous substances. Effleurage improves the skin, encouraging a healthy and glowing complexion

Errors to avoid

Relax your hands and flow, avoiding any jerky or sudden movements (jerky movements cause jangled nerves). The movements must be rhythmic, smooth and even. Use your whole hand and not just the fingertips (you can cover a much wider area), except when working on small areas. No pressure whatsoever on the downward stroke (effleurage is always performed up the back). It can also be applied in a centripetal direction (in a circle travelling towards the centre) or in a centrifugal direction (in a circle travelling outwards away from the centre).

Petrissage

MEANING - This stroke referred to as petrissage derived from 'petrir' meaning 'to knead'. Petrissage can be subdivided into picking up, wringing, squeezing and rolling. If you are good at kneading dough then you will quickly become an expert!

Contd

In picking-up, place your hands flat on the part being treated and) grasp the muscle not the skin firmly with one or both hands, then pull it as far away as possible from the bone. Once you have picked up the muscle you may squeeze it gently. Squeezing is particularly effective in alleviating muscle spasm. You may now roll the muscle in both directions - your thumbs may roll the muscle towards your fingers or your fingers may roll the muscle towards your thumbs. Wringing is a variation on picking-up. It is picking-up with a twist! The muscle is picked up and then pulled towards you and 'wrung' out. Imagine that you are wringing out a towel.

Benefits

By alternately squeezing and relaxing, the veins and lymphatic vessels are emptied and filled, bringing fresh nutrients to the muscles. Any toxins that have accumulated are removed from the deeper tissues.

It also helps to prevent muscle stiffness after exercise and can relieve muscle spasm.

Errors to avoid

Make sure that you use the whole of your hand rather than just your fingers and your thumbs.

Pick up the muscle and not the skin otherwise there is the danger of pinching the flesh. Do not slide your fingers over the receiver's skin.

Friction

Friction movements normally make use of the balls of the thumbs (although the fingertips, knuckles or even the elbows may be used). The muscle is moved against the bone by small circular movements of the balls of the thumbs. This stroke is particularly effective when performed on either side of the spine. If your thumbs are not aching by the time you reach the neck area you are not performing the stroke correctly!

Benefits

This technique is particularly useful for breaking down the knots and nodules that build up in the body due to the stresses and strains of daily life.
Any accumulated waste products may be eliminated. Friction helps to break down the fatty deposits and is therefore of benefit in cases of obesity. It also increases the temperature by increasing cellular activity and bringing an increased flow of blood to an area providing temporary analgesia (pain relief).

Errors to avoid

Work deeper and deeper into the tissues gradually, as the pain tolerance levels vary greatly. Do not over treat an area as this can lead to pain and soreness.
Do not hunch your shoulders with the effort (otherwise you will need a massage yourself straight afterwards). Ensure that you are moving the tissues under the skin and not just the skin. Use the pads of the thumbs only, avoiding digging the nails in!

Tapotement

This consists of a series of briskly applied percussive movements, using the hands alternately to strike or tap the muscles for an invigorating effect. There are many variations on this stroke. It may be applied with the edge of the hand, with the tips of the fingers, or with sides of palms.

Tapotement attempts to release tension and cramping from muscles in spasm.

AFTER CARE OF THE ARTICLES

Remove the screen.

Take the articles to the utility room, wash and replace. Wash hands.

Record and report, if any observations are made.

POSITIONING

POSITIONING

Positioning interventions are designed to reduce pressure and shearing force to the skin. The immobilised patients position should be changed according to activity limit, perceptual ability and daily routines. Change positions frequently. When in bed, change the position of your entire body at least every one to two hours. If you are helping a person move in bed, do not slide him. Lift him to prevent putting stress on the skin

Contd

The head of the bed should be raised as little as possible, for as short a time as possible. This may help prevent damage to the skin from sliding down in bed.

THERAPEUTIC BEDS AND MATTRESSES

THERAPEUTIC BEDS AND MATTRESSES

A variety of special beds and mattresses have been designed to reduce the hazards of immobility to the skin and musculoskeletal system. While selecting the bed, the patient must be assesed for specific needs.

Contd
Types of beds / mattress

Alternating air mattresses made up of poly vinyl air cells are attached to a pump that inflates and deflates them every 3 7 seconds at alternating pressure points. Water mattress disperse and evenly distribute the clients body weight.

SOME OTHER TIPS

Check the skin of the patient several times a day. Keep the skin dry. Keep the skin clean. Using special equipment and pads. Keep the bottom sheet of the bed free of wrinkles. Make sure there are no hard items in the bed, such as crumbs or hairpins. Avoid clothing that has buttons, zippers, or thick seams that could put pressure on your skin. Promote exercises. Exercising helps the blood flow to the skin.

Contd

Eating the right amounts of protein and calories (energy) is very important to prevent or heal pressure sores. Eat regular meals and snacks each day. Drinking plenty of liquids may also help to prevent or heal pressure sores.