Pressure Injuries and Nursing Skills Lecture

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Questions and Answers

What is the primary cause of pressure injuries?

Poor nutritional intake.

Exposure to excessive moisture.

Rapid changes in skin temperature.

Prolonged compression of soft tissue over a bony prominence. (correct)

Which of the following is NOT a risk factor for pressure injuries?

Good skin perfusion. (correct)

Elevated body temperature.

Poor mental status.

Reduced mobility.

According to the NPIAP, what is the hallmark of a Stage 1 pressure injury?

Partial-thickness skin loss with exposed dermis.

Intact skin with non-blanchable erythema. (correct)

Presence of granulation tissue and tunneling.

Full-thickness skin loss with visible adipose tissue.

What characteristic would indicate a pressure injury is Stage 2?

Partial-thickness skin loss with exposed dermis. (A) Signup and view all the answers

In a Stage 3 pressure injury, what tissue layer is visible within the ulcer?

Adipose (fat). (D) Signup and view all the answers

Which of the following characteristics is NOT typically associated with a Stage 2 pressure injury?

Presence of granulation tissue. (D) Signup and view all the answers

What is the term used to describe rolled wound edges that can be present in deeper pressure injuries?

Epibole. (B) Signup and view all the answers

Which of these tissue damage is a result of prolonged pressure and shear forces combined?

Localized damage to the skin and underlying soft tissue (D) Signup and view all the answers

What is the primary focus of the lecture on promoting hygiene?

To discuss and demonstrate nursing skills in promoting personal hygiene, and relevant infections. (A) Signup and view all the answers

Which of the following best describes the scope of nursing skills discussed regarding hygiene?

Practical methods of assisting patients with personal hygiene. (B) Signup and view all the answers

What specific parasitic infestations are explicitly mentioned in the lecture?

Scabies and Pediculosis capitis. (C) Signup and view all the answers

What aspect of pressure injuries will be covered in the lecture?

Contributing factors, characteristics, prevention, and management. (A) Signup and view all the answers

Beyond practical skills, what else is a focus of the lecture?

The signs, symptoms, treatment and related care of parasitic infestations and pressure injuries. (C) Signup and view all the answers

What is a common feature used in the diagnosis of scabies?

Microscopic examination of skin scraping (D) Signup and view all the answers

Which treatment is specifically approved for individuals at least 2 months of age?

Permethrin 5% cream (D) Signup and view all the answers

How should scabicide be applied for effective treatment?

From neck to toes, avoiding lips and eyelids (C) Signup and view all the answers

What is the recommended procedure for treating close contacts of an infested person?

Treat all individuals with topical scabicide simultaneously (D) Signup and view all the answers

What precaution should be taken regarding visitors of an infested patient?

Limit number of visitors and require personal protective equipment (A) Signup and view all the answers

What is a condition that can arise due to pressure or shear over bony prominences?

Pressure injury (B) Signup and view all the answers

How should non-washable items of infested persons be treated?

Place in plastic bags and seal for more than 14 days (B) Signup and view all the answers

Which of the following statements about burrows in scabies is true?

Dark lines will show after an ink test on burrows (C) Signup and view all the answers

What is the primary cause of Pediculosis Capitis?

Pediculus humanus capitis (A) Signup and view all the answers

Which life stage of lice takes the shortest time to mature from egg to adult?

Nymphs (B) Signup and view all the answers

What is a common sign of head lice infestation on the scalp?

Fine black powders (C) Signup and view all the answers

How long do lice typically live once they fall off a host?

2 days (C) Signup and view all the answers

What is the recommended method for decontaminating combs used by a person with head lice?

Disinfect in a mixture of bleach and water (1:1) for 30 minutes (B) Signup and view all the answers

What is a common route of transmission for scabies?

Skin-to-skin contact (C) Signup and view all the answers

Which of the following is NOT a characteristic of Norwegian Scabies?

Localized infection with few mites present (C) Signup and view all the answers

What is the incubation period for scabies?

2-6 weeks (D) Signup and view all the answers

What color are lice eggs typically?

Yellow to white (A) Signup and view all the answers

What is one method used for diagnosing head lice?

Dry-combing with a closed-set tooth comb (C) Signup and view all the answers

What is the purpose of a therapeutic bath?

To treat skin conditions or promote healing (C) Signup and view all the answers

What is a typical location for burrows caused by scabies mites?

Webs between fingers (A) Signup and view all the answers

When using malathion 5% solution for lice treatment, what should be done after the hair has dried?

Wash hair with shampoo with conditioner 12 hours after (D) Signup and view all the answers

Study Notes

Promoting Hygiene Lecture Notes

Learning Objectives: Students will be able to discuss the importance of personal hygiene, demonstrate nursing skills in promoting hygiene, describe signs and symptoms and related care for parasitic infestations (scabies, pediculosis capitis), describe contributing factors and characteristics of pressure injuries, and discuss prevention and management of pressure injuries.

Hair Care

Pediculosis Capitis (Head Lice): Infestation caused by Pediculus humanus capitis. Found on the scalp and in hairs.
Lifecycle stages: eggs → nymphs → adults. Nymphs and adults suck blood. Adult louse is greyish white, size of a sesame seed, and moves quickly among hair. Lice eggs (nits) are oval, yellow to white, and easily found. Common sites of infestation include the occiput, ears, and neck.
Eggs hatch in 7-10 days. Nymphs take 7-13 days to mature into adults.
Lifespan: ~28-30 days, but they usually die 2 days after falling off the host.

Route of Transmission

Direct head-to-head contact.
Sharing articles (e.g., combs) that harbor lice.
Infested upholstered furniture.

Signs & Symptoms

Oval particles clinging to the hair.
Frequent scratching/itching due to allergic reaction to bites (of the lice).
Haemorrhagic spots on skin where lice have sucked blood.
Itching skin excoriation in the affected area.
Fine black powders (louse feces) on the pillow.
Pale colored materials (cast lice skin) on the pillow.
Tiny oval shaped white or clear dots (lice eggs) on the scalp.
Tickling sensation of "something moving in the hair".

Diagnosis

Dry-combing with a closed-set tooth comb.
Wet-combing after applying conditioner.
Direct scalp inspection, parting the hair.
Magnifying glass inspection of the scalp.
Small hemorrhagic areas.
Insect-type bites behind ears or hairline.
Small dandruff-like particles.

Treatments

Topical pediculicides: (e.g., malathion 5% solution).
Decontamination is necessary.

Decontamination

Wash all clothes and beddings used by the infested client separately in hot water (60°C or above) for at least 20 minutes.
Disinfect combs in a mixture of bleach and water (1:1 ratio) for 30 minutes
Seal stuffed toys and other non-washable items in plastic bags for 2 weeks.
Thoroughly vacuum rugs, mattresses, pillows, and furniture

Skin Care

Bathing: Removes accumulated oil, perspiration, some bacteria, and odor, while restoring cleanliness and promoting comfort. It also stimulates circulation, increases a sense of well-being, and reduces infection risk.
Types of Baths:
- Cleansing bath (43°C-46°C)
- Complete/self-help bed bath
- Tub bath/shower
- Bag bath
- Towel bath
- Therapeutic bath
- Medicated bath

Assessment

Physical and emotional factors.
Condition of skin: texture, turgor, temperature, lesions, bruises.
Presence of pain.
Range of motion.
Level of cooperation.
Other aspects of health: mobility, strength, cognition, vital signs.

Planning

General considerations: Location, timing, assistance needed, toileting before bathing, protection of casts/IV sites, environment, temperature, and privacy.
Equipment: Basin with warm water, bath mitt and towels, soap, gloves, apron, bed linen, personal care items (lotion, medication), laundry bag, shaving equipment.

Implementation

Prepare the bed, position the client, lower bed side rail, assist client to move near you, cover client with bath blanket, and remove client's clothes.
Make a bath mitt with a washcloth.

Body Areas for Hygiene

Face, ears and neck, arms and hands, chest and abdomen, Perineal & genitalia area, Back, buttock & anal area, Legs and feet

Precautions

Inspect for abnormalities.
Provide relevant health education.
Perform assisted ROM during bed bath, Clean and dry skin-fold areas carefully (groin, skin under breasts, skin between fingers and toes).
Dress the injured or immobilized side first.
Wash clients with deep vein thrombosis or blood clotting disorder without long, firm strokes on lower extremities.

Scabies

Infestation: by the itch mite Sarcoptes scabiei.
Burrowing: mites burrow just below the skin's surface.
Egg Laying: Adult female mites lay 2-3 eggs a day at tunnel's end.
Egg Development: Eggs take 10-17 days to develop into adult mites.
Mite lifespan: Mites die within 48-72 hours once away from the body.

Scabies: Route of Transmission

Skin-to-skin contact in crowded conditions (hospitals, old-age homes, child care centers).
Sharing clothes, towels, and beddings.
Easily infected sex partners or household members.
Incubation period: 2-6 weeks

Scabies: Signs & Symptoms

Burrows: Greyish-white/pink threadlike lines (0.5-1 cm long), found between fingers/on palm/sides of wrist.
Intense itching: Worsens at night.
Papules: Small elevated reddish papules, sometimes with tiny vesicles on top, seen on skin surface.
Common sites: Webs between fingers, nipples, backs of elbows, wrists, sides and backs of feet, knees, around waist, umbilicus, genital area, axillary folds, buttocks.

Scabies: Diagnosis

Examine burrows/rash.
Ink test: Apply ink on an itchy spot; wiped with alcohol pad. Ink remaining in burrows is shown as dark lines.
Microscopic examination of skin scraping: Identify mites, eggs, or fecal pallets.

Scabies: Treatments

Classic scabies: Permethrin 5% cream, Crotamiton 10% lotion/cream, sulfur ointment, Lindane 1% lotion, ivermectin (oral drug).
Norwegian scabies: Ivermectin (oral drug), Permethrin 5% cream, Benzyl benzoate 25% ointment, Keratolytic cream.

Topical Scabicides: Precautions

Implement contact precautions.
Apply medication from neck to toes (exclude lips and eyelids).
Pay attention to skin folds, webs between fingers and toes, and nails.
Reapply if washed off (during treatment).
Leave on for the recommended period, then take a bath to rinse off the medication.

Permethrin 5% Cream

Approved for scabies treatment in those at least 2 months old.
Kills both mites and eggs.
Two (or more) applications—one week apart—may be necessary to eliminate all mites.

Prevention Measures (infection control)

Isolate infested patients before treatment.
Limit the number of visitors.
Visitors must wear personal protective equipment (PPE).
Avoid close body contact until treatment completes.

Infection Control (Simultaneous treatment):

Simultaneously treat all household members (within 24 hours).
Close contacts, and sexual partners should also be treated, even without symptoms.
Separate belongings for decontamination.
Decontaminate clothes, towels, and beddings used during a three-day period before treatment: Machine wash with hot water (60°C+) for more than 10 minutes and dry items for 20 minutes in dryer.
Place non-washable items in plastic bags sealed for more than 14 days before use.

Infection Control (continued)

For any infested patients, a single room or isolated area is recommended.

Pressure Injury

Definition: Localized injury to skin and/or underlying tissue usually over a bony prominence resulting from pressure, or pressure in combination with shear.

Etiology

Compression of soft tissue over bony prominence for prolonged period of time.
Prolonged compression: occluding blood flow.
Tissue ischaemia (lack of blood flow).
Skin discoloration.
Continued tissue breakdown: resulting in pressure injuries

Pressure Injury Risk Factors

Mobility
Skin status
Tissue perfusion
Blood results
Moisture
Temperature
Nutrition
Age
Mental status
General health status
Quality of care

Pressure Injury Staging

Stage 1: localized non-blanchable erythema (in darkly pigmented skin, may appear different). Sensation, temperature or firmness changes may precede visual changes.
Stage 2: partial-thickness loss of skin with exposed dermis. Wound bed is viable (pink or red, moist), potentially present as an intact or ruptured serum-filled blister; underlying adipose tissue NOT visible. Granulation tissue, slough, and eschar are absent.
Stage 3: full-thickness loss of skin; adipose tissue visible in ulcer. Granulation tissue is present and epibole (rolled wound edges) are visible. Slough and/or eschar are present.
Stage 4: full-thickness skin and tissue loss; exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone are present. Slough and/or eschar may be visible; epibole (rolled wound edges), undermining and/or tunneling may occu.
Unstageable: full-thickness loss; extent of damage obscured by slough or eschar.
Deep Tissue Injury: intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal separation. Dark wound bed/blood-filled blister; pain/temperature changes may precede skin color changes in darkly pigmented skin.

Risk Assessment

Norton Scale
Braden Scale (used to predict pressure sore risk)

Preventive Measures

Relieve pressure.
Minimize friction and shearing force.
Improve mobility; improve nutritional status.
Minimize moisture.
Improve sensory perception.
Improve tissue perfusion.

Relieving Pressure

Protective and pressure relieving devices (alternating pressure mattress, ripple bed, pillows, protectors, foam or gel positioners).
Frequent change of position.
Turning schedule and assessing skin condition during repositioning.
Identifying and addressing external pressure sources (wrinkled linen/clothes, tubing, small parts). Record position changes.

Improving Mobility

Encourage patient to remain active and ambulate.
Remind patients to change position.
Set up turning/exercise schedules.
Encourage self-care activities.
Passive ROM exercise if unable to move independently.
Refer to physiotherapists and occupational therapists.

Improving Nutritional Status

Adequate nutritional and fluid intake.
High-protein diet with vitamin supplements.
Encourage relatives to bring personal food preferences.
Assist with feeding if needed.
Refer to a dietitian for additional supplements.

Minimizing Moisture

Change linen/clothes when soiled/wet.
Maintain skin free from urine, stool, sweat and drainage.
Dry skin thoroughly after cleansing.
Lubricate with creams/lotions (e.g., zinc oxide).
Topical barrier ointments.

Improving Sensory Perception

Help patient recognize and compensate for decreased sensation.
Educate patient and caregivers about potential pressure areas/risk for pressure ulcers.
Encourage self-care

Improving Tissue Perfusion

Encourage exercise, massage and maintain physically.
Do NOT do massage of reddened areas.
Elevate edematous body areas, protecting them from injury. (e.g., use heel protectors).

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Description

Test your knowledge on pressure injuries and related nursing skills with this quiz. It covers causes, stages, risks, and care associated with pressure injuries as discussed in the lecture. Assess your understanding of hygiene promotion and nursing practices for patient care.