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Skin Care Fair Instruction Guide

Part II. Group Discussion Section

Topic: Terrors of the Deep: What It Looks Like When Pressure Sores Develop

We will now replicate the stages of pressure ulcers. Remember that pressure is the root of all the following evil:

1. Deep Tissue Injury: Apple

Description: The blackened/bruised areas of an apple replicate Deep Tissue Injury ulcers. Have the participants close their eyes and then see if they can locate the bruise by feeling the apple. This will simulate how a “mushy” area feels and promote the need to feel over the bony prominence, especially in dark skin tones. It also shows how the bruise is indicating there is damage underneath and that it is not just superficial to the skin of the apple.

DEEP TISSUE INJURY:

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Further Description: Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

STAGE I:

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Further Description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk).

2. Stage II: Orange

Description: To simulate a Stage II ulcer, use a potato peeler to slightly shave rind but not break through to the actual fruit of the orange.

STAGE II:

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

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