Answers in support of
EB competency
Patients name………Fred……............…..
Carers name…………………………………. date / /
Carer to demonstrate knowledge of anatomy of skin
Epidermis
Skin pore
Dermis
Base layer
Label areas marked and list function
a) Epidermis – is the thin top layer of skin. It has no blood supply
and is supported by the dermis
b) Skin pore – helps fluid balance and temperature control in the
body
c) Dermis – is the thicker vascular layer of skin provides
elasticity and strength
d) Base layer – protects organs, bones and muscles
List 3 main functions of the skin
a) To keep the body together …
b) Temperature regulation ….…
c) Barrier to infection……..….…
Section 2
Carer to understand psychological implications of having EB
What is EB?
EB is a genetic condition where the lubricant between skin layers
is missing causing blistering with the least bit of friction.................
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There are 3 types of EB, underline the type........Fred.... has
Dystrophic EB
Junctional EB
Simplex EB
In a short paragraph explain what happens to....Fred’s....... skin
As the skin moves it rubs together and a blister rises. The blisters
just get bigger unless the blister is popped to allow the skin to heal.
How does this affect.....Fred.....in the following areas?
a) Eating / drinking
EB affects the gastro-intestinal tract so his mouth can be very sore
and his oesophagus will contract with scaring
b) Mobility
His feet are permanently blistered and painful so his mobility is
poor
c) Eye site
EB also affects eye site so Fred’s eye site is poor and he needs
glasses
d) Healing
Fred heals well if he has good nutrition but as he blisters all the
time and gets infected it is a continuing process
e) Pain
Fred feels pain the same as anyone else at the same level
f) Continence
It is difficult to sit on a toilet and not worth the extra handling at
night, so he wears a nappy at night
How does this affect...........Fred’s..... body image?
He has said he wishes he didn’t have EB but he has a big
personality and the pain and practical problems worry him more
than body image
How does......Fred...talk about his/her condition?
He is very knowledgeable about his condition and will tell you
about it. Parents and child are also involved In Debra so he tells
you about others with the same problem
What could happen if.....Fred.....decides to move himself?
He could rub the skin from his bottom/ or damage his feet
Does...Fred...... experience pain at more the same level as
unaffected people? Yes No
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If yes can you describe how you feel when
doing...Fred’s...dressings?
It can be very distressing if Fred is in pain. The smell from the
wound is occasionally very strong and upsetting
How does this affect......Fred......?
Fred has analgesia and midazolam to help with the dressings but
he hates his bath
How do the other people in...Fred’s...life cope with....Fred’s ...pain?
Mum
Mum accepts it as part of Fred but she is very involved in Fred’s
care and can get very upset if he has a bad bath and dressing
session
Dad
Does care for Fred but it tends to be mum who takes the lead role.
Dad is occasionally reluctant to give pain relief in case he gets to
used to it
Siblings
Fred has no siblings as parents are concerned the same condition
could occur
School staff
Fred has a 1-2-1 carer who can give pain relief when appropriate
Health care professionals
Most HCP’s have not seen EB prior to meeting Fred so it can be a
big shock. Most are willing to follow advice from specialist unit
Describe how.........Fred.....looks (including dressing)
Fred has a big wide smile! His mum buys larger sizes of trendy
clothes to cover his dressings. He now doesn’t wear shoes as
they caused friction
How does this affect...Fred.....?
Fred is quite secure as a person but obviously likes it better when
he needs fewer dressings
Children with EB have a lot of agencies supporting them. How
does the intrusion affect the family home?
It is difficult to fit in extra appointments on top of dressings and
medicines. Most EB children have to go to GOS which involves
travelling and overnight stays. Parents have to accept strangers in
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their homes and are dependant on others which if they have
problems in their own lives may mean family care can fall down.
Underline any of the following words you recognise in relation
to........Fred........ and family situation
Dependant on others Lack of control of others
Coping Caring
Stressful Busy
Angry Tired
Mutually dependant Loving
Private Independent
Painful Sad
Happy Fun
Section 3
Carer to demonstrate awareness of Health and Safety in EB
Do you have a current moving and handling certificate?
Yes No
List 3 risks to you moving and handling
a) Trying to protect Fred I might over stretch
b) It is not safe to sling/hoist Fred
c) Difficult angles to life Fred from bed/floor
List 4 principles of good moving and handling with a child/young
person with EB
a) Use flat hands
b) Ask child for co-operation and tell them what you’re going to do
in advance
c) Use silks in bed
d) Use cushion/pillow to sit up from lying down
What are the risks of poor moving and handling technique for a
child with EB?
More skin damage and pain leading to friction and infection
Why may......Fred....choke?
Because his oesophagus is now so narrow that he has trouble with
his own secretions
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List 3 things that may trigger a choking attack?
a) Lying down – secretions pooling in throat
b) Chest infection
c) Eating and drinking
Describe how to support.........Fred....when choking?
Follow protocol, keep calm. Sit Fred up and dispose of secretions
Who is you first line of support during a choking attack?
CCN Parent Key worker
(please underline)
What must you do to help keep ...Fred.. calm during an attack?
Phone 999 Keep calm Shout for help
(please underline)
Is it safe for.......Fred...to eat and drink? Yes No
Can....Fred....have anything by mouth? Yes No
List 3 potential hazards when lancing a blister
a) Needlestick injury to child
b) Needlestick injury to self
c) Contact with bodily fluids
d) Introduction of infection
List 3 people who may be put at risk when lancing a blister
a) Child/ young person
b) Parent
c) Self
What is clinical waste?
Waste that has bodily fluid on it
Describe in a short paragraph safe disposal of clinical waste
Clinical waste must be disposed of safely for incineration. It should
go in a yellow bag – the council will collect these separately
Who does safe disposal of clinical waste protect?
Everyone – self, child/young person, family and refuse collector
What risks are associated with use of needles?
Needle stick injury
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List 3 ways of preventing those risks
a) Not re-sheathing needles
b) Lancing blisters at the correct angle
c) Closing sharps box when it is three quarters full
Should you re-sheath needles? Yes No
What must you do if you get or cause a needle stick injury?
a) Squeeze site to make blood flow freely
b) Put under fast flowing water
c) Contact on call and fill in incident form
Where do you record it?
In care plan
Who do you report it to?
On call - CCN
Where is the needle stick injury guidelines in......Fred’s...house?
In his care plan
Section 4
Carer to be aware of strategies to prevent damage to skin/
organs of child/young person with EB
How does blistering occur in a child with EB?
There is no collaboration between layers of skin, so any movement
can cause friction
List 3 organs that may be affected in a child with EB
a) Skin
b) Oesophagus/ bowel
c) Mouth
List 3 ways of preventing damage
a) Use of correct moving and handling
b) Taking care with soft foods
c) Ensure dressings are always well applied
What does friction mean?
Friction means rubbing where there is no lubrication so there is
force surface against surface
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If.......Fred....slides himself what might occur?
Blistering of back of legs or buttocks
How would you ask him to move himself safely?
Support him to lift himself up and down, and not slide.
Is it possible to move himself safely? Yes No
As.....Fred’s....skin heals under its dressing does it get itchy?
Yes No
If yes how can we help to manage this?
Pat the skin with flat hands
Can he scratch? Yes No
When......Fred......is in bed are there any ways we can help move
in bed? Yes No
If yes, what?
Use of silks. Use the pillow to lift him holding the pillow
If.....Fred....was choking in bed and you wanted to sit him/her up
quickly, what might you use?
Use the pillow to hold
What problems could wrinkled dressings cause?
More friction and blisters
Is it safe to straighten them? Yes No
How must the dressing be fixed?
Undone and re-applied
What damage could you cause if you pulled then straight?
More blistering
What does the term ‘flat hands’ mean?
That I don’t grip the child/ young person but hold him with straight
hands
How does ‘flat hands’ make it safer to move......Fred...?
It makes it safer because I place the hands were they will cause
least friction
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EB affects the gastro-intestinal tract . So if.....Fred......has anything
by mouth please describe the texture and consistency?
Sips water only
Why is this important?
It can affect his nutrition which he needs to help support his
healing and growth
When should blisters be lanced?
a) At next bath
b) When gets home from school
c) As soon as they are noticed
Please give reasons for answers
The blisters will just get bigger and bigger if not burst
Section 5
Carer to demonstrate safe lancing of blisters
Hand washing is an important part of any care you give.
How many steps are in the Trust hand washing policy?
2 5 7 8 9
How often do you need to repeat each step?
2 4 5 7 times
How often do you need to wash your hands when caring
for……Fred…?
a) At beginning and end of shift
b) As required throughout the shift
c) Before and after any care you give
(please underline)
List what equipment you require prior to child/young person’s
bath/dressings
.....Towels.................... .....Silks.......................
.....Pre-cut dressing...... .....Green towels.........
.....Cream..................... .....Sharps...................
.....Pyjamas ................. .....Sharps boxes.........
.....Gloves..................... .....Gauze.................
.....Disposal Bag.........
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Describe a suitable environment for....Fred..... bath and dressings
Warm bathroom with room to move
List 3 essential things for this environment?
a) Privacy
b) Warmth
c) Ways of supporting child length of procedure – distraction
Are.........Fred’s...... dressings a sterile technique?
Yes No
How would you describe the dressing technique?
It is a clean technique, it is as clean as possible
What are the universal procedures?
Using gloves and apron and hand washing technique as form of
protection for child/ young person and myself
Who do they protect?
Child/Young person Staff Both
(please underline)
At what angle do we lance the blisters?
Approx 180 degrees
How do we ensure blister is completely drained?
a) Make as many puncture holes as it requires to ensure all fluid
drained
b) Put needle in and tear blister
c) One puncture hole is always sufficient
(please underline)
List 3 things we need to ensure when lancing a blister?
a) Child knows what we are doing and has consented
b) Sharps box is available
c) Swab is ready to collect fluid
How do we collect the fluid from the blister?
Use a gauze swab to collect fluids
How do we dispose of this fluid?
Put swab in disposal bag
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How do we dispose of sharps?
In sharps box
How full should a sharps box be when it is sealed?
Three quarters
Why is the box sealed at that level?
In case anyone is damaged by sharps in box when placing a sharp
in the box
Describe what to do if a needle stick injury occurs to
a).....Fred......
Tell Fred and parents – follow injury client document – accident
form
b) Others, i.e. Parents
Follow client – report – contact GP for instructions – accident form
c) Self
Follow client – contact on call
What form must you fill in?
Incident form
Section 6
Carer to demonstrate how to support child if choking
Why is the incident of choking more likely in......Fred.....?
Because his oesophagus is narrow
Describe in a short paragraph.....Fred’s....care plan for managing
these episodes.
These episodes happen mostly at night so Fred must be sat up
using pillows and not be left throughout the episode
Where is the protocol kept?
In care plan
Is it accessible at all times? Yes No
Is there anything specific that....Fred.....likes you to do during
choking episodes? Yes No
If yes, please explain
Hold bowl and towel and take them away a.s.a.p
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Section 7
Carer to be aware of the importance of good nutrition in EB
How does a ‘normal’ child obtain good nutrition?
Through a healthy diet
List 3 reasons why.....Fred... may not have good nutrition?
a) His problems with narrow oesophagus
b) Sore blisters in his mouth– may make it painful for him to eat
c) Not able to take enough calories in
Why may......Fred.....require better nutrition than other children of
this age?
He needs a lot of calories for the extra healing he requires
How is this managed for.......Fred..... to support his nutrition?
Fred has as gastrostomy for all his nutritional needs – he also has
small feeds overnight. Fred only has sips of water so he also has
extra water especially in summer
Section 8
Carer to recognise importance of record keeping
Why is it important to speak to ……Fred….. in a manor that is age
appropriate?
So he understand what is said as well as not feeling patronised
List 3 words that will reflect how you speak to parents/carers
a) Politely
b) Pleasantly
c) Reflecting their expertise
What do you understand by accurate, appropriate documentation?
Record keeping that reflects exactly what happened in an ordered
manner. It is about Fred and the instructions he required and only
involves others where they are required to Fred’s care……………
Who do you need to write about?
Child-1 family-3 interventions-2
Does it matter when you write the document? Yes No
If so when should it be written?(please list in order)
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As soon as possible …1...
Within shift …2...
Within 24 hours …3...
Who should read this document?
Only people who have permission and need to know....................
What colour should you write this in?
Red blue black purple
List three things you must do to identify the child
a) Name...................
b) Address................
c) Date of birth - community number..........
Can you leave spaces for others to fill in later? Yes No
Who can you share information with about this child?
Only those you have permission to do so with….....…
Do you always need parent’s permission to share information?
Except in cases of patient safety and child protection..................
Underline the words, which apply to good recordkeeping
Factual patient condition
Consistent legible
Accurate understandable
Fiction fit for purpose
Consecutive current
Abbreviations concise
Jargon subjective comments
Contemporaneous
List 3 things you must do to identify who wrote the record and
when the record was written
a) Name print and sign.......
b) Date and time…….........
c) Job title…………..…..…
List who you would report record keeping problems to?
CCN Team…………..............................……………………
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What information would it be suitable to discuss with…Fred’s
teacher in school?
Only information I’d been asked to discuss by parent or Fred…
Section 9
Carer to demonstrate awareness of issues of privacy and
dignity
In a short sentence, explain what privacy means to you.
Privacy means own space, own secrecy, solace…...…………
In a short sentence, explain what dignity means to you.
Dignity means being treated with respect, opinion and beliefs
being respected and feeling valued
List how you would know if …Fred……was
Happy He smiles but does not laugh a lot........
Sad He’ll tell you...............................................
In pain See below.............................................
If possible, give examples
If Fred is in pain he will complain of a poorly tummy even if the
pain is not in his tummy. We then play a game pointing at bits of
the body till he says ‘yes’
How can we preserve ……Fred’s…dignity especially during bating
and changing dressings?
Ensure Fred’s consent is gained prior to bath. Ensure he has
adequate pain relief. Ensure he is listened to throughout the
procedure and his wishes are taken into account where ever
possible
What does child specific mean to you?
This only allows me to look after Fred – no one else
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Questionnaire assessed by
_________________________________print
I certify I am currently registered with the
NMC_____________________sign Assessor
NB. Your responses to the questions in this document are
used to assist in the assessment of your competency to
undertake the particular procedures detailed in the
accompanying competency document and satisfactory
completion of this document is only part of the overall
competency assessment. You may NOT carry out child or
young persons care independently until the competency
document has been signed by your assessor evidencing your
competence, yourself, and your employer if you are a non
NHS Trainee.
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