When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk

1
When Pressure PersistsPrevention of Pressure
Ulcers for Those at Risk

• written byBarbara Levine, PhD,
  CRNPGerontological Nursing Consultant
• revised by
• Ingrid Sidorov, MSN, RN
• Gerontological Nursing Consultant

2
When Pressure PersistsLearning Objectives

• Direct Care Staff will be able to
• Identify the risk factors for pressure ulcers
• Discuss common reasons for pressure ulcers
• Discuss strategies to prevent these wounds
• Describe a team approach to pressure ulcer
  prevention and care
• Describe a pressure ulcer prevention program in
  long term care settings

3
Pressure Ulcer Definition

• A pressure ulcer is localized injury to the skin
  and or underlying tissue, usually over a boney
  prominence, that happens as a result of pressure
  and/or friction/shear issues.
• (NPAUP, 2007)

4
Pressure Ulcers

• Occur more commonly in older people
• Can be prevented in many residents
• Can be painful, lead to infection, and are a
  marker for increased risk of death
• Cost an enormous amount of money

5
What Causes Pressure Ulcers?

• Pressure reduces blood flow to skin
• Friction repeated rubbing causes a break in the
  skin
• Shear sideways pulling on the skin layers until
  it breaks
• Moisture, especially from urine or stool
  increases the risk of wounds multifold

6
Whos at Risk?

• Individuals who
• Are bed or chair-bound
• Have contractures
• Are unable to sense discomfort
• Are incontinent
• Are poorly nourished
• Are dehydrated
• Suffer from an altered LOC or CI
• Are febrile or hypotensive
• Are chronically ill

7
Pressure Points

• Back of the head
• Back of shoulders
• Elbows
• Hip
• Buttocks
• Heels

8
A Team Approach toPrevention

• Identify at-risk individuals
• Maintain and improve skin condition
• Protect against pressure and injury
• Assure adequate nutrition and hydration
• Encourage activity and mobility
• Educate older adults, families, and care
  providers
• Early identification of skin injury

9
Clean and Dry

• Clean gently with warm water
• Prevent incontinence by maintaining toileting
  schedule
• Help person off the bed pan or toilet promptly
• Clean skin at time of soiling
• Absorbent underpads or briefs only as needed
  try to keep off to promote healing
• Use of moisture barriers

10
Beyond Clean and Dry

• Look for and report any changes
• Clean skin and keep it well lubricated
• Minimize dryness and avoid excessive moisture
• Do not rub over reddened areas this only
  increases damage to tissues.

11
Skin Checks

• Check all surfaces at least twice a day
• Remove clothing and position forvisibility
• Check pressure points with everyposition change
• If you note a reddened area, reassess in 15
  minutes

12
Abnormal Skin Changes

• Note location, size and degree of
• Areas of redness or warmth in fair skin
• Areas of duskiness, discoloration and warmth in
  dark skin
• Areas of pain or discomfort
• Blisters fluid-filled or broken
• Weeping or drainage

13
Reducing Pressure in Bed

• Turn at least every two hours
• Prevent skin- to- skin contact
• Complete pressure relief for heels
• Elevate head of bed as little as possible
• Use lift sheets or trapeze
• Do not position directly on hip bone
• Do not rub or massage reddened areas

14
30o Laterally Inclined Position

• Weight not on sacrum or trochanter
• Support with pillows or foam wedge
• Use pillows to protect vulnerable areas
• Head of bed as low as possible

15
Reducing Pressure in Chairs

• Reposition at least every hour
• Instruct to shift weight every 15 minutes
• May need cushion
• Do not use doughnuts or rings

16
Nutrition

• Encourage residents to drink enough fluids
• Assist to eat enough protein and calories

17
You can make adifference!

• Keep your older adults moving
• Position immobile or dependent individuals
  frequently and carefully
• Assist residents with meals and snacks
• Provide plenty of fluids
• Keep those with incontinence clean and dry
• Be alert to changes and report them

18
Objectives Review

• Can you now
• Identify the risk factors for pressure ulcers?
• Discuss common reasons for pressure ulcers?
• Discuss strategies to prevent these wounds?
• Describe a team approach to pressure ulcer
  prevention and care?
• Describe a pressure ulcer prevention program for
  long term care?

19

• Thank you for your attention!
• The End