When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk - PowerPoint PPT Presentation

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

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When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk written by Barbara Levine, PhD, CRNP Gerontological Nursing Consultant revised by – PowerPoint PPT presentation

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Title: 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
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