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

1
When Pressure PersistsPrevention of Pressure
Ulcers for Those at Risk

• byBarbara Levine, PhD, CRNPGerontological
  Nursing Consultant
• Reviewed and updated, Fall 2006 Reviewers
  Catherine R. Curley RN, MSN, Penn Nursing
  Consultation Service and GEC Series Editors

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

3
Pressure Ulcer Definition

• A pressure ulcer is any change in color or break
  in the skin caused by too much pressure on the
  skin for too long a period of time.

4
Pressure Ulcers

• Occur 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 more than 6,000 each to treat

5
What Causes Skin Injury?

• 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

6
Whos at Risk?

• Individuals who are
• bed or chair-bound
• unable to sense discomfort
• incontinent
• poorly nourished or dehydrated
• feverish, have diabetes, or low
• blood pressure

7
Pressure Points

• Back of the head
• Back of shoulders
• Elbows
• Hip
• Buttocks
• Contractures
• 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 resident off the bed pan or toilet promptly
• Clean skin at time of soiling
• Absorbent underpads or briefs
• 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

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 or darkness 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
30 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
Specialty Mattresses

• Help decrease pressure ulcer formation
• Patients still need frequent skin checks
• These mattresses do not replace the need to turn
  the person
• Turn and check the person at least every two to
  three hours
• Sheets and incontinence pads should be crease
  free
• Sheets should be placed loosely on these
  mattresses and never tucked

16
Reducing Pressure in Chairs

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

17
Nutrition

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

18
You can make a make adifference!

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

19
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
  ulcerprevention and care?
• Describe a pressure ulcer prevention program?

20
References

• Bergstrom, N., et al. (2005). The National
  Pressure Ulcer Long-Term Care Study outcomes of
  pressure ulcer treatments in long-term care.
  Journal of the American Geriatrics society, 53
  1721-9.
•  
• Benbow, M (2006) Guidelines for the prevention
  and treatment of pressure ulcers. Nursing
  Standard. 20 (52), 42-44.
• Garcia, AD and Thomas, DR. (2006). Assessment and
  management of chronic pressure ulcers in the
  elderly. Medical Clinics of North America, 90
  (5) 925-44.
•  
•  Thomas, DR. Prevention and treatment of pressure
  ulcers. Journal of the American Medical Directors
  Association, 7 (1), 46-59.  

21
Leadership and Staff

• Lois K. Evans, DNSc, RN, FAAN
• Series Associate Editor
• Viola MacInnes Independence
• Professor
• School of Nursing
• University of Pennsylvania
• Sangeeta Bhojwani
• Associate Director,
• Series Assistant Editor
• DVGEC
• University of Pennsylvania

• Kathleen Egan, PhD
• Series Editor
• DVGEC Program Administrator
• Director, DVGEC University of Pennsylvania
• Mary Ann Forciea, MD
• Series Associate Editor
• Clinical Associate Professor of Medicine
• Division of Geriatric Medicine, University of
  Pennsylvania

22

• Thank you for your attention!
• The End