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

When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk. By: Elizabeth Ciyou-Allee BA, RN, CLNC, CHPN. ELNEC-PEDS, TNCC. When Pressure Persists: Learning Objectives. Direct Care Staff will be able to: Identify the risk factors for pressure ulcers

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

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  1. When Pressure Persists:Prevention of Pressure Ulcers for Those at Risk By: Elizabeth Ciyou-Allee BA, RN, CLNC, CHPN. ELNEC-PEDS, TNCC

  2. When Pressure Persists:Learning 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. Who’s 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 once 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 • 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.

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