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Pressure Ulcer Prevention PowerPoint PPT Presentation

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Pressure Ulcer Prevention. Lessons Learned from Skin Fair Jeri Lundgren, RN, CWS, CWCN Pathway Healthcare Services Jody Rothe, RN, WCC MetaStar, Inc. December 2, 2009. Skin Care . Objectives for our learning session: The importance of hydrating skin How to handle fragile skin

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Pressure Ulcer Prevention

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Pressure Ulcer Prevention

Lessons Learned from Skin Fair

Jeri Lundgren, RN, CWS, CWCN

Pathway Healthcare Services

Jody Rothe, RN, WCC

MetaStar, Inc.

December 2, 2009

Skin Care

  • Objectives for our learning session:

    • The importance of hydrating skin

    • How to handle fragile skin

    • Moisture – friend or foe

    • How to turn the frail elderly patient

    • What causes pressure and the stage definitions

    • Importance of nutrition

    • Overall care of the skin

Causes of Pressure


The Daily Post – The Barren Dessert

  • Protect Dry Skin which can lead to friction injuries and skin tears

  • Use moisturizers frequently and as often as necessary

  • Always be on the look-out for skin changes

The Daily Post – Fragile Handle With Care

  • Be cautious when changing incontinent products, bandages, or even their clothes

  • Your elder’s skin is very fragile and can tear easily

The Daily Post – The Barrier Reef

  • Use a moisture barrier to help protect the skin from stool and urine

  • Barrier creams and ointments only work if they are applied, and applied correctly

  • These creams can be the first line of defense for your elder to stop a pressure ulcer before it develops

The Daily Post – You’re Tearing Me Apart

  • Simple movements, such as turning or lifting, can create friction and shearing, which can injure the skin

  • To move and reposition residents, use lifting devices and draw sheets

  • Avoid dragging.

The Daily Post – Under Pressure

  • Reposition bedbound residents every two (2) hours

  • Reposition chairbound residents every one (1) hour

  • Use devices, such as pillows and cushions, to keep bony prominences from direct contact

The Daily Post – Taster’s Choice and Treasure Hunt

  • Poor nutrition is a risk factor in developing a pressure ulcer

  • Assist residents to eat as necessary

  • Notify the nurse if there is a decline or change in a resident’s eating habits

  • Choose supplements that are tasty

  • Consider choice in dining as a strategy to increase weight

The Daily Post – The Princess and the Pea

  • Use support surfaces on beds and chairs to reduce pressure

  • Avoid donuts

  • Use pillows or devices to raise heels off the bed

The Daily Post – Dorothy’s Shoe

  • Always be on the lookout for anything that could create pressure on the skin, including the feet

The Daily Post – Squeezing Me Too Tight

  • Stage IV pressure sores can take the longest to heal

  • In some residents Stage IV ulcers can develop in a matter of hours (i.e., if left on the wrong surface too long)

Kick Up Your Heels

  • Heels are especially vulnerable to pressure even on a good support surface

  • Heel elevation will help prevent pressure ulcers to the heels

  • Tip: On daily rounds monitor to ensure heels are off on the beds and equipment is being used appropriately

Stages of Pressure Ulcers – Terrors of the Deep


    • Purple or maroon localized area of discolored intact skin or blood-filled blister

    • Due to damage of underlying soft tissue from pressure and/or shear

    • The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

Stage 1

  • Intact skin with non-blanchable redness of a localized area usually over a bony prominence

  • Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area

Stage 2

  • Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough

  • May also present as an intact or open/ruptured serum-filled blister

Stage 3

  • Full thickness tissue loss

  • Subcutaneous fat may be visible but bone, tendon or muscle are not exposed

  • Slough may be present but does not obscure the depth of tissue loss

  • May include undermining and tunneling

Stage 4

  • Full thickness tissue loss with exposed bone, tendon or muscle

  • Slough or eschar may be present on some parts of the wound bed

  • Often include undermining and tunneling


  • Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed

Braden Scale Puzzle – Sensory Perception

  • Sensory Perception:

    • The person’s ability to perceive and respond MEANINGFULLY to pressure related pain & discomfort

  • Interventions

    • Remember the shoe exercise? Check for anything that could be creating pressure on the skin

    • For the resident with limited ability to perceive pressure, put on a turning schedule to ensure pressure relieved at regular intervals

Braden Puzzle – Moisture

  • Moisture:

    • The amount of moisture the skin is exposed to

  • Interventions:

    • Use moisture barrier in particularly wet areas (peri-area, buttocks, etc.)

    • Change clothing, incontinence products, and linen as often as you need to

Braden Scale Puzzle – Activity

  • Activity:

    • Getting up and around

  • Interventions:

    • Change position at least every 2 hours

    • ROM

    • Ambulate

    • Teach resident to change his/her own position

Braden Scale Puzzle – Mobility

  • Mobility:

    • Changing position and controlling body position

  • Interventions:

    • Float the heels

    • Reposition at least every 2 hours for bed-bound residents; hourly for chair bound

    • Use pillows for support

Braden Scale Puzzle – Nutrition

  • Nutrition:

    • USUAL food intake

  • Interventions:

    • Help to eat

    • Get foods they like (within their diet)

    • Offer fluids frequently (as diet allows)

    • Provide supplements as ordered

Braden Scale Puzzle – Friction and Shear

  • Friction & Shear:

    • Ability to move without rubbing or dragging

  • Interventions:

    • Use lift sheet

    • Soft socks on feet

    • Long sleeves or elbow protectors

    • Keep the head of the bed at the lowest degree of elevation consistent with medical condition and other restrictions

    • Limit the amount of time the head of the bed is elevated

Pressure Ulcer Prevention

  • You can make a difference

  • Implement preventative interventions

  • Report changes in skin

  • Thank you

Contact Information:

Jody Rothe, RN, WCC

Quality Consultant

MetaStar, Inc.

2909 Landmark Place

Madison, WI 53713

(608) 274-1940 or (800) 362-2320, ext. 8271

[email protected]

This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  9SOW-WI-PS-09-223.

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