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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. written by Barbara Levine, PhD, CRNP Gerontological Nursing Consultant revised by Ingrid Sidorov, MSN, RN Gerontological Nursing Consultant. When Pressure Persists: Learning Objectives.

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

  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 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. Who’s 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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