Care and Prevention of Pressure Ulcers

Care and Prevention of Pressure Ulcers

Objective:

To show the importance of individualizing turning and repositioning intervals for both comfort and prevention of pressure ulcers.

Lesson:

Pressure is the primary cause of pressure ulcers and an effective turning and repositioning program is an effective way to prevent pressure ulcers. Implementation of a turning and repositioning program is the key and effective monitoring of this by ALL staff can ensure its success.

Consider all bed- or chair bound, or those whose ability to reposition is impaired, to be at risk for pressure ulcers.

Skin care and Early Treatment

1. Inspect the skin at least daily, and document assessment findings.

2. Individualize bathing frequency. Use a mild cleansing agent. Avoid hot water with excessive friction.

3. Assess and treat incontinence. When incontinence cannot be controlled, cleanse skin at the time of soiling, use a topical moisture barrier, and select under pads or briefs that are absorbent and provide a quick drying surface to the skin.

4. Use moisturizers for dry skin. Minimize environmental factors leading to dry skin such as low humidity and cold air.

5. Avoid massage over bony prominences.

6. Use proper positioning, transferring, and turning techniques to minimize skin injury due to friction and shear forces.

7. ALWAYS make sure to report and skin breakdown to the nurse or the BOM.

8. Document your findings in the charting.

9. Reposition bed bound clients every 2 hours, chair bound every hour.

10. Teach chair fast patients that can reposition themselves to and do so every 15 minutes.

11. Use lifting devices like Hoyer lifts or trapeze to move patients rather than dragging them.

12. Use pillows or foam wedges to keep boney-prominences such as knees and ankles from direct contact with each other.

13. Use devices that totally relieve pressure on the heels like a pillow or booties that will “float the heels’ off the bed.

Pressure Ulcer Quiz:

1. Which statement(s) are true about pressure ulcers?

a. They are localized area of tissue damage

b. They tend to occur at bony sites

c. They are caused by prolonged pressure

d. The patient/resident’s nutrition status affects the development of a pressure ulcer

e. All the Above

2. To prevent pressure ulcers from developing, which of the following steps should NOT be taken?

a. Routinely observe high risk bony skin areas

b. Turn clients only if they request it

c. Minimize pressure

d. Keep skin dry and clean

3. A client is at risk for pressure ulcers when they are or have:

a. Bed or chair bound immobility

b. Poor nutritional status

c. Moisture from urine and feces or wound drainage

d. Sensory impairment such as stroke or dementia

e. All the above

4. Assess your clients for risk of pressure ulcers:

a. The first time you see them then again if you think about it

b. When there is a change in condition

c. When the doctor orders it only

d. Every shift

e. Both b and d

5. Which of the following repositioning techniques are key to preventing pressure?

a. Turning bed bound patient at least every 2 hours

b. Floating heels

c. Padding between bony prominences

d. Repositioning chair bound patients every hour

e. All the above

Answer key:

1. E

2. B

3. E

4. E

5. E