2. WHAT IS A PRESSURE ULCER?
According to the National Pressure
Ulcer Advisory Panel (NPUAP):
A pressure ulcer is localized
injury to the skin and/or
underlying tissue usually over a
bony prominence, as a result of
pressure, or pressure in
combination with SHEAR.
3. WHO IS AT RISK?
According to the NPUAP:
Consider all bed-bound and chair-
bound persons, or those whose ability
to reposition is impaired, to be at risk
for pressure ulcers.
Soooo . . . . . Most residents of
SNF’s/ALF’s qualify as either bed-
bound, chair-bound OR “those whose
ability to reposition is impaired”
4. WHAT ARE THE RISK FACTORS? (CLUES!!!)
Pressure
Shear
Skin Microclimate
Heat
Humidity
Friction
Immobility
Device-Related Pressure
5. PRESSURE
Google Definition
The continuous physical force exerted on or
against an object by something in contact with it.
Prolonged pressure impairs blood flow
leading to areas of tissue ischemia => cell
death
Larger surfaces redistribute pressure better
than smaller surfaces
Immersion in the surface without bottoming
out reduces pressure
6. SHEAR
According to the NPUAP:
Shear is a normal mechanic force with
physiological effects.
The deformation of the tissues alters the
tissues physiology and increases the risk for
pressure ulcer.
Some studies suggest that shear may play
more critical role than pressure in ulcer
formation.
7. SKIN MICROCLIMATE
Humidity (Moisture)
Includes Incontinence, Sweating, & External
Sources (spilled milk, juice, soup, etc.)
Moistures affects skin by:
↓ the skin’s stiffness
↓ the skins strength
↑ Friction at the skin surface
↑ Adherence to surfaces => ↑ SHEAR
8. SKIN MICROCLIMATE
Heat
Increased temp => Increased metabolic rate
Increases demand on cells for nutrients, O2, etc. which
are in short supply when under pressure
Increased temp => Increased Sweating, leads to
increased moisture
Encourage patients to wear the least amount
of layers they are comfortable with.
If pt must wear Incontinent Briefs
Least bulky that works & breathable if able
9. FRICTION
Google Definition
The resistance that one surface or object
encounters when moving over another.
Increased friction will increase the shear and
magnify the pressure on the bony
prominences
10. IMMOBILITY
Patients who lack mobility or who have
altered mobility will be at higher risk for
pressure ulcers as they will not be able to
provide adequate pressure redistribution with
assistance
Use Therapy to improve mobility.
If therapy is not available/indicated, then use
restorative aides, activity directors, etc.
11. DEVICE-RELATED PRESSURE
If pt gets pressure ulcer while on pressure
redistribution surface, need to assess the
surface
Flat ROHO example
If pt gets pressure ulcer in an odd place or
with an odd appearance, check pt’s
environment for sources of device-related
pressure
12. RECOMMENDATIONS
Per NPUAP
Reposition chair-bound pt’s at least every hour
Teach pt to do pressure relief activity every 15
minutes for pt’s who are able.
13. RECOMMENDATIONS
Educate Caregivers/Pt’s/Family
Importance of pressure redistribution surfaces
Importance of pressure relief every 15 mins
sitting
Importance of maintaining posture during sitting
Limit sitting time to 1 hour, 3X/day max for at risk
or those with minor (Stage I or II) ulcers
Avoid pressure on Stage III or IV ulcers as much
as possible
14. RECOMMENDATIONS
Use Therapies (Physical & Occupational)
Use for Rehab to improve pt’s strength to
increase
ability to reposition self in seating surfaces
general posture
Many therapists have obtained specialized skills
in assessing and recommending seating
surfaces
Therapists will have good ideas on how to alter
existing surfaces or postures to improve
pressure redistribution
21. ITEMS TO REMEMBER ON SEATING SURFACES
Purpose of seating surfaces is to
REDISTRIBUTE pressure off bony
prominences
If surfaces is too rigid, the surface will
actually magnify the pressure on the bony
prominences
If surface is too soft the bony prominences
will rest on the base surfaces leading to
increased pressure
22. ITEMS TO REMEMBER ON SEATING SURFACES
Select cushions based on individual patient
characteristics
Patients bodies change over time and their
cushion requirements will change too
Donuts, Sheepskin, and Egg
Crates are NOT pressure
redistribution surfaces
May use pillows/foam to achieve position
change on pressure redistribution surface
23. A FEW TAKE HOME ITEMS
Make connections with a seating specialist
(be it a P.T., O.T. or a vendor)
A wheelchair cushion is less expensive than
treating a pressure ulcer (Prevention costs
less than Treatment)
Do what’s best for your patients
