SN Juliene and EN George ( Lentor Residence)

1. PRESSURE INJURY
PREVENTION

2. - A pressure injury is localized damage to the skin and underlying soft
tissue usually over a bony prominence or related to a medical or
other device.
- The injury can present as intact skin or an open ulcer and may be
painful.
- The injury occurs as a result of intense and/or prolonged pressure or
pressure in combination with shear. The tolerance of soft tissue for
pressure and shear may also be affected by microclimate, nutrition,
perfusion, co-morbidities and condition of the soft tissue.
What is pressure injury?

3. - The climate of a very small or restricted area, that differs
from the climate of the surrounding area
- It usually occurs under the bony prominence where pressure
is at its peak and heat build-up causes excessive sweat
- it is created as a result of excessive heat and moisture
usually from sweat, incontinence, discharges from wounds
and when sitting on a seat surface that is not breathable
Microclimate

4. What are the factors that can cause pressure Injury

5. DECREASED MOVEMENT/IMMOBILITY
- SEVERE ARTHRITIS
- STROKE
- MULTIPLE SCLEROSIS
- OBESITY

6. DECREASED SENSATION
- Decreased ability to feel or verbally express pain
and discomfort can affect persons feeling towards
prolonged pressure on the skin.

7. CIRCULATORY PROBLEMS
• Aterosclerosis
• Localized Oedema
• Diabetes

8. POOR NUTRITION
-People who are less in protein, Vit. C, Vit. E,
calcium and Zinc

9. SHEER AND FRICTION
- It causes the skin to stretch and blood vessels to
kink which will impair blood circulation in the skin.

10. What is the common tool to assess
Pressure Sore Risk?
Braden Scale

11. SKIN ASSESSMENT

12. • flattening of the epidermal-dermal junction
• decrease in the melanocytes and Langerhans cells
• decrease in fibroblast function
• decrease in blood flow
• decrease in oil and sweat production
• decrease in subcutaneous tissue, especially fat,
• decline in the reproduction of the outermost layer of the
epidermis
Why elderly have higher risk?

13. REPOSITIONING and OFF-LOADING

15. BED-BOUND
• Use the 30-degree tilted side-lying position.
• Encourage individuals who can reposition themselves to
sleep in a 30- to 40-degree side-lying position.
• Avoid lying postures that increase pressure.

17. BED-BOUND
• Limit head-of-bed elevation to 30 degrees for an individual on
bedrest unless contraindicated.
• If sitting in bed is necessary, avoid head-of-bed elevation or a
slouched position.

18. IF A PATIENT HAS EXISTING PRESSURE ULCER
• Do not position the patient directly on the ulcer or on areas
of non-blanchable redness or deep tissue injury.
• Continue to turn and reposition the patient regardless of the
support surface in use.
• Inspect the skin for additional damage each time the patient
is turned or repositioned.

19. CHAIR-BOUND
• Stand the patient and reseat them in the chair
frequently if possible.
• Provide adequate seat tilt to prevent sliding forward in
the chair
• Elevate the legs or place the feet on a stool if the feet
do not reach the floor
• Elevate the feet and recline the chair by 30 degrees to
reduce pressure.

21. • If the patient can change his/her own position, encourage
pressure relief every 15 minutes. This includes chair pushups,
leaning forward, leaning side to side, or tilting backwards.
Leaning forward is the most effective and might be easier than
chair push-ups.
• Acutely ill patients at risk for pressure ulcers should not sit for
longer than two hours at a time and not return to sitting for at
least an hour.
• Patients who are incapable of changing their position while
sitting should be repositioned at least every hour by a caregiver.

22. If a patient has existing Pressure Ulcer
• Minimize sitting time
• Consider periods of bed rest to promote ischial and sacral ulcer
healing.
• Avoid sitting a patient with an ischial pressure ulcer in a fully erect
posture.
• Patients with existing pressure ulcers on the ischial areas should
limit time sitting up in the chair to three times a day for 60 minutes
or less, and they must use a cushion (gel or air cushions are best)
that redistributes pressure.

23. PRESSURE RELIEVING EXERCISE

24. PRESSURE RELIEVING CUSHION

25. Difference of Pressure Injury and IAD

26. MEDICAL DEVICE RELATED PRESSURE INJURY

27. Shoes

28. Oxygen Cannula

29. Urinary catheter

30. Cast

31. Cervical Collar

32. Naso-gastric Tube

33. Pulse Oximeter

34. QUESTIONS