PREVENTION OF PRESSURE ULCER: burden, common pressure points, risk factors, pathophysiology, stages and preventive measures

1. PRESSURE ULCER PREVENTION
Presented by:
Baby Haokip
2nd Year MSc (N)
College of Nursing, NEIGRIHMS

2. BURDEN DUE TO PRESSURE ULCER:
As given by Agency for Health Care Research
Quality:
o Described as one of the most costly and
physically debilitating complications .
 3rd most expensive disorder after cancer and
cardiovascular diseases.
 2.5 million patients are affected per year.
 2nd most common claim after wrongful death and
greater than falls or emotional distress.
 60,000 patients die as a direct result of a pressure
ulcer each year.

3. DEFINITION:
 As defined by National
pressure ulcer Advisory
Panel
“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”.

4. ANATOMY OF THE SKIN:

5. COMMON AREAS OF PRESSURE POINTS:

6. MECHANISM AND RISK FACTORS:
Moisture

7. PATHOPHYSIOLOGY OF PRESSURE ULCER:
external pressure, shearing force and friction acts on the areas of soft
tissue over bony prominences
When the external pressure exceeds normal capillary pressure i.e 12-32
mmHg
Tissue compression from pressure restrict blood flow to the skin
Resulting in reduced tissue perfusion and oxygenation
eventually leading to tissue ischemia, necrosis

8. STAGES OF PRESSURE ULCER

9. STAGE 1: NON-BLANCHABLE ERYTHEMA OF INTACT
SKIN
Test for blanching

10. STAGE 2: PARTIAL THICKNESS SKIN LOSS
WITH EXPOSED DERMIS:

11. STAGE 3: FULL-THICKNESS SKIN LOSS

12. STAGE 4: FULL-THICKNESS SKIN AND
TISSUE LOSS

13. UNSTAGEABLE: OBSCURED FULL THICKNESS SKIN
AND TISSUE LOSS:

14. SUSPECTED DEEP TISSUE INJURY:

15. PREVENTION
Conduct skin and
risk assessments
Manage moisture
Optimize
hydration and
nutrition
Minimize
pressure, shear
and friction
Treating pressure
ulcer

16. 1. CONDUCT SKIN AND RISK ASSESSMENTS
Assess and document skin condition on
admission and every shift
Implement risk assessment tool:
o The most widely used is the Braden
Scale.
o Others include the Norton, Gosnell,
Knoll and Water low Scales.
 Assess risks within four hours of
admission
 Document risk assessment daily or on
every shift.
 Develop an individualized care plan for
each patient
 Conduct nurse-to-nurse shift reports
at the bedside eyes

17. 2.MANAGE MOISRURE:
Use cotton pads
that wick away
moisture
Topical agents
such as
emollients/
lotion
Do not massage
or vigorously
rub skin
Cleanse the skin
following episodes
of incontinence
Diapers should
only be used to
preserve a patient’s
dignity
Engage family
and caregivers

18. 3. OPTIMIZE HYDRATION AND NUTRITION:
Nutrition Assessment:
 Weight status and weight loss
 Ability to eat independently
 Adequacy of intake
Protein and Energy and vitamin intake:
provide
 1.25 to 1.5 gram/kg body protein
 30-35 kcal/kg body of energy
 Vitamin A and C contributes wound healing
 Enteral/parenteral supplement
HYDRATION;
Monitor signs and symptoms of
dehydration:
 Change in weight, skin turgor,
urine output, serum sodium.
 Provide additional fluid.

19. 4. MINIMIZE PRESSURE SHEAR AND FRICTION:
1. Off-load pressure over bony prominences :
 Position knees in slight flexion for offloading the
heels
 If awake, ask about any complaints of pain
 Reposition patients at least every two hours in bed
 Every 15 minutes if chair bound’
 Avoid positioning on existing pressure ulcer
 Use a 30-degree side-lying position (alternately, right
side, back, left side).
2. Provide adequate support surfaces:
to redistribute pressure :
 Use pillows (only for limbs).
 use special beds, mattresses and foam wedges
 The following ‘devices’ should not be used to
elevate heels:
• synthetic sheepskin pads
• cutout ring, or donut-type devices
• intravenous fluid bags
• water-filled gloves

20. 3. Reduce friction and shearing forces:
 wrinkle free bed.
 proper seating alignment to reduce
patient’s tendency to slide down
 Do not drag/pull
 Use lift sheet while transferring patient

21. WOUND CLEANSING:
performed gently to
minimize
mechanical trauma
to the healing
tissue.

22. WOUND DRESSING:
 protect the wound,
 reduce or prevent wound infection
 stimulate autolytic debridement
 reduce wound pain and
 stimulate development of granulation
tissue
It has been demonstrated
experimentally that
wounds that maintained
in a moist heal 40%
faster than air-exposed
wounds