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When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk By: Elizabeth Ciyou-Allee BA, RN, CLNC, CHPN. ELNEC-PEDS, TNCC.

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Presentation on theme: "When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk By: Elizabeth Ciyou-Allee BA, RN, CLNC, CHPN. ELNEC-PEDS, TNCC."— Presentation transcript:

1 When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk By: Elizabeth Ciyou-Allee BA, RN, CLNC, CHPN. ELNEC-PEDS, TNCC

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

3 Pressure Ulcer: Definition A pressure ulcer is any change in color or break in the skin caused by too much pressure on the skin for too long a period of time.

4 Pressure Ulcers  Occur 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 more than $6,000 each to treat

5 What Causes Skin Injury?  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

6 Who’s at Risk? Individuals who are:  bed or chair-bound  unable to sense discomfort  incontinent  poorly nourished or dehydrated  feverish, have diabetes, or low blood pressure

7 Pressure Points  Back of the head  Back of shoulders  Elbows  Hip  Buttocks  Contractures  Heels

8 A Team Approach to Prevention  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 resident off the bed pan or toilet promptly  Clean skin at time of soiling  Absorbent underpads or briefs  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

11 Skin Checks  Check all surfaces at least once a day  Remove clothing and position for visibility  Check pressure points with every position 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 or darkness 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 30° 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 Specialty Mattresses  Help decrease pressure ulcer formation  Patients still need frequent skin checks  These mattresses do not replace the need to turn the person  Turn and check the person at least every two to three hours  Sheets and incontinence pads should be crease free  Sheets should be placed loosely on these mattresses and never tucked

16 Reducing Pressure in Chairs  Reposition at least every hour  Instruct to shift weight every 15 minutes  Do not use doughnuts or rings

17 Nutrition  Encourage residents to drink enough water  Assist residents to eat enough protein and calories

18 You can make a make a difference!  Keep your older adults moving  Position immobile or dependent individuals frequently and carefully  Assist with meals and snacks  Provide plenty of clear, cool water  Keep those with incontinence clean and dry  Be alert to changes and report them

19 Objectives Review  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?

20 References Bergstrom, N., et al. (2005). The National Pressure Ulcer Long- Term Care Study: outcomes of pressure ulcer treatments in long-term care. Journal of the American Geriatrics society, 53: Benbow, M (2006) Guidelines for the prevention and treatment of pressure ulcers. Nursing Standard. 20 (52), Garcia, AD and Thomas, DR. (2006). Assessment and management of chronic pressure ulcers in the elderly. Medical Clinics of North America, 90 (5): Thomas, DR. Prevention and treatment of pressure ulcers. Journal of the American Medical Directors Association, 7 (1),


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