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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
When Pressure Persists:
Prevention of Pressure
Ulcers for Those at Riskby
Barbara Levine, PhD, CRNPGerontological Nursing
Consultant
Reviewed and updated, Fall 2006 Reviewers: Catherine R. Curley RN, MSN, Penn Nursing Consultation Service and GEC Series Editors
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
When Pressure Persists:
Learning ObjectivesDirect 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
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
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.
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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
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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
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Who’s at Risk?
Individuals who are: bed or chair-bound unable to sense discomfort incontinent poorly nourished or
dehydrated feverish, have diabetes, or
lowblood pressure
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Pressure Points
Back of the head Back of shoulders Elbows Hip Buttocks Contractures Heels
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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
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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
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Beyond Clean and Dry
Look for and report any changes
Clean skin and keep it well lubricated
Minimize dryness and avoid excessive moisture
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Skin Checks Check all surfaces at least twice
a day Remove clothing and position for
visibility Check pressure points with
everyposition change
If you note a reddened area, reassess in 15 minutes
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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
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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
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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
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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
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Reducing Pressure in Chairs
Reposition at least every hour
Instruct to shift weight every 15 minutes
Do not use doughnuts or rings
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Nutrition
Encourage residents to drink enough water
Assist residents to eat enough protein and calories
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You can make a make adifference!
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
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
Objectives ReviewCan you now:
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 ulcerprevention and care?
Describe a pressure ulcer prevention program?
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
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: 1721-9.
• Benbow, M (2006) Guidelines for the prevention and
treatment of pressure ulcers. Nursing Standard. 20 (52), 42-44.
• Garcia, AD and Thomas, DR. (2006). Assessment and management of chronic pressure ulcers in the elderly. Medical Clinics of North America, 90 (5): 925-44.
• Thomas, DR. Prevention and treatment of pressure
ulcers. Journal of the American Medical Directors Association, 7 (1), 46-59.
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
Leadership and Staff:
Lois K. Evans, DNSc, RN, FAANSeries Associate Editor Viola MacInnes IndependenceProfessorSchool of Nursing University of Pennsylvania
Sangeeta BhojwaniAssociate Director, Series Assistant EditorDVGECUniversity of Pennsylvania
Kathleen Egan, PhD Series EditorDVGEC Program Administrator Director, DVGEC University of Pennsylvania
Mary Ann Forciea, MDSeries Associate EditorClinical Associate Professor of MedicineDivision of Geriatric Medicine, University of Pennsylvania
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© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter© 2006 University of Pennsylvania© 2006 University of Pennsylvania Delaware Valley Geriatric Education Delaware Valley Geriatric Education CenterCenter
Thank you for your attention!
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