Unit 14 Prevention of Pressure Ulcers

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Unit 14Prevention of Pressure Ulcers

• Nurse Aide I Course

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Prevention Of Pressure Ulcers

• Introduction

• As a direct care giver, the nurse aide will be
  the key team member in the prevention of pressure
  ulcers.
• Knowledge of the relationship between blood
  supply and tissue destruction, as well as the
  skills necessary to properly position residents
  to minimize the effects of pressure, are
  essential.

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• 14.0 Discuss pressure ulcers and methods used to
  prevent them.

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Pressure Ulcers

• Previously called decubitus ulcers or bed sores
• Caused by pressure on area of skin that
  interferes with circulation

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• 14.1 Identify areas where pressure ulcers most
  frequently occur.

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Pressure Ulcers(continued)

• Occur where bones come close to the skin surface.
• toes, heels, ankles, knees
• hips, elbows, shoulders
• spine (especially tailbone area)
• ears, cheeks, collarbone area
• back of head

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Pressure Ulcers(continued)

• Can develop where areas of body rub together and
  moisture collects, especially in obese residents
• Under breasts
• Between folds of abdomen
• Between crease of buttocks
• Between thighs

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• 14.1.2 List the methods used to prevent the
  formation of pressure ulcers.

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Methods Used To PreventPressure Ulcers

• Keep skin clean and dry
• Reposition residents at least every two hours
• Keep linen dry and free of wrinkles and objects
  that cause pressure to the skin
• Clean urine and feces from skin as soon as
  possible

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Methods Used To PreventPressure
Ulcers(continued)

• Make sure clothing and shoes do not bind or
  constrict
• Pat skin dry when bathing never scrub
• Encourage adequate nutrition and fluids

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Methods Used To PreventPressure
Ulcers(continued)

• Massage pressure points when the resident is
  repositioned
• Report any changes in skin condition immediately

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• 14.1.3 Identify devices used to prevent pressure
  ulcers.

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Preventive Devices Used To Prevent Pressure Ulcers

• Bed cradle
• Heel and elbow protectors
• Flotation pads or cushions
• Pillows
• Water beds
• Alternating pressure mattresses
• Eggcrate mattresses

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment
Prevention is best treatment
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• 14.1.4 Review the four stages of tissue breakdown
  and identify the nurse aides role in assisting
  with treatment.

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment

• Tissue breakdown occurs in stages
• Stage One - red, darkened or non-blanchable skin,
  which is still present 30 minutes after pressure
  relieved

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment(continued)

• Tissue breakdown occurs in stages
• Stage One (continued)
• position off area and report do not massage
• observe every 2 hours and report changes to
  supervisor

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment(continued)

• Tissue breakdown occurs in stages
• Stage Two - addition of blister-like lesions
  skin may be broken
• position off area at all times
• report need for dressing changes
• report odor, drainage, any change in size

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment (continued)

• Tissue breakdown occurs in stages
• Stage Three - skin tissue is destroyed and fatty
  tissue may be involved infection and eschar
  (scab) may result
• continue prevention practices
• report any changes in area

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment (continued)

• Tissue breakdown occurs in stages
• Stage Four - skin, fatty tissue destroyed and
  muscle and bone involved.
• continue prevention practices 
• report any changes in area

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Pressure Ulcers Stages Of Tissue Breakdown And
Treatment (continued)

• Tissue breakdown occurs in stages
• Stage Four (continued)
• report any signs of systemic infection, including
  but not limited to 
• wound odor 
• pain 
• elevated temperature with confusion 

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• 14.2 Identify three purposes for positioning
  residents.

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Positioning

• Purposes
• Assist with examinations
• Assist with procedures
• Prevent pressure on skin for prolonged periods of
  time

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• 14.2.1 Discuss the various types of positions and
  suggest reasons for use.

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Types Of Positions

• Dorsal recumbent position
• flat on back
• knees slightly separated and flexed
• feet flat on bed

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Types Of Positions(continued)

• Horizontal recumbent position supine
• flat on back
• legs slightly separated and extended

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Types Of Positions(continued)

• Prone position
• flat on abdomen with head turned to side
• arms at sides or flexed on either side of head

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Types Of Positions(continued)

• Side lying position
• positioned on either side
• head in straight line with spine
• pillows used to support head, back, arm, and leg

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Types Of Positions(continued)

• Lateral position
• positioned on either side
• bottom arm extended behind back, top arm flexed
  in front of body
• top leg slightly flexed

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Types Of Positions(continued)

• 30? Lateral Reclined Position
• hips rotated 30 degrees
• pillow between knees
• pillow under arm for comfort and to relieve
  pressure on elbow
• pressure relieved from sacrum and hip

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Types Of Positions(continued)

• Fowlers position
• sitting position in bed with head elevated at
  45-60 degree angle.
• knees slightly flexed
• position causes pressure on sacrum and buttocks

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Types Of Positions(continued)

• Sim's position
• positioned on left side
• left arm extended behind body
• right arm flexed in front of body
• right leg flexed toward abdomen
• used for enema administration

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• 14.3 Discuss moving, turning, positioning and
  lifting residents.

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Moving, Turning, PositioningAnd Lifting

• Good body mechanics necessary
• Prevents injury to resident
• Protects nurse aide from injury
• Good body alignment promotes comfort for resident

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Moving, Turning, PositioningAnd
Lifting(continued)

• Safety major consideration
• Get help if needed
• Receive directions from supervisor regarding any
  restrictions for positioning or movement

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Moving, Turning, PositioningAnd
Lifting(continued)

• Safety major consideration (continued)
• Protect and secure any special equipment being
  used by the resident prior to movement (e.g.,
  drainage tubes).
• Elevate bed to comfortable working level

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Moving, Turning, PositioningAnd
Lifting(continued)

• Safety major consideration (continued)
• Protect skin from friction
• roll when possible
• lift with assistance
• prevent sliding
• use turning sheet

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Moving, Turning, PositioningAnd
Lifting(continued)

• Use postural supports as directed
• Rolled blankets
• Pillows
• Rolled towels
• Footboards
• Bed cradles

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Moving, Turning, PositioningAnd
Lifting(continued)

• Reposition at least every two hours or as
  directed
• Eliminates pressure on bony areas
• Provides comfort
• Exercises muscles
• Moves joints
• Stimulates circulation

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Moving, Turning, PositioningAnd
Lifting(continued)

• Coordinate lifting and moving
• Move on a certain count, usually count of three
• Gain cooperation of resident
• Have residents help themselves as much as possible

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Moving, Turning, PositioningAnd
Lifting(continued)

• Coordinate lifting and moving (continued)
• Use transfer belt (gait belt) when appropriate
• When in doubt, always ask for assistance from
  co-workers

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• 14.4 Demonstrate the procedure for moving the
  resident up in bed.

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• 14.5 Demonstrate the procedure for moving a
  resident up in bed using a turning sheet.

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• 14.6 Demonstrate the procedure for positioning a
  resident on side.

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• 14.7 Discuss repositioning the resident in a
  chair or wheelchair.

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Repositioning Resident In ChairOr Wheelchair

• Reasons for changing position every two hours or
  as directed
• Promotes comfort
• Reduces pressure
• Increases circulation
• Exercises joints
• Promotes muscle tone

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Repositioning Resident In ChairOr
Wheelchair(continued)

• Body kept in good alignment with head in straight
  line with spine
• Plastic or vinyl surface of chair covered, with
  use of pressure-relieving cushion preferred
• Pillows or soft blankets used for support

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Repositioning Resident In ChairOr
Wheelchair(continued)

• Feet rest on floor or footrest of wheelchair
• Hips positioned well back in chair
• Weight shifting utilized in between repositioning

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