Higher Acuity – Pressure Ulcers

Caring for a higher acuity resident population increases the risk of health complications, including pressure ulcers.  There are many factors that put your residents at risk for skin breakdown, including advanced age, chronic health conditions (e.g., heart disease, diabetes, etc.), cognitive impairments, incontinence, and decreased activity.  Understanding pressure ulcers, what causes them, and how to prevent them is critical knowledge for you and your staff.

What is a Pressure Ulcer?
According to the National Pressure Ulcer Advisory Panel, a pressure ulcer is “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.”

Pressure ulcers are staged or categorized based on the degree of tissue loss.  The categories range from Stage 1 which features redness with intact skin. to stage 4 which includes full thickness tissue loss with exposed bone, tendon, or muscle.  Click here to learn more about pressure ulcer stages.

Preventing Pressure Ulcers
The National Institutes of Health recommend the following interventions to prevent pressure ulcers:

  1. Monitor for breakdown: Pay special attention to the areas where pressure ulcers often form. These are:
    • Your heels and ankles
    • Your knees
    • Your hips
    • Your spine
    • Your tailbone area
    • Your elbows
    • Your shoulders and shoulder blades
    • The back of your head
    • Your ears
  1. Notify the resident’s physician if you see early signs of pressure ulcers. These are:
    • Skin redness
    • Warm areas
    • Spongy or hard skin
    • Erosion of the top layers of skin or a sore
  1. Keep skin clean and dry
    • When washing, use a soft sponge or cloth. Do not scrub hard.
    • Use moisturizing cream and skin protectants on the skin every day, if prescribed by the physician.
    • Clean and dry areas underneath breasts and in the groin
    • Do not use talc powder or strong soaps
    • Try not to take a bath or shower every day. It can dry out the skin more.
    • Eat enough calories and protein to stay healthy.
    • Drink plenty of water every day.
  1. Ensure clothes are not increasing the risk of developing pressure ulcers.
    • Avoid clothes that have thick seams, buttons, or zippers that press on the skin.
    • Do not wear clothes that are too tight.
    • Keep clothes from bunching up or wrinkling in areas where there is any pressure on the body.
  1. If the resident uses a wheelchair:
    • Make sure the wheelchair is the right size for the resident.
    • Have the doctor or physical therapist check the fit once or twice a year.
    • Use a foam or gel seat cushion that fits the wheelchair. Do NOT sit on donut-shaped cushions.
    • Assisted/remind the resident to shift his/her weight in the wheelchair every 15 – 20 minutes. This will increase blood flow and take pressure off certain areas.
  1. When the resident is in bed:
    • Use a foam mattress or one that is filled with gel or air. Place pads under the resident’s buttocks to absorb wetness to help keep the skin dry.
    • Use a soft pillow or a piece of soft foam between parts of the body that press against each other or against the mattress
    • Do NOT put pillows under your knees. It puts pressure on your heels.
    • NEVER drag the resident to change position or get in or out of bed. Dragging will cause skin breakdown.
    • Change position every 1 – 2 hours to keep the pressure off any one spot.
    • Sheets and clothing should be dry and smooth, with no wrinkles.
    • Remove any objects such as pins, pencils or pens, or coins from the bed.
    • Do not raise the head of your bed to more than a 30-degree angle. Being flatter keeps the body from sliding down.
  1. When to Call the Doctor: Call the doctor right away if: you notice a sore, redness, or any other change in the skin that last for more than a few days or becomes painful, warm, or begins to drain pus.

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