Pressure Ulcers in Older Adults Objectives l l
Pressure Ulcers in Older Adults
Objectives l l l Identify how to calculate the incidence and prevalence of pressure ulcers Perform a risk assessment for pressure ulcers, using validated risk assessment scale Define pressure ulcer, including staging Plan care for prevention of pressure ulcers Plan care to include debridement, cleansing, dressing, and pressure relief 2
Prevalence 3
Incidence 23. 9% 4
Healthy People 2010 “Reduce the proportion of nursing home residents with a diagnosis of pressure ulcers to 8 diagnoses per 1, 000 residents. ” 5
Risk Assessment: Braden Scale 1. Sensory Perception 2. Skin Moisture 3. Activity 4. Mobility 5. Nutrition 6. Friction / Shear Braden Scale Try This Assessment Series available on Hartford Institute website at www. hartfordign. org 6
Risk Assessment: Norton Scale 7
Pressure Ulcer defined l Any lesion, caused by unrelieved pressure resulting in damage of underlying tissue. 8
Staging Source: National Pressure Ulcer Advisory Panel, 1989 9
Factors to consider… l Nutritional deficiencies / weight l Aging l Lowered mental status l Immunosuppressant drugs l Infection l Continence 10
Stage I Observable pressure-related alteration of intact skin. Indicators l Skin temperature l Tissue consistency l Sensation 11
Stage II l Involves partial thickness skin loss involving epidermis, or both l The ulcer is superficial l Clinical presentation: abrasion, blister, or shallow crater 12
Stage III l Full thickness skin loss; damage or necrosis of subcutaneous tissue to underlying fascia. l Clinical presentation: deep crater with or without undermining of adjacent tissue 13
Stage IV Full thickness skin loss: 1. Extensive destruction 2. Tissue necrosis; sinus tracts 3. Damage to muscle, bone or supporting structures 14
Key Staging Points l Only stage once l Stage to maximum anatomic depth of tissue involved l Do not Reverse Stage 15
Limitations of staging system l Difficult to evaluate darkly pigmented skin l Use natural or halogen light, NOT FLOURESCENT l Cannot be staged if with eschar 16
Prevention: Risk Assessment l Bed-or chair-bound persons at risk l Use Braden Scale l Identify ALL risk factors l Assess on admission and regularly 17
Prevention: Skin Care and Early Treatment l l l l Inspect skin daily Individualize bathing frequency Assess / treat incontinence Use moisturizers; avoid massaging bony prominences Proper positioning Dry lubricants Correct nutritional deficiencies 18
Prevention: Mechanical Loading and Support Surfaces l Reposition bed-bound persons every 2 hours l Consider postural alignment l Teach chair-bound persons to shift their weight every 15 minutes l Use lifting devices l Use pillows or foam wedges l Elevate HOB as little as possible l Use repositioning schedule 19
Prevention: Education l Implement educational programs l Include etiology, risk assessment, skin assessment, support surfaces, individualized programs of skin care, demonstration of positioning l Accurate documentation l Mechanism to evaluate 20
Management of Pressure Ulcers AHRQ Guidelines Algorithm 21
Nutritional Assessment AHRQ Guidelines Algorithm 22
Management of Tissue Loads AHRQ Guidelines Algorithm 23
Ulcer Care AHRQ Guidelines Algorithm 24
Managing Bacterial Colonization and Infection AHRQ Guidelines Algorithm 25
Questions? 26
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