Module 7. Pressure Ulcers in Older Adults

							Pressure Ulcers in
     Older Adults
Objectives
   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
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Prevalence




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Incidence




            23.9%




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Healthy People 2010

 “Reduce the proportion of nursing
 home residents with a diagnosis of
 pressure ulcers to 8 diagnoses per
 1,000 residents.”



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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
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Risk Assessment: Norton Scale




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Pressure Ulcer defined
   Any lesion, caused by unrelieved pressure
    resulting in damage of underlying tissue.




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Staging




   Source: National Pressure Ulcer Advisory Panel, 1989
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Factors to consider…
    Nutritional deficiencies / weight
    Aging
    Lowered mental status
    Immunosuppressant drugs
    Infection
    Continence
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Stage I

  Observable pressure-related alteration
  of intact skin.
   Indicators
    Skin temperature
    Tissue consistency
    Sensation


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Stage II

    Involves partial thickness skin loss
     involving epidermis, dermis, or both

    The ulcer is superficial

    Clinical presentation: abrasion,
     blister, or shallow crater
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Stage III

    Full thickness skin loss;
     damage or necrosis of
     subcutaneous tissue to
     underlying fascia.

    Clinical presentation:
     deep crater with or without
     undermining of adjacent tissue
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Stage IV

Full thickness skin loss:
1. Extensive destruction

2. Tissue necrosis; sinus
   tracts
3. Damage to muscle, bone
   or supporting structures
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Key Staging Points
   Only stage once

   Stage to maximum anatomic depth of
    tissue involved

   Do not Reverse Stage



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Limitations of staging system

   Difficult to evaluate darkly pigmented
    skin

   Use natural or halogen light, NOT
    FLOURESCENT

   Cannot be staged if with eschar
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Prevention: Risk Assessment

    Bed-or chair-bound persons
     at risk
    Use Braden Scale
    Identify ALL risk factors
    Assess on admission and
     regularly
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Prevention: Skin Care and
Early Treatment
    Inspect skin daily
    Individualize bathing frequency
    Assess / treat incontinence
    Use moisturizers; avoid massaging bony
     prominences
    Proper positioning
    Dry lubricants
    Correct nutritional deficiencies
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Prevention: Mechanical
Loading and Support Surfaces
   Reposition bed-bound persons every 2 hours
   Consider postural alignment
   Teach chair-bound persons to shift their weight
    every 15 minutes
   Use lifting devices
   Use pillows or foam wedges
   Elevate HOB as little as possible
   Use repositioning schedule
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Prevention: Education
    Implement educational programs
    Include etiology, risk assessment, skin
     assessment, support surfaces,
     individualized programs of skin care,
     demonstration of positioning
    Accurate documentation
    Mechanism to evaluate
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Management
of Pressure
Ulcers

AHRQ Guidelines
Algorithm




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Nutritional
Assessment


AHRQ Guidelines
Algorithm




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Management
of Tissue
Loads
AHRQ Guidelines
Algorithm




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Ulcer Care


AHRQ Guidelines
Algorithm




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Managing
Bacterial
Colonization
and Infection




AHRQ Guidelines
Algorithm

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Questions?


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