Patients who develop stage 3 and 4 pressure injuries with prolonged wound chronicity and complexity may require surgical intervention. One surgical method used to encourage healing in pressure injuries is flap surgery, which involves taking a section of skin with an intact blood supply and...
By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Pressure ulcer risk assessment is crucial to the prevention of pressure ulcers. There are many factors which put certain patients at higher risk of developing these painful injuries that increase health care costs and lead to prolonged hospitalization, and sometimes death.
Continue reading to see how many of the following risks factors you are already aware of and which you might not have considered.
- Poor mobility/immobility: Patients who are unable to independently change position are at increased risk of developing a pressure ulcer, due to pressure exerted over bony prominences which results in reduced blood flow to the tissues and subsequent hypoxia.
- Poor nutritional status: Although there are few studies to support this idea, it is widely accepted (based on anecdotal evidence) that patients who are compromised nutritionally are at higher risk for the development of pressure ulcers; for this reason, patients with poor nutritional status may benefit from a dietary consult.
- Compromised blood flow: Whenever there is compromised blood flow to the tissues, there is increased risk of pressure ulcer development. What are some common reasons that blood flow might be compromised? Peripheral arterial disease (PAD), venous insufficiency and shock are common culprits.
- Neuropathy/compromised sensation: Obviously, if you cannot feel pain or pressure, you are at higher risk of developing a pressure ulcer. Patients who fit into this category include patients with spinal cord damage, stroke, MS, neuropathy and other conditions that compromise one’s ability to perceive pain and/or pressure.
- Skin color/changes: Patients with darker skin pigmentation may be at risk for pressure ulcers simply because health care professionals fail to recognize the early signs of pressure damage (i.e. blanching erythema). In addition, patients with conditions that change the normal appearance of the skin are at high risk (e.g. patients with bruising, dermatitis, eczema and other skin diseases).
- Support surfaces: The surface upon with the patient lies or sits can profoundly influence pressure over bony prominences, as can lying or sitting in the same position for long periods of time. Support surfaces should be assessed frequently and adjusted accordingly.
- Pain: Pain may prevent patients from moving, even when they are feeling the unpleasant effects of pressure. Too much pain medication may sedate patients to the point where they don’t change position as often as they should. Patients should be assessed for their ability to move while still maintaining an acceptable level of comfort.
- Age: At the extremes of age, patients may be at higher risk for the development of pressure ulcers due to inability to move/change position independently. Very young infants are unable to change position by themselves; the elderly may be similarly unable to change position due to other health problems limiting movement.
- Mental status: Patients suffering from dementia or other cognitive disorders may be unable to comprehend instruction given that could help prevent pressure injuries, or may fail to recognize discomfort as a signal to change position.
- Incontinence: Incontinence may cause skin damage that can increase the risk of developing pressure ulcers. This skin damage may make it more difficult for health care professionals to recognize the early warning signs of pressure ulcers (i.e. reddened areas of skin that blanch when light pressure is applied).
How did you do? Were you aware of all of the above listed contributing factors to pressure injuries? Being able to assess your patient for risk factors for pressure ulcers is important in developing a treatment plan to prevent pressure ulcers in vulnerable patients.
Guy, H. (2012). Pressure ulcer risk assessment. Nursing Times. http://www.nursingtimes.net/pressure-ulcer-risk-assessment/5040368.article
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.