Terms to Know: Pressure Injury Prevention

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By the WoundSource Editors

Adherence – A term used to replace “compliance” in reference to a patient following clinician orders for wound care. The updated term reflects patient choice in treatment recommendations.

Bottoming Out – A support surface has bottomed out if the clinician is able to place their hand under the support surface and is then able to palpate the bony prominence the support surface is meant to be protecting. The surface should be replaced immediately if this occurs.

Braden Scale for Predicting Pressure Sore Risk© – A risk assessment tool commonly used in the United States to determine the likelihood of an adult patient developing a pressure injury. The lower the score, the more at risk the patient is. For pediatric patients, the Braden Q Scale is used.

Cellulitis – An infection that usually occurs in the lower extremities but that can also affect other areas. Skin is generally red, painful, and warm to the touch.

Full-thickness wound – Tissue damage involving total loss of epidermis and dermis and extending, at the minimum, into the subcutaneous tissue and possibly through the fascia, muscle, or bone.

Norton Scale – Developed in the 1960s for use in determining pressure injury risk in adult patients. The lower the score, the more at risk the patient is for developing a pressure injury.

Partial-thickness wound – Tissue damage involving only the first two layers of skin, the epidermis and dermis. Wounds that involve anything below the dermis are considered full-thickness.

Patient Monitoring Technologies – Generally wireless devices that monitor such things as patient position, movement, and skin temperature. May also feature auditory cues, alerting patients and caregivers that the patient needs to be repositioned.

Pressure Mapping – Technology that can be used to determine areas of high pressure on the body, allowing clinicians to determine what areas need to be offloaded and/or protected.

Pressure Ulcers – Scale for Healing (PUSH) – Designed by the National Pressure Ulcer Advisory Panel (NPUAP), this tool is used to measure the status of pressure injuries over time. If scores lower over time, it can be indication that the wound is healing.

Turgor – Skin turgor is tested by pulling up the skin on the back of the hand. If the skin is slow to return to the original state, it is a sign of dehydration, which puts the patient at higher risk of pressure injury development.

Waterlow Pressure Ulcer Risk Assessment/Prevention Policy Tool – The most frequently used tool for pressure injury risk assessment in the United Kingdom. This tool includes a “Special Risks” category that can raise a patient’s score. The higher the score, the higher the patient is at risk for developing a pressure injury.

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.

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