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Wheelchairs and Pressure Injuries

By Ivy Razmus, RN, PhD, CWOCN

People in wheelchairs are limited in their mobility, sensory perception, and activity. These limitations can lead to increased temperature and moisture on the areas that are in contact with the wheelchair surface. These risk factors place wheelchair users at a higher risk for pressure injuries. A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. Pressure from medical devices against the skin may also cause pressure injury. Patients with spinal cord injury (SCI) and its associated comorbidities are among the highest-risk population for developing pressure injuries. The incidence of pressure ulcers in patients with SCI is 25%–66%.

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moisture-associated skin damage

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

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Age and Pressure Injury

By Ivy Razmus, RN, PhD, CWOCN

The very old and the very young are more alike than you might think when you consider risk for skin injuries. They are alike regarding their limited sensory perception, mobility, and activity. They are also alike in their potential for inadequate nutrition and their skin's supporting structures (muscle, collagen and elastin). These similarities place them at greater risk for pressure injuries.

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Product Selection

by Ivy Razmus, RN, PhD, CWOCN

As we continually focus on improving our skills in prevention and management of skin and wounds, we are beginning to understand that one size does not fit all; or, in other words, prevention and management in wound care are dependent on the size and age of the patient. In wound care, one method of care does not fit all types of patients. Although those clinicians who work with younger populations know this to be true based on our personal experience, this can be a problem if the purchasing of products for younger patients' skin and wound care is decided without the input of the providers and caregivers who care for them.

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