A patient at-risk of developing a pressure ulcer (injury) is an individual who has limitations in daily living activities that could result in chronic problems if exposed to pressure, shear, friction or moisture. Bed-ridden patients, especially those with spinal cord injuries, those who are hemodynamically unstable, the elderly and the very young are primarily at risk of developing pressure ulcers.
Symptoms of Pressure Ulcers
A developing pressure ulcer will present as changes in skin temperature and appearance along with mild discomfort. Blisters may develop in the area.
An injury, disability or age which causes a patient to experience limited mobility puts that patient at risk for the development of pressure ulcers.
In addition to immobility and recuperation from surgery, other factors which may increase the risk of developing pressure ulcers include: poor nutrition, dehydration, diabetes, peripheral vascular disease, low albumin levels/anemia and obesity. Patients exposed to high levels of moisture, friction or shear are also at a dramatically higher risk of developing pressure ulcers.
Care must be taken that attempts to offload or protect an at-risk limb do not exert pressure elsewhere on the patient's body, putting that area at renewed risk.
The European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel recommend the adoption of a scale for pressure ulcer risk assessment to be used in conjunction with clinical judgment and an assessment of the patient's skin condition.
Treatment & Prevention of Pressure Ulcers/Injuries
At the most basic, pressure ulcer prevention can be as simple as scheduled repositioning of the patient, maintaining proper nutrition, supplementation, and hydration and minimizing shear. Offloading devices, which temporarily protect the affected area from pressure and shear, can be as simple as a pillow placed length-wise under the calf. Offloading boots and devices come in a variety of designs to protect various at-risk locations. They are the primary means for preventing pressure ulcers from forming or getting worse. Pressure mapping, the creation of a three-dimensional map of the pressures exerted on the patient, can alert caregivers to areas at risk for pressure ulceration before any symptoms have begun to present. Full body mapping should be used to evaluate pressure points in order for proper management to be initiated.
Chou R, Dana T, Bougatsos C, et al. Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
Bluestein D, Javaheri A. Pressure Ulcers: Prevention, Evaluation, and Management. Am Fam Physician. 2008. 78(10):1186-1194.
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington, DC: National Pressure Ulcer Advisory Panel; 2009.
National Pressure Ulcers Advisory Panel. Pressure Ulcer Prevention Points. http://www.npuap.org/resources/educational-and-clinical-resources/pressu.... Accessed on July 6, 2013.
Swezey L. Pressure Mapping for Pressure Ulcer Prevention: What Nurses Should Know. WoundSource. 2012. http://www.woundsource.com/blog/pressure-mapping-pressure-ulcer-preventi.... Accessed on July 6, 2013.
Swezey L. Prevention Heel Pressure Ulcers: Simple Methods and Identifying Risk Factors. WoundSource. 2011. http://www.woundsource.com/blog/preventing-heel-pressure-ulcers-simple-m.... Accessed on July 6, 2013.
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