Pressure Injury

Holly Hovan's picture

By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Pressure injuries (PIs) typically are the result of unrelieved pressure, shear, or force. In an inpatient or hospital setting, interventions are put into place to prevent pressure injuries based on evidence and patient risk. However, PIs still develop in some patients despite interventions. Experts agree that most PIs are in fact avoidable; however, some patients may experience unavoidable skin breakdown at end of life (EoL).¹ Kennedy terminal ulcers (KTUs), skin changes at life’s end (SCALE), and Trombley-Brennan terminal tissue injuries (TB-TTIs) are some of the common terms used to describe unavoidable skin changes at EoL.¹

WoundSource Editors's picture

By WoundSource Editors

Pressure injuries are common among patients who experience extended exposure to pressure on a bony prominence or shear to areas of poor turgor, two factors that lead to constriction of a patient’s blood supply to the exposed area. A patient who is bedridden or has certain chronic conditions, such as diabetes, is more likely to develop a pressure injury. When mechanical force is imposed on the skin, it can result in poor blood flow and damage to the bone-muscle interface, thus making tissue sensitive and painful. For patients with limited mobility, this can be especially frustrating because they may not be able to adjust positions or medical equipment. If pressure injuries are left untreated or unnoticed, they can also become infected and even enter muscle and bone. Risk assessment tools are available to assess pressure injury risk and can work in tandem with practice standardization, thereby leading to effective treatment plans for practitioners and patients.

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WoundSource Practice Accelerator's picture

Pressure injuries are among the most serious health and patient safety concerns that health care facilities deal with on a daily basis, according to The Joint Commission. The number of patients affected annually is 2.5 million. Hospital-acquired pressure injuries (HAPIs) cost the US health care system between $9.1 and $11.6 billion per year.

Heidi Cross's picture

by Heidi Cross, MSN, RN, FNP-BC, CWON

The following is a wrap up of the 2019 pressure injury guidelines of the National Pressure Injury Advisory Panel (NPIAP)1 related to nutrition, of which there are 15. For guidelines #1 to #10, see my last few blogs (Parts 1, 2, 3 of this blog series).

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Dianne Rudolph's picture

By Dianne Rudolph, DNP, GNP-bc, CWOCN

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

Charles Buscemi's picture

By Charles P. Buscemi, PhD, APRN, CWCN and Arturo Gonzalez, DNP, APRN, ANP-BC, CWCN-AP

Urinary catheters serve several purposes, including monitoring urine output, relieving urinary retention, and facilitating diagnosis of disease in the lower urinary tract. These catheters can be inserted easily and are universally available, which usually results in their continued and indiscriminate usage. Urinary catheters can be indwelling or external-condom types. The indwelling catheter can be either a suprapubic or a urethral catheter. The external catheter provides a safe alternative to an indwelling catheter for patients having urinary incontinence (UI). It comprises a sheath surrounding the penis with a tube situated at the tip linked to a collection bag. Conversely, the condom catheter seems an attractive option for patients with UI. About 40% of condom catheter users have urinary tract infections. Moreover, 15% of condom catheter users have necrosis, ulceration, inflammation, and constriction of the penile skin. There is also an additional risk of urine leakage and condom detachment. Furthermore, the use of the external catheter requires significant nursing time. Overall, the condom catheter cannot be satisfactorily used for managing UI; nevertheless, it is useful for the non-invasive measurement of bladder pressure.

Cathy Wogamon-Harmon's picture

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

Many questions arise and confusion develops when wound care providers mention Kennedy terminal ulcers (KTUs). Because these wounds are not frequently seen, and because they develop rapidly and observation ends abruptly with the death of the patient, wound care providers may have never observed a KTU, even in a long career in wound care. Although the literature reveals that there is a lack of knowledge regarding the exact cause of a KTU, let’s look at the facts currently known from published resources.