Preventing Pressure Ulcers

Preventing Pressure Ulcers
InvacarE ® Limited
South Road · Bridgend Industrial Estate · BRIDGEND CF31 3PY
Tel. +44 (0) 1656 647327 · Fax +44 (0) 1656 649016
E-mail: [email protected] · Order: [email protected]
Web: www.invacare.co.uk
Preventing Pressure Ulcers · UK · 01/09 · Part-No. 1517303
© Invacare ® International SARL 2008. All Rights Reserved.
In keeping with our policy of continuous improvement, we reserve the right to modify designs without prior notice. All rights reserved.
None of the contents of this publication may be reproduced in any form without the prior permission of Invacare® Ltd.
Registered Trademarks of Invacare® Ltd : Softform, Flo-tech, Propad.
INVACARE ® Ireland Ltd
Unit 5 · Seatown Business Campus
Seatown Road · SWORDS · County Dublin
Tel. (353) 181 107 84 · Fax (353) 181 107 85
Email: ireland @invacare.com · Web: www.invacare.ie
Preventing
Pressure Ulcers
– A Patient’s Guide
This booklet has been produced by Invacare® Ltd. All rights reserved. None of
the contents of this booklet may be reproduced in any form without the prior
permission of Invacare® Ltd. This work is subject to copyright.
Introduction ...................................................................................................................... 2
What are Pressure Ulcers? ...................................................................................... 3
What Causes Pressure Ulcers? ............................................................................. 4
Who is at Risk of Developing a Pressure Ulcer? ..........................................5
Reducing the Risk .......................................................................................................... 7
Preventing Pressure Ulcers
Contents
Professional Advice ...................................................................................................... 8
How Should I Care For My Skin? ........................................................................ 9
Can Special Mattresses, Beds & Cushions Help? ....................................... 9
How Do I Check For Pressure Ulcers?........................................................... 10
Where Can I Find More Information On Pressure Ulcers? ............. 11
Bibliography .................................................................................................................... 12
1
Introduction
This booklet is for anyone who may be at risk of developing a
pressure ulcer. It contains advice drawn from a wide range
of professional nursing sources and national and international
government health agency publications.
Please note this booklet is not intended to replace advice or
treatment given by your health care professional/s.
2
A pressure ulcer is an area of damage to the skin and underlying
tissue caused by unrelieved pressure, shear or friction. Pressure
ulcers usually occur over the bony parts of the body; these
prominences are sometimes called the pressure points.
Seated
Preventing Pressure Ulcers
What are Pressure Ulcers?
Shoulder
Blades
Spinal
Protrusion
Elbows
Sacrum
Ischial
Tuberosity (IT)
Lying on Back
Heels
Toes
Heels
Back of
Sacrum Spine
Elbows Shoulder Head
Blades
Lying on Side
Knee
Ankle
(Internal & External)
Hip
Ear
Shoulder
Care must be taken to prevent pressure ulcers as they can be
painful and can become infected, and may take a long time to heal.
3
What Causes Pressure Ulcers?
Pressure - this is the direct force on the skin that is in contact with
the chair or mattress. This force squashes the skin between the chair or
mattress and the bony parts of the body. Pressure restricts the blood
supply to the squashed area and if prolonged can eventually cause tissue
to die resulting in a pressure ulcer.
Normally this pressure and squashing is not a problem because after a
while we become uncomfortable and change positions.
Body
Weight
Muscle
Bone
Tissue
Skin
Mattress
Shear – can occur when someone partially slips down the bed or chair,
the skin can stay stuck to the mattress or cushion distorting the underlying
tissues. This can cause damage to the skin.
Occiput
Shearing Force
Shoulder
Blades
Elbows
Toes
Sacrum
Surface of bed
Heels
Friction
4
Ischial
Tuberosity (IT)
Friction - this is when the skin is rubbed against another surface and
can occur when slipping down a chair or down the bed. This type of
damage is usually quite superficial and should heal without problems.
However for some ill or elderly people healing may be impaired and a
shallow ulcer might go on to become more serious.
There are a large number of contributing factors towards
the development of a pressure ulcer.
Mobility and Sensation
Pressure ulcers usually only occur when individuals have
restricted mobility and/or sensation.
Preventing Pressure Ulcers
Who is at Risk of Developing a
Pressure Ulcer?
Medical Condition
Some medical conditions can increase the risk of the
formation of a pressure ulcer for example, diabetes,
leg ulcers, stroke, spinal cord injury or some forms of
arthritis.
Medication
Some types of long-term medication such as Steroids,
anti-inflammatory and cytotoxic drugs can increase
the likelihood of skin damage by weakening the skin in
someway. If you are concerned about any medication you
are taking, you should discuss this with your doctor. You
should not stop taking medication before discussing it with
your doctor.
Circulation
Poor circulation causes a reduced blood flow to the legs and
feet making them more vulnerable to pressure ulcers. Heavy
smoking can also restrict blood flow.
5
Moisture
Moist skin from whatever source - urine, faeces, sweat, or a leaky wound
can weaken the skin, making it more vulnerable to breakdown from
pressure and shear. For this reason skin should be kept clean and dry.
Diet and fluids
Individuals who are underweight may be vulnerable to tissue
breakdown as they may have very prominent bony areas. Overweight
individuals may also be at increased risk due to excessive body
weight pressing on the bony prominences.
A healthy balance of protein, carbohydrate, fats, minerals, vitamins
and roughage all help to maintain healthy skin and are essential for
healing any wounds or pressure ulcers that may exist. A dietician or
nutritionist can advise you on an appropriate diet.
Fluids are also very important as they help to keep the skin healthy
and are a necessary component of digestion. Alcohol can increase
the likelihood of dehydration.
Previous Pressure Ulcers
If you have had pressure ulcers in the past which are now healed,
scar tissue could be present. Scar tissue can be weaker than the
original healthy tissue and can therefore be vulnerable to future
breakdown.
6
Change Your Position Regularly
Normally the most effective way of preventing pressure ulcers is to
relieve the pressure over the bony parts of the body in contact with the
chair cushion or mattress. Ideally this should be done, if safe to do so, by
standing and stretching or taking a walk.
If most of your day has to be spent sitting, and you are able to do so
safely, stand regularly e.g. every half hour or so.
Preventing Pressure Ulcers
Reducing the Risk
Relieve Pressure While You Are Sitting
If you are unable to stand without assistance, pressure can be relieved
by easing your bottom off the chair from time to time. Another way
of relieving the pressure is to rock from side to side from one bottom
cheek to the other or by leaning forward.
By returning to bed for parts of the day, where practical, the risk of
developing a pressure ulcer can be reduced. This will help to redistribute
your weight more evenly over the mattress, thereby giving greater
pressure relief to your bottom.
If most of your time has to be spent in bed this can be achieved by
regularly changing your position in bed.
Recumbent
Semi-recumbent
7
Professional Advice
If you are receiving professional care, staff should be able to
advise you on....
• How to sit or lie properly
• How to adjust your posture whilst sitting or lying
• The frequency of such changes to your posture
• How to keep a good posture
• Equipment that you should use such as mattress, bed, cushion and
chair
• Advice on foot wear and leg support
• How to inspect your skin and what to look for
• How to best care for your skin when washing and drying
8
Excessive moisture can soften the skin making it more vulnerable to
pressure ulcers.
Urine and faeces are particularly damaging as they contain enzymes
which can breakdown the skin.
When washing the skin a neutral pH soap or skin cleanser should be
used. The skin should be dried by dabbing with a soft towel. Rubbing
should be avoided as the friction can scuff and damage the skin.
Synthetic fibres next to the skin should be avoided as these encourage
sweating, weakening the skin and also increasing the risk of friction/
shearing.
Preventing Pressure Ulcers
How Should I Care For My Skin?
Can Special Mattresses, Beds and
Cushions Help?
Many different types of mattresses, beds and cushions are available to
help reduce the risk of pressure ulcers. Such items may be foam, gel or
air cushions and mattresses or even electrically powered systems.
If a special mattress, bed, cushion or chair has not been offered to you
and you feel that such an item may be of help, please discuss this with a
health professional involved in your care.
Softform Mattress
Flo-tech Cushion
9
How Do I Check For Pressure Ulcers?
Your skin should be assessed regularly for early signs of skin damage that
could lead to pressure ulcer formation. Discuss this inspection with your
carers as the frequency of re-inspection will vary upon your assessed
level of risk and changes over time depending on your general level of
health. You may want to do this yourself.
• On lighter skin, look for persistent red patches forming which do not
fade after re-positioning or bluish/purple patches on darker skin. Note
these might also be hot, cool or shiny with these signs not fading after
re-positioning. You should also look for...
• Swellings
• Dry areas
• Blisters or areas of torn skin which might be broken blisters
• Hard or soft patches of skin
• Change in skin colour
If you inspect your own skin, you may find it useful to use a mirror to see
difficult areas such as the bottom, shoulder blades or feet. Also try and
feel your skin over the bony prominences for hot or cool areas which
are especially important for dark skin as skin colour change may not be
noticeable.
If you, or your carer notice any changes in your skin you should inform a
Health Care Professional.
10
If you require further information, it is best to talk with your professional
health care staff.
Preventing Pressure Ulcers
Where Can I Find More
Information On Pressure Ulcers?
Useful Contacts
Doctor
Nurse
Other
Other
11
Bibliography
Anton, L. (2006) Pressure Ulcer Prevention in Older People who sit
for long periods. Nursing Older People. May ; 18,4.
Collins, F. (2001) Selecting cushions and armchairs: how to make an
informed choice. J Wound Care. 10 (10): 423-7
EPUAP European Pressure Ulcer Advisory Panel (1998). Guide to
Pressure Ulcer Grading. Available on line at: www.epuap.org
EPUAP European Pressure Ulcer Advisory Panel (1999). Pressure
Ulcer Treatment Guidelines. Available on line at: www.epuap.org
12
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertisement