DFS Approved Curriculum-Unit 141 Unit 14 Prevention of Pressure Ulcers Nurse Aide I Course

DFS Approved Curriculum-Unit 14 1

Unit 14Prevention of Pressure Ulcers

Nurse Aide I Course

Prevention Of Pressure Ulcers

As a direct care giver, the nurse aide will be the key team member in the prevention of pressure ulcers.

Knowledge of the relationship between blood supply and tissue destruction, as well as the skills necessary to properly position residents to minimize the effects of pressure, are essential.

Introduction

14.0 Discuss pressure ulcers and methods used to prevent them.

Pressure Ulcers

• Previously called decubitus ulcers or bed sores

• Caused by pressure on area of skin that interferes with circulation

14.1 Identify areas where pressure ulcers most frequently occur.

Pressure Ulcers(continued)

• Occur where bones come close to the skin surface.–toes, heels, ankles, knees–hips, elbows, shoulders–spine (especially tailbone area)–ears, cheeks, collarbone area–back of head

Pressure Ulcers(continued)

• Can develop where areas of body rub together and moisture collects, especially in obese residents–Under breasts–Between folds of abdomen–Between crease of buttocks–Between thighs

14.1.2 List the methods used to prevent the formation of pressure ulcers.

Methods Used To PreventPressure Ulcers

• Keep skin clean and dry• Reposition residents at least

every two hours• Keep linen dry and free of

wrinkles and objects that cause pressure to the skin

• Clean urine and feces from skin as soon as possible

(continued)

• Make sure clothing and shoes do not bind or constrict

• Pat skin dry when bathing; never scrub

• Encourage adequate nutrition and fluids

(continued)

• Massage pressure points when the resident is repositioned

• Report any changes in skin condition immediately

14.1.3 Identify devices used to prevent pressure ulcers.

Preventive Devices Used To Prevent Pressure Ulcers

• Bed cradle• Heel and elbow protectors• Flotation pads or cushions• Pillows• Water beds• Alternating pressure

mattresses• Eggcrate mattresses

Pressure Ulcers: Stages Of Tissue Breakdown And Treatment

14.1.4 Review the four stages of tissue breakdown and identify the nurse aide’s role in assisting with treatment.

• Tissue breakdown occurs in stages–Stage One - red, darkened or non-

blanchable skin, which is still present 30 minutes after pressure relieved

(continued) • Tissue breakdown occurs in stages

–Stage One (continued)• position off area and report; do not massage

• observe every 2 hours and report changes to supervisor

(continued) • Tissue breakdown occurs in stages

–Stage Two - addition of blister-like lesions; skin may be broken• position off area at all times• report need for dressing changes• report odor, drainage, any change in size

(continued)

• Tissue breakdown occurs in stages

–Stage Three - skin tissue is destroyed and fatty tissue may be involved; infection and eschar (scab) may result

• continue prevention practices

• report any changes in area

(continued)

• Tissue breakdown occurs in stages–Stage Four - skin, fatty tissue

destroyed and muscle and bone involved. • continue prevention practices • report any changes in area

(continued)• Tissue breakdown occurs in stages

–Stage Four (continued)• report any signs of systemic infection, including but not limited to: –wound odor –pain –elevated temperature with

confusion

14.2 Identify three purposes for positioning residents.

Positioning

• Purposes–Assist with

examinations–Assist with procedures–Prevent pressure on

skin for prolonged periods of time

14.2.1 Discuss the various types of positions and suggest reasons for use.

Types Of Positions

• Dorsal recumbent position–flat on back–knees slightly separated and flexed–feet flat on bed

Types Of Positions(continued)

• Horizontal recumbent position – supine–flat on back–legs slightly separated and

extended

• Prone position

–flat on abdomen with head turned to side

–arms at sides or flexed on either side of head

• Side lying position

–positioned on either side

–head in straight line with spine

–pillows used to support head, back, arm, and leg

• Lateral position

–positioned on either side

–bottom arm extended behind back, top arm flexed in front of body

–top leg slightly flexed

• 30 Lateral Reclined Position

–hips rotated 30 degrees

–pillow between knees

–pillow under arm for comfort and to relieve pressure on elbow

–pressure relieved from sacrum and hip

• Fowler’s position

–sitting position in bed with head elevated at 45-60 degree angle.

–knees slightly flexed

–position causes pressure on sacrum and buttocks

• Sim's position

–positioned on left side

–left arm extended behind body

–right arm flexed in front of body

–right leg flexed toward abdomen

–used for enema administration

14.3 Discuss moving, turning, positioning and lifting residents.

Moving, Turning, PositioningAnd Lifting

• Good body mechanics necessary

–Prevents injury to resident

–Protects nurse aide from injury

–Good body alignment promotes comfort for resident

Moving, Turning, PositioningAnd Lifting(continued)

• Safety major consideration

–Get help if needed

–Receive directions from supervisor regarding any restrictions for positioning or movement

• Safety major consideration (continued)

–Protect and secure any special equipment being used by the resident prior to movement (e.g., drainage tubes).

–Elevate bed to comfortable working level

• Safety major consideration (continued)–Protect skin from friction

• roll when possible• lift with assistance• prevent sliding• use turning sheet

• Use postural supports as directed:

–Rolled blankets

–Pillows

–Rolled towels

–Footboards

–Bed cradles

• Reposition at least every two hours or as directed–Eliminates pressure on bony areas–Provides comfort–Exercises muscles–Moves joints–Stimulates circulation

• Coordinate lifting and moving–Move on a certain count, usually

count of three–Gain cooperation of resident–Have residents help themselves as

much as possible

• Coordinate lifting and moving (continued)

–Use transfer belt (gait belt) when appropriate

–When in doubt, always ask for assistance from co-workers

14.4 Demonstrate the procedure for moving the resident up in bed.

14.5 Demonstrate the procedure for moving a resident up in bed using a turning sheet.

14.6 Demonstrate the procedure for positioning a resident on side.

14.7 Discuss repositioning the resident in a chair or wheelchair.

Repositioning Resident In ChairOr Wheelchair

• Reasons for changing position every two hours or as directed

–Promotes comfort

–Reduces pressure

–Increases circulation

–Exercises joints

–Promotes muscle tone

(continued)

• Body kept in good alignment with head in straight line with spine

• Plastic or vinyl surface of chair covered, with use of pressure-relieving cushion preferred

• Pillows or soft blankets used for support

(continued)

• Feet rest on floor or footrest of wheelchair

• Hips positioned well back in chair

• Weight shifting utilized in between repositioning

DFS Approved Curriculum-Unit 141 Unit 14 Prevention of Pressure Ulcers Nurse Aide I Course

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