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DFS Approved Curriculum-Unit 14 1
Unit 14Prevention of Pressure Ulcers
Nurse Aide I Course
DFS Approved Curriculum-Unit 14 2
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
DFS Approved Curriculum-Unit 14 3
DFS Approved Curriculum-Unit 14 4
14.0 Discuss pressure ulcers and methods used to prevent them.
DFS Approved Curriculum-Unit 14 5
Pressure Ulcers
• Previously called decubitus ulcers or bed sores
• Caused by pressure on area of skin that interferes with circulation
DFS Approved Curriculum-Unit 14 6
14.1 Identify areas where pressure ulcers most frequently occur.
DFS Approved Curriculum-Unit 14 7
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
DFS Approved Curriculum-Unit 14 8
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
DFS Approved Curriculum-Unit 14 9
14.1.2 List the methods used to prevent the formation of pressure ulcers.
DFS Approved Curriculum-Unit 14 10
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
DFS Approved Curriculum-Unit 14 11
Methods Used To PreventPressure Ulcers
(continued)
• Make sure clothing and shoes do not bind or constrict
• Pat skin dry when bathing; never scrub
• Encourage adequate nutrition and fluids
DFS Approved Curriculum-Unit 14 12
Methods Used To PreventPressure Ulcers
(continued)
• Massage pressure points when the resident is repositioned
• Report any changes in skin condition immediately
DFS Approved Curriculum-Unit 14 13
14.1.3 Identify devices used to prevent pressure ulcers.
DFS Approved Curriculum-Unit 14 14
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
DFS Approved Curriculum-Unit 14 15
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
DFS Approved Curriculum-Unit 14 16
14.1.4 Review the four stages of tissue breakdown and identify the nurse aide’s role in assisting with treatment.
DFS Approved Curriculum-Unit 14 17
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
• Tissue breakdown occurs in stages–Stage One - red, darkened or non-
blanchable skin, which is still present 30 minutes after pressure relieved
DFS Approved Curriculum-Unit 14 18
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
(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
DFS Approved Curriculum-Unit 14 19
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
(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
DFS Approved Curriculum-Unit 14 20
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
(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
DFS Approved Curriculum-Unit 14 21
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
(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
DFS Approved Curriculum-Unit 14 22
Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
(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
DFS Approved Curriculum-Unit 14 23
DFS Approved Curriculum-Unit 14 24
14.2 Identify three purposes for positioning residents.
DFS Approved Curriculum-Unit 14 25
Positioning
• Purposes–Assist with
examinations–Assist with procedures–Prevent pressure on
skin for prolonged periods of time
DFS Approved Curriculum-Unit 14 26
14.2.1 Discuss the various types of positions and suggest reasons for use.
DFS Approved Curriculum-Unit 14 27
Types Of Positions
• Dorsal recumbent position–flat on back–knees slightly separated and flexed–feet flat on bed
DFS Approved Curriculum-Unit 14 28
Types Of Positions(continued)
• Horizontal recumbent position – supine–flat on back–legs slightly separated and
extended
DFS Approved Curriculum-Unit 14 29
Types Of Positions(continued)
• Prone position
–flat on abdomen with head turned to side
–arms at sides or flexed on either side of head
DFS Approved Curriculum-Unit 14 30
Types Of Positions(continued)
• Side lying position
–positioned on either side
–head in straight line with spine
–pillows used to support head, back, arm, and leg
DFS Approved Curriculum-Unit 14 31
Types Of Positions(continued)
• Lateral position
–positioned on either side
–bottom arm extended behind back, top arm flexed in front of body
–top leg slightly flexed
DFS Approved Curriculum-Unit 14 32
Types Of Positions(continued)
• 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
DFS Approved Curriculum-Unit 14 33
Types Of Positions(continued)
• 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
DFS Approved Curriculum-Unit 14 34
Types Of Positions(continued)
• 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
DFS Approved Curriculum-Unit 14 35
DFS Approved Curriculum-Unit 14 36
14.3 Discuss moving, turning, positioning and lifting residents.
DFS Approved Curriculum-Unit 14 37
Moving, Turning, PositioningAnd Lifting
• Good body mechanics necessary
–Prevents injury to resident
–Protects nurse aide from injury
–Good body alignment promotes comfort for resident
DFS Approved Curriculum-Unit 14 38
Moving, Turning, PositioningAnd Lifting(continued)
• Safety major consideration
–Get help if needed
–Receive directions from supervisor regarding any restrictions for positioning or movement
DFS Approved Curriculum-Unit 14 39
Moving, Turning, PositioningAnd Lifting(continued)
• 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
DFS Approved Curriculum-Unit 14 40
Moving, Turning, PositioningAnd Lifting(continued)
• Safety major consideration (continued)–Protect skin from friction
• roll when possible• lift with assistance• prevent sliding• use turning sheet
DFS Approved Curriculum-Unit 14 41
Moving, Turning, PositioningAnd Lifting(continued)
• Use postural supports as directed:
–Rolled blankets
–Pillows
–Rolled towels
–Footboards
–Bed cradles
DFS Approved Curriculum-Unit 14 42
Moving, Turning, PositioningAnd Lifting(continued)
• Reposition at least every two hours or as directed–Eliminates pressure on bony areas–Provides comfort–Exercises muscles–Moves joints–Stimulates circulation
DFS Approved Curriculum-Unit 14 43
Moving, Turning, PositioningAnd Lifting(continued)
• 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
DFS Approved Curriculum-Unit 14 44
Moving, Turning, PositioningAnd Lifting(continued)
• Coordinate lifting and moving (continued)
–Use transfer belt (gait belt) when appropriate
–When in doubt, always ask for assistance from co-workers
DFS Approved Curriculum-Unit 14 45
DFS Approved Curriculum-Unit 14 46
14.4 Demonstrate the procedure for moving the resident up in bed.
DFS Approved Curriculum-Unit 14 47
14.5 Demonstrate the procedure for moving a resident up in bed using a turning sheet.
DFS Approved Curriculum-Unit 14 48
14.6 Demonstrate the procedure for positioning a resident on side.
DFS Approved Curriculum-Unit 14 49
DFS Approved Curriculum-Unit 14 50
14.7 Discuss repositioning the resident in a chair or wheelchair.
DFS Approved Curriculum-Unit 14 51
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
DFS Approved Curriculum-Unit 14 52
Repositioning Resident In ChairOr Wheelchair
(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
DFS Approved Curriculum-Unit 14 53
Repositioning Resident In ChairOr Wheelchair
(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 14 54