Pressure ulcers are preventable and it can develop on immobilized( bedridden) persons faster than we think.Studies show that about 50% of pressure ulcer can develop in few hours. Assessment of all patients for pain related to pressure ulcer is very important. Health care providers should not assume that because a patient did not complain of pain does not mean that the patient is not in pain.Controlling the source of pain is critical in healing the patient physical and emotional wounds
Patients with pressure ulcer need to undergo psychological assessment in order to determine if they fully understand the disease process and are willing and ready to comply with the recommended treatment program that are needed.Their assessment should include history of polysubstance abuse,polypharmacy, mental health, support system, resources,financial services,availability of caregivers at home upon discharge to help with bath ,wound care,dressing change, feeding, ability to learn and retain.
There are some recommendations on how to prevent and manage pressure ulcers.
- Keep the patient skin clean by sponge bedbath or other types of baths.Dry the skin with clean towel and apply moisturizing body cream. Moisturize the skin thoroughly.
- Do not massage the legs but keep the muscles active.Elevate lower extremities and float the heel of the feet from the foot of the bed.
- Do not apply pressure on bony prominence areas. Rather relieve pressure over bony prominence.
- Encourage patients to eat nutritional meals and drink plenty of water. Provide vitamins and mineral supplements if patients are deficient. These can be confirmed through laboratory tests and results. If lack of important vitamins continues,nutritional support such as tube feeding will be recommended by Dietitian per doctor orders and used to place patient into positive nitrogen balance required. Approximately around 30 to 35calories/kg/day and about 1.25 to 1.5grams of protein/kg/day.This is according to the recommended goals of care.
- Intake and Output : Monitor patient intake and output. Is patient taking adequate fluids?Does patient have adequate output to compare with what patient took in.The nurse should keep track of amount of urine and bowel movement each shift.
- Use devices such as pillows or foam so that contact between bony prominences such as ankles, hip, knees are prevented.Do not use DONUT shaped devices.
- Change patient position every two hours while in bed and every one hour if patient is in the wheelchair. It is important to reposition the patient while sitting so that points under pressure are shifted every one hour. If this goal will not be met,return the patient to bed.If patient is able to shift weight while in bed, patient should be encouraged and taught to shift their weight every 15minutes .
- Use of overhead Trapeze to help patient reposition self in bed.
- Head of bed should be in the lowest position as ordered by the doctor unless contraindicated.
- Red areas over bony prominence should not be rubbed.Do not position patient directly on the wound .#health, #woundcare,#painassessment,#prevention of pressure ulcer.