Reducing a Patient’s Risk for Pressure Injuries
There is no single preventive for pressure injuries. Give priority to pressure relief. Reduce other risks to help maintain a healthy flow of nutrients to the patient’s skin.
Promote good nutrition
Cells regenerate more quickly when nutrition is supplemented. To identify malnutrition, weigh the patient and review blood test results. Consult with a dietitian and doctor about any dietary adjustments:
Feed the patient more frequently.
Order foods high in protein and calories.
Give vitamin supplements.
Use tube feedings, if necessary.
Relieving pressure is the single most important factor in preventing and treating pressure injuries.
You can relieve pressure and restore the skin’s blood supply by repositioning the patient and using special devices. Post a schedule to remind you to reposition the patient — from side to back or from stomach to side. Make minor position changes even more frequently. Specially designed pillows, beds, or mattresses can also help reduce pressure.
In a bed
Use pillows under calves to elevate the legs from above the knees to the ankles.
Alter the angles of arms and legs.
In a wheelchair
Be sure the wheelchair is the proper size for the patient to give optimal support. For example, if the seat it too narrow, it will put extra pressure on the hips.
Cushion the back and buttocks with pillows or wheelchair cushions, and pad the footrest.
Use a special wheelchair cushion that is designed to distribute weight evenly and relieve pressure points.
Have special cushions tested and adjusted at the proper times as recommended by the manufacturer. This will allow the pressure relief to remain effective.
Keep skin clean and lubricated, but free of excess moisture. Put the patient on a regular toilet schedule. Use incontinent devices, if appropriate. Consult with a doctor about using diarrhea medicines:
Use talc-free powders or barrier creams.
Place towels between skin folds.
Pat skin dry after bathing.
Lubricate skin with lotion.
Reduce shear and friction
Prevent skin breakdown by reducing friction and shear. Patients are less likely to slide down in bed if they’re supported by pillows and the head of the bed isn’t raised too high. During bed or wheelchair transfers, lift—don’t drag—the patient. If you can’t do this alone, get help. And be sure to use assistive devices, whenever possible.
In a bed
Use draw-sheets or transfer boards to move patients.
Clean and smooth the bed surface.
Lift the head of the bed no more than 30°.
Raise the foot of the bed slightly.
In a wheelchair
Support the patient’s back with a pillow.
Use a foot extension.
March 14, 2018
Agency for Healthcar Research and Quality, Patient Safety and Quality, An Evidence Based Handbook for Nurses, 2008, Pressure Ulcer Treatment Strategies A Systematic Comparative Effectiveness Review. Smith, M. Archives of Physical Medicine and Rehabilitation. 2013, is. 159, ed. 1, pp.39-50., Stephens, M., Understanding the association between pressure ulcers and sitting in adults what does it mean for me and my carers? Journal of Tissue Viability (2017)
Freeborn, Donna, PhD, CNM, FNP,Hurd, Robert, MD