Nurses Key Role in Pressure Ulcer Prevention

What is Bedsore or Pressure Ulcer?

A bed sore, also known as a pressure ulcer, develops when there is too much-unrelieved pressure or friction on one part of the body. This condition is more common in bedridden patients, who spend a long time in one position, for example, because of paralysis, illness, old age, or frailty.

Pressure ulcer prevention guidelines
Fig: Pressure ulcer prevention guidelines

Nursing Management of Pressure Ulcer or Bedsores:

Nursing management and precautions help to prevent pressure ulcers from occurring. The aim of the nursing intervention is to reduce the number of pressure ulcers in people admitted to secondary or tertiary care or receiving NHS care in other settings, such as primary and community care and emergency departments. Some important nursing care for pressure ulcer has pointed out the below:

  1. Use the Braden scale to identify the risk level of the patient.
  2. Position the patient every 2 hours to stop pressure ulcer forming.
  3. When repositioning the patient, look at all areas of the skin daily. (Regular inspection of the following areas is required: sacrum, heels, elbows, a temporal region of skull, shoulders, and toes).
  4. Prevent friction and shearing forces during re-positioning and transfers the patient.
  5. Avoid raising the head of the bed more than 30 degrees to prevent the patient from sliding down the bed.
  6. Support the leg with a cushion below the knees and never place cushioning or pillows directly under the knees.
  7. Heels must be suspended off the bed using gel pads or pillows.
  8. Have to provide pressure reduction via the use of cushions, foams, or mattress overlays.
  9. Avoid the use of plastics (underpads and diapers) choose liner or fabric instead.
  10. Avoid Massage and vigorously rubbing of bony prominences area.
  11. Reposition tubes and face masks every two hours.
  12. Keep the skin dry and moisture-free. Wash skin daily and apply a barrier cream.
  13. To reduce the risk of skin damage; consider using a skin moisturizer to hydrate dry skin.
  14. Avoid applying lotion between toes.
  15. Use pH balanced soaps or skin cleansers to clean skin and wash skin gently with water.
  16. Inspect for risk areas of redness and warmth as the beginning signs of pressure ulcer forming.
  17.  Investigate the incontinence of the patient; develop and implement an individualized continence management plan.
  18. Cleanse the skin promptly following episodes of incontinence.
  19. Maintain adequate nutrition and hydration for high or very high-risk patients and be referred to a dietician for a nutritional assessment and appropriate dietary recommendations.
  20. Provide high nutritional support to prevent or correct nutritional deficits such as achieve positive nitrogen balance and maintain serum albumin levels.
  21. Manage pain properly so that patient can be able to move or be moved at frequent intervals.
  22. Have to determine accurate topical wound care based on assessment findings to promote healing.
  23. Assess and recommend appropriate dressing or support surfaces.
  24. Protect the area from friction, shear, and maceration using a transparent film dressing or thin hydrocolloids.
  25. Use solid or liquid barriers to protect peri-wound skin from maceration damage.
  26. Irrigate with normal saline using a 20-35 ml syringe and 19 gauge needles or angiocath.
  27. Place 4×4 Gauze packed loosely and fills dead space with appropriate filler (including sinus tracts).
  28.  Protect from contamination by using an absorbent outer semi-occlusive dressing.
  29. Provide debridement of nonviable tissue as appropriate and do not debride stable hard dry eschar in ischemic limbs.
  30. Develop useful procedures and policies that are research and evidence-based to advance the clinical practice of nursing staff.
  31. Provide patient and family education on prevention and management of pressure ulcers.
  32. Consult wound care specialist or physician to evaluate wounds that show signs of infection or fail to progress.
  33. Use oral antibiotics or antibiotic cream help to treat an infection.

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