Geriatric Quick Consult      Pressure Ulcers      Do #8

Remember prevention.

Knowledge Action

Pressure ulcers occur most often in patients who are bed- or chairbound or who cannot reposition themselves.

Prevalence is higher in several hospital subgroups:

  • critical care
  • quadriplegics
  • elderly with femoral fractures
  • neurosurgical or stroke patients.

Most occur in the elderly and most occur below the waist.

At-risk patients can be identified.

Risk factors include: immobility, altered consciousness, malnutrition, incontinence, stroke, contractures, sensory loss.

Identify and modify risk factors if possible to decrease the risk of pressure ulcers.

Clinical evidence suggests repositioning every 2 hours can prevent tissue damage in most patients, although very high-risk patients may need more frequent turning.

  • Identify risk factors.


  • Modify risk factors.


  • Reposition every 2 hours.

Pressure reduction interventions:

  1. Mobilize patient as much as possible
  2. Reposition frequently
  3. Use pressure-reducing cushions or mattresses when appropriate.
  4. Position bedbound patient at 30 degree angles to bed surface to avoid pressure directly over greater trochanters.
  5. Reposition patients sitting in wheelchairs and consider cushions.
  • Implement a pressure ulcer prevention program for all high risk patients.
A variety of screening tools have been used to identify high risk patients.

Two in common use are the Braden scale2 and the Norton scale3.

The Braden scale includes an evaluation of mobility, moisture, nutritional status, and consciousness.
  • Use screening tools to target extra attention for high risk patients:


    • Braden scale.


    • Norton scale.
Mattresses that decrease skin surface pressure to below capillary filling pressure (about 25-35 mm Hg) also may help prevent skin damage1.

Don't forget shear forces: when head of bed is raised the patient slides down and traction occurs on the skin and over the sacrum and buttocks. This can disrupt blood supply to these areas.

Friction can cause skin damage when patient is dragged across bed sheets causing abrasions.

When excessive moisture is present (urine, perspiration), the skin injury can be greater.
  • Use matresses that decrease skin surface pressure.


  • Remember shear forces.

References:

  1. Ferrell BA. Pressure ulcers. In Reuben DB, Yoshikawa TT, Besdine RW (eds.) Geriatrics Review Syllabus 3rd ed. Dubuque, Iowa: Kendall/Hunt Publishing Company for the American Geriatrics Society: 1996.
  2. Braden BJ, Bergstrom N. Clinical utility of the Braden scale for predicting pressure sore risk. Decubitus. 1989; 2(3): 44-51.
  3. Norton D. Calculating the risk: reflections on the Norton scale. Decubitus 1989; 2(3): 24.
[home]