Pressure Injuries: Risk factors & Interventions

• Risk factors for pressure ulcers include being bedridden, immobile, or experiencing stroke-related paralysis.
• Nerve damage that compromises pain perception and feelings is a risk factor, as is incontinence.
• Use the Braden Scale to assess risk factors, considering sensory perception, mobility, friction, and nutrition.
• Pressure injury problems are linked to impaired communication, lack of awareness, and delays in getting help.

Interventions for Pressure Injuries

• Reposition patients every 2 hours for universal pressure injury prevention.
• Use pressure-relieving devices such as air mattresses, heel protectors, and wedges.
• Use gel seat cushions, inflatable waffle cushions, air mattresses, or memory foam in wheelchairs, directing patients to shift weight.

Blood Work and Pressure Injuries

• Prealbumin levels (normal range: 15-36ml/dl) are relevant.
• Monitor WBC to track infection progress.
• Anemia and dehydration are not directly related to pressure injuries.

Preventing Injuries When Moving Patients

• Use transfer devices like a Hoyer lift, mechanical lift, overhead trapeze, or friction sheet.

Managing Incontinence

• Implement voiding routines and bladder and bowel training programs, taking patients to the restroom every two hours.
• Clean and dry patients after accidents, applying skin protectant before reapplying the diaper.
• Educate them about voiding and advise against caffeinated drinks like coffee, tea, and soda.
• Incontinent patients are more likely to get pressure injuries and infections (UTIs such as cystitis or pyelonephritis).
• Poor care of incontinent patients can lead to rash (dermatitis).

Falls

• Risk factors for falls include poor balance (stroke, paralysis) and altered mental status or confusion.

Home Safety

• Look for loose rugs, lighting issues, clutter, and lack of assistive devices.
• Hospitals have grab bars (showers, room), shower chairs, and railings.

Fall Risk Patients

• Check on patients hourly.
• Constantly remind them to call for help.
• Use bed alarms to monitor when they are getting up.
• Fall risk is indicated by a fall risk band, a falling star outside the door with the patient's name, and notations for NPO, allergies, and code status (DNR).
• Use a gait belt for patients with balance issues.

Abuse Reporting

• Report to the supervisor first, then the ombudsman, and law enforcement if an injury is suspected.

Walker Use

• When supervising a patient using a walker on the sidewalk, be aware of curbs.
• To navigate a curb, pick up the walker and lift it.
• Night lights are good for patients.
• Alzheimer's patients need to be redicrected.

Caregiver Role Strain

• Symptoms include irritability, changes in physical appearance, weight loss and eye bags.

Mental Status Examination

• Affect (emotional expressions), patient behavior and appearance and memory (short-term and long-term) are measured.
• Active listening and asking open-ended questions can help discover underlying sources of stress.
• Successful dementia units offer scheduled activities, routines, limit choices.
• Dementia is not reversible, while delirium is acute.
• Delirious elderly patients may pace, talk to themselves, hear things, climb out of bed, yell, scream, or become combative.
• Advise patients that are about to pee to hold their breath.

Examine the risk factors for pressure ulcers, including immobility, nerve damage, and incontinence. Learn appropriate interventions include repositioning patients and using pressure-relieving devices. Also, learn about the role of blood work, especially prealbumin levels, in pressure injury management.