Nurse Teaching on How to Prevent Pressure Ulcer Development

Nurse educated the patient/caregiver on following measures to help prevent pressure ulcer development:

1.  Discourage prolonged bedrest and promote ambulation & weight bearing, unless bedrest is medically recommended. Activity and ambulation can help prevent excessive pressure on dependent body parts and thus prevent development of pressure ulcers.
2. Change your position frequently, every 15 – 20 minutes, which can help with shifting the weight evenly and prevent excessive pressure on any one spot of the skin, thus helping to prevent pressure ulcer development.
3. In individuals with limited independence for position change and compromised ability for ADL performance, caregivers must follow a 30 minute – one hour scheduled pattern for changing the patient’s position in the bed or wheelchair, to avoid any incidents of skin breakdown.
4. Wheelchair and bedbound patients must keep a regular close watch for symptoms of evolving pressure ulcers on the skin of dependent body parts, such as, black/blue discoloration, pale color, local changes with temperature, loss of sensitivity, pain, tenderness, swelling, and/or drainage & report them to the health care personnel, to prevent progression of the injury and facilitate an early intervention. Caregivers must extend assistance to watch for symptoms of evolving pressure ulcers, as needed.
5. Wheelchair and bedbound patients must be encouraged for exercises to improve the upper body and arm strength, as tolerated and allowed. Better upper body and arm strength can allow more independence with frequent position change and relieve pressure on the vulnerable areas of skin prone for breakdown.
6. Bedbound patients can be periodically turned onto their sides, their back supported with the help of pillows and cushions. Wheelchair bound patients could be safely tilted onto their sides, to reposition them and redistribute the weight, to help prevent pressure ulcer development.
7. Excessive elevation of head of bed can lead to sliding down low in the bed and shearing injury of skin, which can lead to pressure ulcer development. Elevate the head of your bed to no more than 30 degrees. This can help prevent sliding down in the bed, avoid any shearing injury to the skin, and prevent development of pressure ulcers.
8. In patients undergoing prolonged bedrest, having pillows under the back of legs, with the heels floating and not resting on the bed surface, can help prevent pressure ulcer development on the heels.
9. Doughnut cushions were used to prevent any excessive pressure on the wound sites. Discourage use of doughnut cushions, as they can result in increased pressure on the skin surrounding the wound site, thus deteriorating the wound further.
10. Poor fluid intake is an important risk factor for pressure ulcer development. Observe compliance with recommended fluid intake to help pressure ulcer prevention. An average adult in general could be needing 2.5 liters to 3 liters of fluid in a day and requirements could vary subjective to an individual’s metabolism and activity levels. Individuals with any heart & kidney complaints and recommended fluid intake limitations, must comply with the recommendation made.
11. Protein and nutrition intake are needed for maintenance, repair of damaged skin tissue and restoration of normal skin integrity. Reduced protein and nutrition intake contribute heavily to poor tissue repair, damage to skin integrity, and pressure ulcer development. Observe compliance with recommended protein and nutrition intake to help promote skin integrity, timely repair of damaged tissues, and pressure ulcer prevention.
12. Caregiver must exercise caution during moving/transporting/dressing/changing the position of patients, to prevent the patient being dragged along the surface of bed. To provide assistance for these tasks, caregivers must arrange for needed help, for a clean and complete lifting of the patient from the surface of contact, which can prevent any friction damage to the skin and consequent breakdown.
13. Maintain the skin on vulnerable body parts and around the genital areas clean and dry. Cleanse the skin regularly with a mild cleanser and pat dry the sites. Applying gentle moisturizer to areas of dry skin can help prevent breakdown. Applying mild talcum powder to the skin in areas of excessive perspiration and friction can help ease the skin, reduce irritation, and offer soothing in such areas.
14. Continuous moisture in individuals with excessive perspiration, fecal incontinence, urinary incontinence, and draining wounds can damage the skin and lead to pressure ulcer development. Gently cleanse the patient’s involved skin using a mild cleanser, pat dry the area, and change the patient’s bedsheets & clothing, as needed, to prevent any damage to skin due to the moisture.