1. Pressure Ulcers Module #3 Diane L. Krasner PhD, RN, FAAN &
Lia van Rijswijk
DNP, MSN, RN, CWCN
Module #3

2. Objectives
To define pressure ulcers, common risk factors and anatomical locations
To distinguish pressure ulcer categories/stages
To identify general intervention strategies for pressure ulcers
To correlate pressure ulcers to nursing concepts, nursing diagnoses and practice issues

5. Common Risk Factors Pressure Shear Friction Moisture
Immobility: Bedfast or chairfast individuals
Poor nutritional status
Compromised perfusion and oxygenation
Less-than-optimal general health status
Patients at end of life
Existing pressure ulcer or history of pressure ulcers

6. Risk Assessment Scales
Most commonly used pressure ulcer risk assessment tools in North America:
Braden Scale
Norton Scale
Waterloo Scale
Remember: Recognize additional risk factors and use clinical judgement when using a risk assessment tool (NPUAP 2014)
Braden, B.J. & Blanchard, S. (2014). Risk assessment in pressure ulcer prevention. In: Krasner D.L. (ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications. Downloadable at

7. Pressure Ulcer Classification with the International NPUAP/EPUAP/PPPIA Pressure Ulcer Classification System
Pressure Ulcer Classification (staging) is an important component of pressure ulcer assessment.
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia; Van Rijswijk, L. & Eisenberg, M. (2014). Wound assessment and documentation. In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA, HMP Communications. Downloadable at

8. Normal Skin
© NPUAP Used with permission

16. General Intervention Strategies for Pressure Ulcer Prevention
Turning & Repositioning
Careful Lifting
Reduce HOB ≤ 30 degrees
Elevate Heels
Support Surfaces (bed, chair) / Offloading Devices
Topical Treatments
Nutrition & Hydration
Incontinence Care

17. Key Nursing Concepts Assessment Caring Communication Ethics
Evidence-based practice
Infection
Infection Control
Pain
Patient Education
Prevention
Self Care Deficit
Safety
Tissue Integrity

18. Key Nursing Diagnoses Potential for Alteration in Skin Integrity
Tissue Integrity
Impaired Skin Integrity
Impaired Tissue Integrity
Oral Mucous Membranes, Altered
Knowledge Deficit r/t
Self Care Deficit r/t

19. Key Nursing Practice Issues
Avoidable vs. Unavoidable Pressure Ulcers
End of Life Pressure Ulcers
(Kennedy Terminal Ulcers, Skin Failure, SCALE Wounds)
Medical Malpractice related to Pressure Ulcers

20. Websites for Further Information on Pressure Ulcers
- Association for the Advancement of Wound Care
- Canadian Association for Wound Care
EEuropean Pressure Ulcer Advisory Panel
- National Pressure Ulcer Advisory Panel
- World Union of Wound Healing Societies
- Wound Ostomy Continence Nurses Society

21. Websites for Further Information on Pressure Ulcers at the End of Life
Kennedy Terminal Ulcer
Skin Changes At Life’s End
SCALE Wounds

22. Additional Websites for Information on Pressure Ulcer Prevention & Care
Agency for Health Research and Quality (AHRQ):
Pressure Ulcers in Hospitals: A toolkit for improving quality of care. ( ulcertoolkit/)
AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention (