1. Unit 14 Prevention of Pressure Ulcers
Nurse Aide I Course
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2. Prevention Of Pressure Ulcers
Introduction
As a direct care giver, the nurse aide will be the key team member in the prevention of pressure ulcers.
Knowledge of the relationship between blood supply and tissue destruction, as well as the skills necessary to properly position residents to minimize the effects of pressure, are essential.
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Pressure Ulcers
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Objective
14.0 Discuss pressure ulcers and methods used to prevent them.
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Pressure Ulcers
Previously called decubitus ulcers or bed sores
Caused by pressure on area of skin that interferes with circulation
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Objective
14.1 Identify areas where pressure ulcers most frequently occur.
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7. Pressure Ulcers (continued)
Occur where bones come close to the skin surface.
toes, heels, ankles, knees
hips, elbows, shoulders
spine (especially tailbone area)
ears, cheeks, collarbone area
back of head
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8. Pressure Ulcers (continued)
Can develop where areas of body rub together and moisture collects, especially in obese residents
Under breasts
Between folds of abdomen
Between crease of buttocks
Between thighs
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Objective
List the methods used to prevent the formation of pressure ulcers.
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10. Methods Used To Prevent Pressure Ulcers
Keep skin clean and dry
Reposition residents at least every two hours
Keep linen dry and free of wrinkles and objects that cause pressure to the skin
Clean urine and feces from skin as soon as possible
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11. Methods Used To Prevent Pressure Ulcers (continued)
Make sure clothing and shoes do not bind or constrict
Pat skin dry when bathing; never scrub
Encourage adequate nutrition and fluids
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12. Methods Used To Prevent Pressure Ulcers (continued)
Massage pressure points when the resident is repositioned
Report any changes in skin condition immediately
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Objective
Identify devices used to prevent pressure ulcers.
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14. Preventive Devices Used To Prevent Pressure Ulcers
Bed cradle
Heel and elbow protectors
Flotation pads or cushions
Pillows
Water beds
Alternating pressure mattresses
Eggcrate mattresses
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15. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
Prevention is
best treatment
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Objective
Review the four stages of tissue breakdown and identify the nurse aide’s role in assisting with treatment.
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17. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment
Tissue breakdown occurs in stages
Stage One - red, darkened or non-blanchable skin, which is still present 30 minutes after pressure relieved
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18. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment (continued)
Tissue breakdown occurs in stages
Stage One (continued)
position off area and report; do not massage
observe every 2 hours and report changes to supervisor
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19. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment (continued)
Tissue breakdown occurs in stages
Stage Two - addition of blister-like lesions; skin may be broken
position off area at all times
report need for dressing changes
report odor, drainage, any change in size
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20. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment (continued)
Tissue breakdown occurs in stages
Stage Three - skin tissue is destroyed and fatty tissue may be involved; infection and eschar (scab) may result
continue prevention practices
report any changes in area
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21. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment (continued)
Tissue breakdown occurs in stages
Stage Four - skin, fatty tissue destroyed and muscle and bone involved.
continue prevention practices 
report any changes in area
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22. Pressure Ulcers: Stages Of Tissue Breakdown And Treatment (continued)
Tissue breakdown occurs in stages
Stage Four (continued)
report any signs of systemic infection, including but not limited to: 
wound odor 
pain 
elevated temperature with confusion 
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Positioning
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Objective
14.2 Identify three purposes for positioning residents.
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Positioning
Purposes
Assist with examinations
Assist with procedures
Prevent pressure on skin for prolonged periods of time
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Objective
Discuss the various types of positions and suggest reasons for use.
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Types Of Positions
Dorsal recumbent position
flat on back
knees slightly separated and flexed
feet flat on bed
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28. Types Of Positions (continued)
Horizontal recumbent position – supine
flat on back
legs slightly separated and extended
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29. Types Of Positions (continued)
Prone position
flat on abdomen with head turned to side
arms at sides or flexed on either side of head
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30. Types Of Positions (continued)
Side lying position
positioned on either side
head in straight line with spine
pillows used to support head, back, arm, and leg
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31. Types Of Positions (continued)
Lateral position
positioned on either side
bottom arm extended behind back, top arm flexed in front of body
top leg slightly flexed
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32. Types Of Positions (continued)
30 Lateral Reclined Position
hips rotated 30 degrees
pillow between knees
pillow under arm for comfort and to relieve pressure on elbow
pressure relieved from sacrum and hip
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33. Types Of Positions (continued)
Fowler’s position
sitting position in bed with head elevated at degree angle.
knees slightly flexed
position causes pressure on sacrum and buttocks
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34. Types Of Positions (continued)
Sim's position
positioned on left side
left arm extended behind body
right arm flexed in front of body
right leg flexed toward abdomen
used for enema administration
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Moving, Turning,
Positioning
And Lifting
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Objective
14.3 Discuss moving, turning, positioning and lifting residents.
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37. Moving, Turning, Positioning And Lifting
Good body mechanics necessary
Prevents injury to resident
Protects nurse aide from injury
Good body alignment promotes comfort for resident
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38. Moving, Turning, Positioning And Lifting (continued)
Safety major consideration
Get help if needed
Receive directions from supervisor regarding any restrictions for positioning or movement
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39. Moving, Turning, Positioning And Lifting (continued)
Safety major consideration (continued)
Protect and secure any special equipment being used by the resident prior to movement (e.g., drainage tubes).
Elevate bed to comfortable working level
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40. Moving, Turning, Positioning And Lifting (continued)
Safety major consideration (continued)
Protect skin from friction
roll when possible
lift with assistance
prevent sliding
use turning sheet
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41. Moving, Turning, Positioning And Lifting (continued)
Use postural supports as directed:
Rolled blankets
Pillows
Rolled towels
Footboards
Bed cradles
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42. Moving, Turning, Positioning And Lifting (continued)
Reposition at least every two hours or as directed
Eliminates pressure on bony areas
Provides comfort
Exercises muscles
Moves joints
Stimulates circulation
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43. Moving, Turning, Positioning And Lifting (continued)
Coordinate lifting and moving
Move on a certain count, usually count of three
Gain cooperation of resident
Have residents help themselves as much as possible
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44. Moving, Turning, Positioning And Lifting (continued)
Coordinate lifting and moving (continued)
Use transfer belt (gait belt) when appropriate
When in doubt, always ask for assistance from co-workers
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Demonstration
and
Return
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Objective
14.4 Demonstrate the procedure for moving the resident up in bed.
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Objective
14.5 Demonstrate the procedure for moving a resident up in bed using a turning sheet.
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Objective
14.6 Demonstrate the procedure for positioning a resident on side.
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Repositioning
Resident in
Chair or Wheelchair
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Objective
14.7 Discuss repositioning the resident in a chair or wheelchair.
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51. Repositioning Resident In Chair Or Wheelchair
Reasons for changing position every two hours or as directed
Promotes comfort
Reduces pressure
Increases circulation
Exercises joints
Promotes muscle tone
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52. Repositioning Resident In Chair Or Wheelchair (continued)
Body kept in good alignment with head in straight line with spine
Plastic or vinyl surface of chair covered, with use of pressure-relieving cushion preferred
Pillows or soft blankets used for support
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53. Repositioning Resident In Chair Or Wheelchair (continued)
Feet rest on floor or footrest of wheelchair
Hips positioned well back in chair
Weight shifting utilized in between repositioning
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The
End
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