Demand on your CARE: Skin Disorders and Pressure Injuries
Skin is the largest organ of our body which protecting us from damage. Ageing skin and skin disorders may bring various degrees of impact to older adults. Taking this course will help you understand the normal ageing skin, common skin disorders, skin care tips, prevention and management of pressure injuries among older adults.
Chapter 1
Ageing skin
EP 1. Older adults' perspectives
EP 2. Dry and itchy skin among older adults
EP 3. Selecting and using moisturizers
EP 4. The correct approach of using steroids
EP 5. Skincare tips for older adults
EP 6. Common skin disorders
EP 7. Skin examination tutorial
Dr. Chan Lecture Video - Ch.1 Ageing skin
Normal ageing skin
Preventing skin cancer - 10 Sunscreen tips
- End of Chapter 1-
Chapter 2
Common skin disorders in older adults
Dr. Chan Lecture Video - Ch.2.1 Asteatotic eczema
Bathing tips for older adults
Dr. Chan Lecture Video - Ch.2.2 Tinea Pedis
Foot care
Dr. Chan Lecture Video - Ch.2.3 Skin Cancer
Dr. Chan Lecture Video - Ch.2.4 Herpes Zoster
Dr. Chan Lecture Video - Ch.2.5 Bullous pemphigoid and Scabies
Moisture-Associated Skin Damage (MASD) and Skin Tear
Moisture-Associated Skin Damage (MASD) and skin tear are two skin conditions commonly found in frail older adults, which required proper skin care for prevention of skin injury.
Moisture-Associated Skin Damage (MASD)
MASD is classified as an irritant-contact dermatitis. The skin has developed inflammation and erosion caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus or saliva. The excessive exposure of the skin to bodily fluids can compromise its integrity and barrier function, making it more permeable and susceptible to damage. It has negative impact on wellbeing and quality of life.
MASD is an umbrella term and subdivided into four categories:
Incontinence-associated dermatitis (IAD) - skin damage associated with exposure to urine, stool or a combination of these
Peristomal dermatitis – skin damage relating to colostomy, ileostomy/ ileal conduit, urostomy, suprapubic catheter, or tracheostomy
Intertriginous dermatitis (intertrigo: where two skin areas may touch or rub together)
Periwound maceration
Management of MASD
Identify and manage the risks
Remove irritants from the skin
Minimize skin-on-skin contact and friction (intertrigo)
Skin protection and management
Ensure skin integrity
Keep skin clean and dry
Use of skin protection products
For incontinence cases, we should pay attention to incontinence associated dermatitis. Please refer to MOOC 10 Incontinence to learn about proper skin care of incontinence among older adults.
Skin Tear
Think about~
Do you familiar with the below situations when taking care of older adults?
1. When try to remove the tape or dressing on the skin, the thin layer skin tear accidentally!
2. When you transfer an older adult from bed to wheelchair and his legs just bumping into the wheelchair paddle or bed rail have tear the skin.
You may notice that it is not uncommon to come across the above situations especially in nursing homes.
What is skin tear?
Skin tear:
International Skin Tear Advisory Panel defines skin tear:
"A skin tear is a traumatic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer)" (LeBlanc et al, 2018)
Skin tear:
o occur at any age and any part of our body
o the most common sites of skin tear are upper and lower limbs
o one of the common skin problems among frail older adults that lead to skin injury or other complications
o preventable and treatable
In Chapter 1, you have learnt about how our skin aged and changed the composition. Aged skin has increased the risk for skin tear especially among the vulnerable old age group. You may see some frail older adults' skins become vulnerable and easily injured. The ageing skin turns out to be thin, fragile, or easily bruises. If not care properly, it could be a series problem like pressure injury. Skin tear can become a chronic wound that is painful and distressing.
Risk factors for development of skin tear
Intrinsic
Extrinsic
Dry/thin/fragile skin Inelastic tissue Old age Impaired cognition Agitation Impaired nutrition
• Assess wound using STAR or Payne-Martin classification
Payne and Martin classification
STAR classification
CATEGORY IA
Can be realigned back to normal position. Linear skin tear with separated epidermis and dermis, without tissue loss.
A skin tear where the edges can be realigned to the normal anatomical position and the skin or flap colour is not pale, dusky or darkened.
CATEGORY IB
Can be realigned back to normal position. The epidermal flap completely covers the dermis within one millimetre of the wound margin.
A skin tear where the edges can be realigned to the normal anatomical position and the skin or flap colour is pale, dusky or darkened.
CATEGORY IIA
Cannot be realigned back to normal position. Scant tissue loss < 25% of the lost epidermal flap.
A skin tear where the edges cannot be realigned to the normal anatomical position and the skin or flap colour is not pale, dusky or darkened.
CATEGORY IIB
Cannot be realigned back to normal position. Tissue loss > 25 % of the lost epidermal flap.
A skin tear where the edges cannot be realigned to the normal anatomical position and the skin or flap colour is pale, dusky or darkened.
CATEGORY III
Complete tissue loss. The epidermal flap is absent.
A skin tear where the skin flap is completely absent.
image source from: www.skintears.org
Management for skin tear
Identify the high-risk cases and implement the prevention program.
In case of skin tear:
o It is important not to remove the skin.
o Clean wound and remove blood clots/slough/foreign bodies.
o Use simple dressing and try to replace the "skin flap" or piece of skin that was torn.
o Apply a moist wound dressing; a non-adherent wound contact layer, along with bordered foam dressing
o Consider tetanus prophylaxis
Warning signs that require attention:
• the skin tear is widespread or associated with a full thickness skin injury
• has significant bleeding
• has haematoma formation
Consult medical advice if any of the above. It may require surgical review and intervention to repair the injury.
Skin Tear Prevention Program
Skin Tear Prevention Program helps to lower the risk of skin tear in nursing homes or other care settings.
Components include:
• Assess all older adults on admission for skin tear risk factors
• At risk cases should protect skin: wear sleeves, long pants and long socks
• Shin guards for persons who have skin tears
• Proper skin care and apply moisturizers (emollients) twice a day or as appropriate
• Educate staff on appropriate transfer strategies to avoid skin tears
• Identify environmental causes and cover with protective devices
• Avoid daily bathing and non-emollient soaps
Reference
Fletcher J, Beeckman D, Boyles A et al., (2020). International Best Practice Recommendations: Prevention and management of moisture-associated skin damage (MASD). Wounds International. Retrieved from www.woundsinternational.com
LeBlanc, K., Langemo, D., Woo, K., Campos, H., Santos, V., & Holloway, S. (2019). Skin tears: Prevention and management. British Journal of Community Nursing, 24(Sup9), S12-S18.
- End of Chapter 2-
Chapter 3
Pressure Injuries
Case scenario 1
Mr M is a 70-year-old man who is suffering from hypertension and stroke with lower limbs weakness for 6 months. He is reluctant to move and always loves to sit on his wheelchair and watch TV. Recently, his skin is remarkably red in colour over his buttock and legs area especially sever over the sacrum area. He also complains of pain over his buttock and legs.
What's wrong with him?
Is there anything you could do?
You will find the answers in this Chapter. Let’s start!
3.1 What are pressure injuries?
What are pressure injuries?
According to the European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP) & Pan Pacific Pressure Injury Alliance (PPPIA) (2019), a pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbid conditions, and condition of the soft tissue.
Pressure injury (PI) updates:
New terminology
Pressure injury previously called pressure ulcers, bedsores, pressure sores or decubitus. Now we use ‘Pressure Injury’.
Friction was eliminated in the definition of pressure injury since it is not a causative factor in the development of pressure injury.
Staging system
Numbering was changed from Roman numbers (I, II, III, IV) to Arabian numbers (1, 2, 3, 4).
The term "suspected" was removed from the ‘Suspected Deep Tissue Injury’ of staging system and now used ‘Deep Tissue Pressure Injury’.
International guidelines recommend that risk assessment be conducted within the first 8 hours of hospital admission.
(Edsberg, et al., 2016)
Pressure injury can happen to anyone at any age. It’s not uncommon to see older adults with pressure injuries or at risks of developing pressure injuries.
Infection is the most common major complication of pressure injuries. Pressure injury could be a serious problem which increases the risk of morbidity and mortality. It imposes significant burden to caregivers and causing considerable financial burden to healthcare system. It also has great impact to the quality of life.
Epidemiology
Incidence varies widely in different clinical settings.
Globally, Stage 1 and Stage 2 pressure injuries represent over half of all pressure injuries among hospitalized adults. The most frequently affected anatomical locations are the sacrum followed by heels and hips (Li et al., 2020).
In USA, overall prevalence of pressure injuries was 10.1%. Estimated 3 million patients had pressure injuries yearly, with costs of treatment up to $17.8 billion (Hajhosseini, et al., 2020).
Pressure injuries prevalence 0.3%–46% and incidence 0.8%–34% among older adults across 14 countries worldwide (Hahnel, et al., 2016)
Kwong et al. (2016) revealed that incidents of pressure injuries in four private, government-subvented nursing homes in Hong Kong ranged from 2.5% to 25%.
Local studies found that (Kwan, 2017):
8.9% of older patients admitted to a geriatric convalescence hospital had pre-existing pressure injuries
17% of older residents with advanced dementia had a pressure sore in residential care settings
Incidence of hospital-acquired pressure injuries under Hospital Authority of Hong Kong 0.45 per 1000 bed-days
Pressure injury can develop so fast. Older patients with serious acute conditions lying on a trolley while waiting for assessment and admission in AED can develop PI within a short length of stay i.e. 2 to 4 hours (Gefen, 2008).
Common sites of pressure injuries
Any area subjected to prolonged pressure
Usually over a bony prominence, commonly at the sacrum, buttocks and heels when the patients are lying supine position
The greater trochanters and the ischial tuberosities when the patients lie in the lateral or sitting position
How do we differentiate Stage 1 pressure injuries?
Normal Skin
Differentiation of tissue injuries
Blanchable hyperemia – no tissue damage
Area that appears red and warm will blanch (turn to light colour) following fingertip pressing down.
Non-blanchable hyperemia – stage 1 PI
Redness that persists after fingertip pressing down.
Indicates tissue damage and is commonly in the first stage of pressure injury development
Reversible if the pressure is relieved and the tissue protected
Staging of pressure injuries
According to the level of damaging, pressure injury is differentiated into several staging including Stage 1 to 4, Unstageable and Deep Tissue Pressure Injury.
Do not reverse stage a pressure injury. Once a Stage 4 always a Stage 4. For examples:
- A Stage 4 pressure injury does not become a Stage 3, then Stage 2, then Stage 1, then “intact skin” as it heals.
- A stage 4 pressure injury that has closed (healed) is classified as “healed stage 4 pressure injury” but not a Stage 0.
Stage 1
Intact skin with non-blanchable erythema of a localized area usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness or pain may also be present.
Stage 2
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister.
Stage 3
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Some slough may be present. May include undermining and tunneling.
Stage 4
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often include undermining and tunneling.
Unstageable
Full thickness tissue loss in which the base of the pressure injury is covered by slough (yellow, tan, grey, green, or brown) and/or eschar (tan, brown or black). The depth of wound is unknown.
Deep Tissue Pressure Injury
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.
Alert for any warning signs of pressure injuries over bony prominence:
Unusual changes in skin color or texture
Swelling
Pus-like draining
An area of skin that feels cooler or warmer to the touch than other areas
Tender areas
Complications of pressure injuries can be life threatening!
Seek medical advice if the warning sign does not relief after pressure relief intervention.
If any sign of infection occurs, seek medical advice immediately.
3.2 What causes pressure injuries?
Pathophysiology
In the early stage of pressure injuries, it shows up as persistent redness in light-colored skin. In dark-colored skin, the area may appear red, blue or purplish color.
Multiple factors may cause pressure injuries
Pressure – prolonged pressure on the skin and underlying soft tissue >>> insufficient oxygen and nutrients supply
Shearing forces – a mechanical force exerted against the skin while the skin remains stationary and the bony structures move such as elevate the head of bed >30 degree, the body skeleton actually slides down in relation to the skin.
Tissue tolerance – tolerance of soft tissue for pressure and shear
Pressure - increases exposure of the skin to excess pressure
Impaired sensory perception
Impaired mobility
Impaired activity
Who are at risk of pressure injury?
Advanced age
Immobility or inactivity e.g. bed or chair-bound
Incontinence (fecal more so than urinary)
Impaired sensory perception e.g. neuropathy, stroke
Poor nutritional status
Comorbidities e.g. diabetes, or peripheral vascular disease
Prolonged pressure on tissues e.g. medical devices (oxygen mask, Foley’s catheters)
Altered skin moisture (excessively dry or moist)
Why are older adults more prone to develop pressure injuries?
Older adults are the high-risk group of pressure injury. As we age, age-related changes make us more prone to develop pressure injuries:
Decreased metabolism, body fat and muscle mass
Cellular senescence
Changes in skin pH
Decreased immune function
Vascular changes, altered tissue perfusion
Nutritional status changes
Poor hydration
These changes affect skin integrity and tissue healing, and raise the risk of pressure-related skin injury.
3.3 Identifying older adults at risk of pressure injury
Assessment should be performed on admission for care planning and monitoring. Reassessment for any changes of health condition.
Comprehensive assessments of pressure injuries
clinical history
pressure injury risk scale
skin assessment
pain assessment
mobility and activity assessment
nutritional assessment
continence assessment
cognitive assessment
assessment of extrinsic risk factors
Alert to the risk factors
Physical and mental condition
Skin status
Continence status
Malnutrition
Pressure damage caused by medical devices
Chronic illnesses
Activity
Mobility
Friction & shear
Pressure injury risk assessment scale
Risk assessment is essential for prevention of pressure injury and plan for the care. In addition, clinical judgment is also the key in managing pressure injury.
Standardized risk assessment tools for pressure injuries
The Norton scale and the Braden Scale for Predicting Pressure Injury Risk were widely used to foster early identification of patients at risk for developing pressure injuries.
Developed in 1988 by Barbara Braden and Nancy Bergstrom
Consists of six subscales and the total scores range from 6-23
A lower Braden score indicates higher levels of risk for pressure injury development. Generally, a score of 18 or less indicates at-risk status.
Items included in the Norton scale and Braden Scale
Norton
Braden
Mobility
+
+
Moisture exposure
+
+
Physical activity
+
+
General condition
+
-
Nutrition
-
+
Friction/shear force
-
+
Sensory perception
-
+
Mental status
+
-
Documentation
General skin condition and risk assessment
Position: indicate frequency and time client’s position was changed
Record pressure injury:
characteristics of the wound (i.e., presence of granulation tissue)
Location and size (i.e., depth, width)
Stage
Type of preventive measures / care given
Treatment and progress
Exercise
After studying the previous chapters, what will you do for the below case?
Case scenario 2
Amy is a 78-year-old woman who is living in a residential care home. She is suffering from Parkinson’s disease and diabetic mellitus. She has double incontinence. Her body mass index is below 18 kg/m2 which is lower than normal. She always rests on her bed and seldom go to the activity room or dining room.
Do you think she is at risk of pressure injury?
How would you assess her risk of pressure injury?
What is your care plan to prevent pressure injury?
Answer:
a. Yes
b. Use Braden Scale
c.
✓ Proper skin care
✓ Pressure redistribution
✓ Nutritional support
✓ Encourage mobility/activity
Let's return to case scenario 1 Mr. M's situation:
After assessment, he was at high risk of pressure injuries. He used to sit on his wheel chair all day long that made him more prone to develop pressure injuries. There were also warning signs: red skin colour and complaint of pain. If there was no skin breakdown, Stage 1 pressure injury was suspected. Prompt intervention should be provided in order to relieve the pressure and protect his skin with proper care.
Various strategies can help to improve his situation. Care plan can be decided according to the risk assessment that we have done. Let’s move on to Chapter 3.4 to know more about the intervention and management.
3.4 Prevention and Management of Pressure Injuries
Prevention is always the golden rule. It is the most cost-effective treatment for pressure injuries.
The key is how we take appropriate prevention and in case of developed pressure injuries, how we manage it.
Management of Pressure Injuries
Prevention of Pressure Injuries
Prevention of pressure injuries
3.4.1 Skin care
3.4.2 Pressure Redistribution
Proper positioning
Reduce friction and shearing forces
Use of pressure relieving devices
Optimize mobility
3.4.3 Nutritional support
3.4.4 Education
3.4.1 Skin care
Skin care is playing an important role in prevention of pressure injuries.
Keep skin dry and clean
Proper continence care, check and change napkins frequently to avoid skin maceration
Do not vigorously rub skin that is at risk for ulceration
Use skin emollients to hydrate dry skin and protect the skin from exposure to excessive moisture to reduce risk of skin damage
Frequent skin inspection
Frequent assessment for any warning sign
Perform the assessment at any time e.g. personal care, bathing, positioning etc.
Inspect any sign of erythema and blanching over body pressure area
Early detection and treatment accelerate recovery and reduce complications of pressure injuries
3.4.2 Pressure Redistribution
Proper positioning
High pressures over bony prominences, for a short period of time, and low pressures over bony prominences, for a long period of time, are equally damaging. Passive or active mobilization is recommended.
Proper repositioning should be undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body.
Frequent turning, formulate reposition schedule / turning schedule at least every 2-4 hours.
Example of repositioning /turning schedule:
1000-- Prone position
1200--Left Sim's position
1400--Supine position
1600--Right Sim's position
1800--Prone position (Generally, seldom use in Hong Kong)
Avoid pressure on the pressure injury and high-risk areas.
Keep proper body alignment while repositioning
Use support device or foams wedges to separate skin areas in contact each other and to assist with maintaining positions.
Use cautiously because these devices can become an additional source of pressure if they are not properly placed.
Follow the “Rule of 30” in positioning.
Reduce friction and shearing forces
Keep bed as flat as possible while turning. Limit Fowler's position to only 30 minutes at a time.
Use enough personnel to lift the client up in bed or chair rather than pulling or sliding skin surfaces.
Use lifting devices to raise patient in bed.
No dragging client across the surface in the bed.
Proper sitting position
Prevention of Pressure Injuries - Proper Sitting Position
For chair-bound cases:
Proper sitting position is important in preventing pressure injuries
Plan the sitting schedule to shift weight for prevention of pressure injuries
Perform pressure relief exercise
Provide pressure-reducing support surfaces e.g. gel, air, or foam cushion
Can you recommend a suitable chair to the case Mr. M and educate him on the proper sitting position now?
Also, let’s teach him on the following pressure relief exercise!
Pressure relief exercises for wheelchair/chairbound clients
Regular pressure relief techniques are effective for prevention of pressure injury.
Before the chair exercise, remember to check that the wheels are locked or the chair is stable and undone the seat belt.
The forward lean – Lean forward as far as you can – imagine that you are trying to rest your chest on your knees! This movement is particularly good for relieving pressure on the coccyx.
Leaning side-to-side – Whilst seated, shift your body weight onto your left side to lift your right side out of your seat. Then repeat on the other side. This movement relieves pressure from the buttocks and the lower back.
The push-up – If the upper limbs are strong enough, use the wheelchair armrests (or wheels if you don’t have any) to push up out of the seat with your arms. You should straighten your arms fully so that your elbows are locked. Then ensure that the buttocks and lower back are fully out of the seat.
Performing each movement for 10 seconds for every 15 minutes of wheelchair use.
Any of the three movements mentioned above can be performed independently, or with assistance, depending on individual mobility levels. For frail cases, seek for health care professional advice for the best way of chair exercise.
Use of pressure relieving devices
Support pillows or foam wedges
Flotation gel pads
Trapeze bar
Bed cradles
Heel protectors
Bed / mattress
Polyurethane foam overlays
Gel-filled overlays
Air-filled overlays
Water-filled overlays
Alternating pressure mattress
Low air-loss bed
Optimize mobility
Assess level of immobility for appropriate intervention
Increase mobility level
Encourage active exercise and perform passive exercise as indicated
Adhere to turning and sitting schedule
3.4.3 Nutrition and Pressure Injuries
Nutrition and pressure injuries
Role of nutrition in pressure injuries
Malnutrition is an independent risk factor of pressure injury development
Nutrient is essential for tissue regeneration
Optimize circulation around wound site
Challenges in nutrition Management
Various impacting factors that affect nutrient requirements
Infection
Malabsorption
Chronic diseases
Requirement differs from different staging of pressure injuries
Nutrition review and close monitoring plays a key role
Obese adults have a higher risk due to poorer circulation and greater capillary pressure, skin friction etc.
However, it’s controversial. Some researchers argued that obese adults have extra body fat stores that reduced the risk of PI, rather than adding pressure on the skin, provide an enhanced subcutaneous cushion to ease the pressure.
Mobility
Greater risk if bed bound, spinal cord injured, etc.
Avoid low energy density food to maximise energy intake
Salad → stir fried choi sum
Water, tea → milk/ nutritional formula/ soy milk/ juice
Jelly → cake, biscuit
• Food fortification
Oil in the meal
Add margarine into oatmeal/congee
Use more vegetable oil to stir fry food
High energy beverage/food
Fatty fish
Full cream milk
• Minimize food restriction
Eliminate food phobia due to worries on increasing blood cholesterol/blood pressure etc.
Prioritizing energy and protein intake in a meal over low fat, low sugar etc.
Consume rice and meat first before vegetable
Allow them to eat meat with some fat until wound healing is observed
Still need to consume enough fruit and vegetable for effective wound healing (without compromising energy intake)
Splitting meal is key
Improve appetite as the main goal
• Supplementation
As indicated by doctor or dietitian
Calorie-containing drink may be useful as a high energy beverage option such as full cream milk & nutritional formula
Important to try all food options (frequent meals, fortification) before commencing supplementation
Arginine supplement is only found effective in PI stage 2 or above, such as Abound and Arginaid
Require close monitoring by medical professional if arginine supplement is to be used
Multivitamin Supplement can be considered if the older adult’s appetite is very poor and unable to consume enough fruit and vegetable
Case Study – Mary Q1
70-year-old female, no observable PI
Independent, sedentary most of the time
No special medical issues in the past months
Very responsive in chatting
No habit of measuring body weight (measured on the day: 59kg, 160cm)
In the past year, appetite is not as good as before, and feel full if eat less food
Action?
Answer:
Case Study – Mary Q1 Answer:
1. MNA-SF screening – low to moderate risk of malnutrition.
2. No observable PI.
3. Basic healthy eating principle, encourage exercise and active lifestyle and to drink more calorie containing fluid.
4. Understand barriers in achieving a healthier lifestyle. If found difficult, refer to medical professional (dietitian/physical trainers/nurse) for follow up.
Case Study – Mary Q2
After 1 year, you see Mary again…
PI stage 1
Rarely leave home in the past year
Weight measured: 49kg (17% loss in 1 year)
Getting thinner than before and listless
Feel full as soon as eating, and stomach acid refluxes all day long, eating less than before
Other conditions are the same as last year
Risk?
Action?
Answer:
Case Study – Mary Q2 Answer:
1. MNA-SF screening – high risk of malnutrition
2. BMI <20 and > 65yo + stage 1 PI
3. High risk of delayed healing of PI
4. Immediate action: understand barriers and capacity to change, make referral to dietitian, provide necessary nursing support
5. Long term action: arrange oral nutrition supplements order (if needed)
6. May provide simple eating strategies immediately to give comfort to her, and reinforce that dietitian could provide support to improve condition.
Summary of nutritional support
Nutritional assessment is essential
Provide appropriate nutrition intervention, based on individual need
Monitor and evaluate the nutritional outcome, with reassessment of nutritional status at frequent intervals while an individual is at risk
3.4.4 Education
Educate patient, family members and caregivers
Educate causes and risk factors of PI development and ways to minimize risks
Provide information and technique:
Understanding pressure injury
Risk assessment tools
Use of support devices
Skin assessment
Proper skin care
Appropriate positioning
Documentation of appropriate data
3.5 Treatment in pressure injuries
Debridement - remove dead tissue from the pressure injury to help healing.
Types of debridement:
surgical sharp
conservative sharp
autolytic
enzymatic
mechanical
larval (also called Biological debridement, but this is not common in Hong Kong)
Dressings - wound care with appropriate dressing is crucial to facilitate the wound healing.
alginate dressings – made from seaweed and contain sodium and calcium, which are known to speed up the healing process
hydrocolloid dressings – encourages the growth of new skin cells in the ulcer
other dressing types: foams, films, hydrofibres/gelling fibres, gels and antimicrobial dressings may also be used
Antibiotics for severe wound infection
Multidisciplinary team care approach
Geriatricians, nurses, dietitians, physiotherapists and occupational therapists
Evaluate the contributing factors and formulate the care plan for pressure injury management
Reference
Bergstrom N, Braden BJ, Laguzza A, Holman V. (1987). The Braden Scale for Predicting Pressure Sore Risk. Nursing Research, 36, 205-210.
Cowan, L., Broderick, V., & Alderden, J. (2020). Pressure Injury Prevention Considerations for Older Adults. Critical Care Nursing Clinics of North America, 32(4), 601-609.
Edsberg, L., Black, J. , Goldberg, M. , McNichol, L. , Moore, L. , & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Journal of Wound, Ostomy and Continence Nursing, 43 (6), 585-597. doi: 10.1097/WON.0000000000000281.
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.).
Gefen, A. (2008). How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage, 54(10), 26-8, 30-5
Hajhosseini, B., Longaker, M., & Gurtner, G. (2020). Pressure Injury. Annals of Surgery,271(4), 671-679.
Li, Z., Lin, F., Thalib, L., & Chaboyer, W. (2020). Global prevalence and incidence of pressure injuries in hospitalized adult patients: A systematic review and meta-analysis. International Journal of Nursing Studies, 105, 103546.
Morley, J., Tolson, D., Ouslander, J. G., Vellas, B. (2013). Nursing home care. McGraw Hill Professional.
Munoz, N., Posthauer, M. E., Cereda, E., Schols, J. M., & Haesler, E. (2020). The role of nutrition for PRESSURE injury prevention And Healing: The 2019 international clinical PRACTICE Guideline Recommendations. Advances in Skin & Wound Care, 33(3), 123–136.
Norton, D., McLaren, R. and Exton-Smith, A.N. (1962) An Investigation of Geriatric Nursing Problems in Hospital. Churchill Livingstone, London, 193-224.
Thomas, M., & Compton, M. (2014). Pressure Ulcers in the Aging Population: A Guide for Clinicians.
Trans Tasman Dietetic Wound Care Group (2011). Evidence based practice guidelines for the dietetic management of adults with pressure injuries.
The videos in this course provide information for educational purposes only. The videos do not provide medical recommendations or diagnoses and are not substitutes for medical advice. It is crucial that you talk with your healthcare providers to discuss any questions you may have and seek them for medical advice, before you make any medical decisions. As the videos are only for educational purposes, we will not be responsible for any decisions you will make or consequences you will have based on the information they provide. In no event shall the Funder have any liability of any kind to any person or entity arising from or related to any actions taken or not taken as a result of any of the contents herein.
