pressure ulcer care, the management and prevention of pressure ulcers. Also called decubitus ulcer care. ▪ METHOD: Prevention of pressure ulcers begins with an understanding of proper body positioning, the importance of turning and repositioning, and the need for suitable support surfaces for sleeping and sitting. Support surfaces include overlays, mattress replacements, specialty beds, and special chair cushions. “Donut” rings should not be used to relieve pressure because they reduce blood supply. Bedfast patients should be repositioned at least every 2 hours, and chairfast patients should be repositioned every 15 minutes. Bed linen should be kept dry and wrinkle free. To avoid shear, a sheet or mechanical lift is used to move a patient. Skin should be inspected at least once daily for redness or discoloration, and each time the patient is repositioned the bony areas should be inspected. Dark skin will not show redness; close observation is needed to detect changes in color. A prophylactic measure is daily skin care, in which all areas are washed, rinsed, and dried thoroughly, and lotion is gently applied to bony prominences. The perineal and perianal areas are washed with mild soap and warm water after defecation and urination. A high protein diet with vitamin and mineral supplements is usually required. One method of classifying pressure ulcers is staging. If necrotic material exists in the ulcer, staging is not possible until it has been removed. Necrotic material can be eschar or slough. Topical wound management involves debridement, wound cleansing, the application of dressings, and possibly adjunct therapy (electrical stimulation, hyperbaric oxygen, ultrasound). Clinical Practice Guidelines for Treatment of Pressure Ulcers may be obtained from the U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. Normal saline is recommended for cleaning most pressure ulcers. An ideal dressing for a pressure ulcer should protect the wound and provide ideal hydration. The pressure ulcer wound bed should be moist. Devices such as heat lamps and hair dryers should not be used. Dead space within a wound should be eliminated by loosely filling all cavities with dressing materials. ▪ INTERVENTIONS: The nurse plays a major role in the prevention of pressure ulcers and in their treatment if they occur, turning the patient at frequent intervals, applying the ordered medications and dressings to the lesions, avoiding rubbing in the administration of daily skin care, and encouraging good nutrition. The nurse conducts active or passive exercises with massage to the patient’s extremities and, when indicated, prepares for debridement of advanced ulcers. ▪ OUTCOME CRITERIA: Pressure ulcers are often resistant to treatment, and large areas of ulceration can be life-threatening and costly, especially in a debilitated patient. Prompt and continued care of early lesions can prevent invasion of underlying tissue and promote healing. The nurse may elicit the cooperation and participation of the patient in a nursing care plan that includes all preventive measures. The importance of frequent change of position, pressure, friction, moisture, shear, and good nutrition is emphasized.
