Positioning, Ergonomics and Pressure Sores Flashcards Preview

OTA 130 - Kinesiology > Positioning, Ergonomics and Pressure Sores > Flashcards

Flashcards in Positioning, Ergonomics and Pressure Sores Deck (44)
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1

Septicemia

A serious bloodstream infection. Occurs when a bacterial infection elsewhere in the body, such as the skin, enters the bloodstream. This is dangerous because the bacteria and their toxins can be carried through to entire body.

2

Reasons older populations develop skin problems

• Reduced sensitivity of immune system
• Reduced sebum secretion (dry, itchy skin)
• Less melanin production (sensitive to sun)
• Delayed wound healing
• Sensory receptors diminish in capacity
• Skin weakens, collagen loss, decreased elasticity
• Reduced efficiency of sweat glands/dermal blood supply
• Vascularity decreases in subcutaneous tissue (less pressure stops blood flow)

3

Substances that have negative affects when applied on older skin

• Alkaline soaps (reduces skin thickness; alters pH)
• Alcohol and Acetone (dehydrate skin)
• Starches (reduce protective barrier)

4

Areas where most pressure ulcers occur

Over major weight-bearing body parts such as sacrum, heels and ischial tuberosities (sit bones).

5

Classification of Pressure Ulcers

Grade 1: Non-blanchable erythema of intact skin; discoloration; warmth; edema; hardness

Grade 2: Partial-thickness skin loss; superficial ulcer; abrasion/blister

Grade 3: Full-thickness skin loss; may extend down to—not through—underlying fascia

Grade 4: Extensive destruction; tissue necrosis; damage to muscle/bone/supporting structures; with/without full-thickness skin loss

6

Tissue Tolerance

Amount of pressure an individual can withstand before capillary occlusion. Reduced by:
• Low blood pressure
• Malnutrition
• Sustained pressure
• Patient immobility

7

Risk Factors for Pressure Ulcers

• Older age
• Incontinence
• Poor skin hygiene
• Immobility
• Impaired nutrition/hydration
• Altered consciousness
• Sensory impairment
• Comorbidity
• Acute/Long-term/Terminal illness
• Previous pressure damage

8

Problems that occur when sitting/lying without moving much

(in order of severity):
• Pressure sores
• Skin breakdown
• Decubitus ulcers

9

# of Deaths in US Yearly Related to Hospital-Acquired Pressure Uclers?

60,000 yearly
(Mortality rate 2-6x higher than those without pressure ulcers)

10

% of New Nursing Home Pts with Pressure Sore

11-56%

11

Role of OT in Pressure Sores

• Decide if Pt is at risk
• Come up with solutions to prevent breakdown in advance
• If already breakdown, come up with solutions to heal
• Allow for most functional performance of ADLs

12

Schematic for OT Prevention/tx of Pressure Ulcers

1) Risk assessment and Skin assessment
2) Record the assessment
3) Develop a care plan
4) OT intervention (education, positioning, moisture, nutrition, etc.)
5) Reassessment
** Return to Step 1

13

Risk Assessment – Person

• Previous skin breakdown
• Sensory impairment
• Decreased consciousness (meds?)
• Cognition (self-advocating?)
• Pain (meds?)
• Psycho-emotional status
• Mobility
• Skeletal deformity (protrusions? Scoliosis?)
• Posture
• Nutrition/Hydration
• Incontinence
• Positioning preference (sleeping position?)
• Age

14

Risk Assessment – Environment

• Pressure*
• Shear*
• Friction*
• Moisture
• Socio-economic status
• Support surfaces over 24-hr period

*Biggest risk factors

15

Risk Assessment – Skin

• Persistent erythema (redness)
• Non-blanching redness
• Blisters
• Localized heat/coolness
• Localized induration (hardening)
• Localized edema
• Purplish/bluish localized area (bruise)
• Skin breakdown

**On darker skin, may not see all signs; look for discoloration, temp, raised areas

16

Bony Prominences most likely to have skin breakdown

• Sacrum
• Ischium
• Iliac crest
• Rib Cage
• Elbows
• Trochanters
• Knees
• Heels
• Toes
• T1 vertebra
• Back of head

17

Scales to Predict Pressure Ulcer Risk

Norton Scale – 1962 – scores 5-20, with 14 indicating risk

**Braden Scale – 1980s – replaced Norton Scale and is still most widely-used; Score 6-23, with lower scores at-risk starting around 16-18

Waterlow Scale – 1987 – Never took off. Score betw 4-40, higher scores 10+ = at risk

18

Categories Graded in Braden Scale

• Sensory Perception (1-4)
• Moisture (1-4)
• Activity (1-4)
• Mobility (1-4)
• Nutrition (1-4)
• Friction and Shear (1-3)
** Higher score = LESS risk

19

Braden Scale – Manage Moisture

• Use commercial moisture barrier
• Use absorbent pads/diapers that wick/hold
• Address cause if possible
• Offer bedpan/urinal and glass of water in conjunction with turning schedules

20

Braden Scale – Manage Nutrition

• Increase protein
• Increase calorie intake to spare proteins
• Supplement with multivitamin (A, C, E)
• Act quickly to alleviate deficits
• Consult dietician

21

Braden Scale – Manage Friction and Shear

• Elevate HOB no more than 30˚
• Use trapeze when indicated
• Use lift sheet to move patient
• Protect elbows and heels if exposed to friction

22

Braden Scale – Other General Care

• No massage of reddened bony prominences
• No donut type devices
• Maintain good hydration
• Avoid drying the skin

23

Braden Scale – Predictive Cut-Off Values

Acute Care: 16
Home Residents: 18
Home Health Patients: 19
*Considered at risk at these scores or lower

24

Stage 1 Pressure Sore

• Skin intact
• Red skin that doesn’t lighten/blanch when touched
• On darker skin, may be no color change but also doesn’t blanch; may be bluish or ashen
• Site may be painful, firm, soft, warmer or cooler than surrounding skin

25

Stage 2 Pressure Sore

• Open wound
• Outer layer of skin (epidermis) and part of underlying layer (dermis) are damaged/lost
• Ulcer may appear as shallow pinkish-red, basin-like wound
• May also appear as intact or ruptured blister

26

Stage 3 Pressure Sore

• Ulcer is now a deep wound
• Loss of skin exposes some fat
• Ulcer has crater-like appearance
• Bottom of wound may have yellowish dead tissue (slough)
• Damage may extend beyond primary wound below layers of healthy skin

27

Stage 4 Pressure Sore

• Ulcer exhibits large-scale loss of tissue
• Wound may expose muscle, bone and tendons
• Bottom of wound likely contains slough or dark, crusty, dead tissue (eschar)
• Damage extends beyond primary wound below layers of healthy skin

28

Treatment Options for Stages of Pressure Sores

Stage 1: Pressure relief

Stage 2: Pressure relief, keep tissue clean/moist (avoid scabs)

Stage 3: Pressure relief, remove infected tissue (Wound Care steps in)

Stage 4: Pressure relief, remove infected tissue (Wound Care still involved)

29

Preventing Skin Breakdown

• Diligent inspection of skin by therapist, nurse, caregiver, AND patient
• Patients may need a mirror to check all areas of body
• Remember: Skin damage can occur in as little as 30 minutes!

30

General Tips on Pressure Relief

• NO DONUTS
• No evidence for sheepskin/egg crates helping, but don’t hurt
• Turn pt every 2 hours
• Keep back at 30˚ to bed (alleviates pressure on trochanter and lateral malleolus)
• Float heels
• Keep HOB at lowest possible angle to minimize shear stress/slippage
• Drawsheet and trapeze can reduce shear