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)
Loading flashcards...


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.


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)


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)


Areas where most pressure ulcers occur

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


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


Tissue Tolerance

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


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


Problems that occur when sitting/lying without moving much

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


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

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


% of New Nursing Home Pts with Pressure Sore



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


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


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


Risk Assessment – Environment

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

*Biggest risk factors


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


Bony Prominences most likely to have skin breakdown

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


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


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


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


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


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


Braden Scale – Other General Care

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


Braden Scale – Predictive Cut-Off Values

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


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


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


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


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


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)


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!


General Tips on Pressure Relief

• 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