1、DHSR Approved Curriculum-Unit 14,1,Unit 14 Prevention of Pressure Ulcers,Nurse Aide I Course,DHSR Approved Curriculum-Unit 14,2,Prevention Of Pressure Ulcers,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
2、 blood supply and tissue destruction, as well as the skills necessary to properly position residents to minimize the effects of pressure, are essential.,Introduction,DHSR Approved Curriculum-Unit 14,3,DHSR Approved Curriculum-Unit 14,4,14.0 Discuss pressure ulcers and methods used to prevent them.,D
3、HSR Approved Curriculum-Unit 14,5,Pressure Ulcers,Previously called decubitus ulcers or bed sores Caused by pressure on area of skin that interferes with circulation,DHSR Approved Curriculum-Unit 14,6,14.1 Identify areas where pressure ulcers most frequently occur.,DHSR Approved Curriculum-Unit 14,7
4、,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,DHSR Approved Curriculum-Unit 14,8,Pressure Ulcers (continued),Can develop where areas of body
5、 rub together and moisture collects, especially in obese residents Under breasts Between folds of abdomen Between crease of buttocks Between thighs,DHSR Approved Curriculum-Unit 14,9,14.1.2 List the methods used to prevent the formation of pressure ulcers.,DHSR Approved Curriculum-Unit 14,10,Methods
6、 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,DHSR Approved Curriculum-Unit 14,11,Methods Used To Prevent Press
7、ure Ulcers (continued),Make sure clothing and shoes do not bind or constrict Pat skin dry when bathing; never scrub Encourage adequate nutrition and fluids,DHSR Approved Curriculum-Unit 14,12,Methods Used To Prevent Pressure Ulcers (continued),Massage pressure points when the resident is repositione
8、d Report any changes in skin condition immediately,DHSR Approved Curriculum-Unit 14,13,14.1.3 Identify devices used to prevent pressure ulcers.,DHSR Approved Curriculum-Unit 14,14,Preventive Devices Used To Prevent Pressure Ulcers,Bed cradle Heel and elbow protectors Flotation pads or cushions Pillo
9、ws Water beds Alternating pressure mattresses Eggcrate mattresses,DHSR Approved Curriculum-Unit 14,15,Pressure Ulcers: Stages Of Tissue Breakdown And Treatment,Prevention is best treatment,DHSR Approved Curriculum-Unit 14,16,14.1.4 Review the four stages of tissue breakdown and identify the nurse ai
10、des role in assisting with treatment.,DHSR Approved Curriculum-Unit 14,17,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,DHSR Approved Curriculum-U
11、nit 14,18,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,DHSR Approved Curriculum-Unit 14,19,Pressure Ulcers: Stages Of T
12、issue 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,DHSR Approved Curriculum-Unit 14,20,Pressure Ulcers:
13、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,DHSR Approved Curriculum-Unit 14,21,Pressure
14、 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,DHSR Approved Curriculum-Unit 14,22,Pressure Ulcers: Stages Of Tissue Break
15、down 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,DHSR Approved Curriculum-Unit 14,23,DHSR Approved Curriculum-Unit 14,24,14.2 Identify thre
16、e purposes for positioning residents.,DHSR Approved Curriculum-Unit 14,25,Positioning,Purposes Assist with examinations Assist with procedures Prevent pressure on skin for prolonged periods of time,DHSR Approved Curriculum-Unit 14,26,14.2.1 Discuss the various types of positions and suggest reasons
17、for use.,DHSR Approved Curriculum-Unit 14,27,Types Of Positions,Dorsal recumbent position flat on back knees slightly separated and flexed feet flat on bed,DHSR Approved Curriculum-Unit 14,28,Types Of Positions (continued),Horizontal recumbent position supine flat on back legs slightly separated and
18、 extended,DHSR Approved Curriculum-Unit 14,29,Types Of Positions (continued),Prone position flat on abdomen with head turned to side arms at sides or flexed on either side of head,DHSR Approved Curriculum-Unit 14,30,Types Of Positions (continued),Side lying position positioned on either side head in
19、 straight line with spine pillows used to support head, back, arm, and leg,DHSR Approved Curriculum-Unit 14,31,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,DHSR Approved Curriculum-U
20、nit 14,32,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,DHSR Approved Curriculum-Unit 14,33,Types Of Positions (continued),Fowlers position s
21、itting position in bed with head elevated at 45-60 degree angle. knees slightly flexed position causes pressure on sacrum and buttocks,DHSR Approved Curriculum-Unit 14,34,Types Of Positions (continued),Sims position positioned on left side left arm extended behind body right arm flexed in front of b
22、ody right leg flexed toward abdomen used for enema administration,DHSR Approved Curriculum-Unit 14,35,DHSR Approved Curriculum-Unit 14,36,14.3 Discuss moving, turning, positioning and lifting residents.,DHSR Approved Curriculum-Unit 14,37,Moving, Turning, Positioning And Lifting,Good body mechanics
23、necessary Prevents injury to resident Protects nurse aide from injury Good body alignment promotes comfort for resident,DHSR Approved Curriculum-Unit 14,38,Moving, Turning, Positioning And Lifting (continued),Safety major consideration Get help if needed Receive directions from supervisor regarding
24、any restrictions for positioning or movement,DHSR Approved Curriculum-Unit 14,39,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 co
25、mfortable working level,DHSR Approved Curriculum-Unit 14,40,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,DHSR Approved Curriculum-Unit 14,41,Moving, Tur
26、ning, Positioning And Lifting (continued),Use postural supports as directed: Rolled blankets Pillows Rolled towels Footboards Bed cradles,DHSR Approved Curriculum-Unit 14,42,Moving, Turning, Positioning And Lifting (continued),Reposition at least every two hours or as directed Eliminates pressure on
27、 bony areas Provides comfort Exercises muscles Moves joints Stimulates circulation,DHSR Approved Curriculum-Unit 14,43,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 t
28、hemselves as much as possible,DHSR Approved Curriculum-Unit 14,44,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,DHSR Approved Curriculum-Unit 14,45
29、,DHSR Approved Curriculum-Unit 14,46,14.4 Demonstrate the procedure for moving the resident up in bed.,DHSR Approved Curriculum-Unit 14,47,14.5 Demonstrate the procedure for moving a resident up in bed using a turning sheet.,DHSR Approved Curriculum-Unit 14,48,14.6 Demonstrate the procedure for posi
30、tioning a resident on side.,DHSR Approved Curriculum-Unit 14,49,DHSR Approved Curriculum-Unit 14,50,14.7 Discuss repositioning the resident in a chair or wheelchair.,DHSR Approved Curriculum-Unit 14,51,Repositioning Resident In Chair Or Wheelchair,Reasons for changing position every two hours or as
31、directed Promotes comfort Reduces pressure Increases circulation Exercises joints Promotes muscle tone,DHSR Approved Curriculum-Unit 14,52,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 cov
32、ered, with use of pressure-relieving cushion preferred Pillows or soft blankets used for support,DHSR Approved Curriculum-Unit 14,53,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,DHSR Approved Curriculum-Unit 14,54,
