Unit 14

Prevention of Pressure Ulcers

Nurse Aide I Course

DHSR Approved Curriculum-Unit 14 1

 Prevention Of Pressure Ulcers
Introduction
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 blood supply and tissue
destruction, as well as the skills
necessary to properly position
residents to minimize the effects of
pressure, are essential.
DHSR Approved Curriculum-Unit 14 2
DHSR Approved Curriculum-Unit 14 3
14.0 Discuss pressure ulcers and
methods used to prevent them.

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 Pressure Ulcers
• Previously called decubitus ulcers or
bed sores
• Caused by pressure on area of skin
that interferes with circulation

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14.1 Identify areas where pressure
ulcers most frequently occur.

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 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 7

 Pressure Ulcers
(continued)
• Can develop where areas of
body rub together and moisture
collects, especially in obese
residents
– Under breasts
– Between folds of abdomen
– Between crease of buttocks
– Between thighs
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14.1.2 List the methods used to
prevent the formation of
pressure ulcers.

DHSR Approved Curriculum-Unit 14 9

 Methods 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 10
 Methods Used To Prevent
Pressure 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 11
 Methods Used To Prevent
Pressure Ulcers
(continued)

• Massage pressure points when the

resident is repositioned
• Report any changes in skin condition
immediately

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14.1.3 Identify devices used to prevent
pressure ulcers.

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Preventive Devices Used To Prevent
Pressure Ulcers
• Bed cradle
• Heel and elbow protectors
• Flotation pads or cushions
• Pillows
• Water beds
• Alternating pressure
mattresses
• Eggcrate mattresses
DHSR Approved Curriculum-Unit 14 14
Pressure Ulcers: Stages Of Tissue
Breakdown And Treatment

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14.1.4 Review the four stages of tissue
breakdown and identify the
nurse aide’s role in assisting
with treatment.

DHSR Approved Curriculum-Unit 14 16

 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-Unit 14 17

 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 18

 Pressure Ulcers: Stages Of Tissue
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 19
 Pressure Ulcers: 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 20
 Pressure 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 21

 Pressure Ulcers: Stages Of Tissue
Breakdown 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 22
DHSR Approved Curriculum-Unit 14 23
14.2 Identify three purposes for
positioning residents.

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 Positioning
• Purposes
– Assist with
examinations
– Assist with
procedures
– Prevent pressure on
skin for prolonged
periods of time
DHSR Approved Curriculum-Unit 14 25
14.2.1 Discuss the various types of
positions and suggest reasons
for use.

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 Types Of Positions

• Dorsal recumbent position

– flat on back
– knees slightly separated and flexed
– feet flat on bed

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 Types Of Positions
(continued)
• Horizontal recumbent position –
supine
– flat on back
– legs slightly separated and
extended

DHSR Approved Curriculum-Unit 14 28

 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 29

 Types Of Positions
(continued)
• Side lying position
– positioned on either side
– head in straight line with spine
– pillows used to support head, back,
arm, and leg

DHSR Approved Curriculum-Unit 14 30

 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-Unit 14 31

 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 32
 Types Of Positions
(continued)
• Fowler’s position
– sitting 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 33

 Types Of Positions
(continued)
• Sim's position
– positioned on left side
– left arm extended behind body
– right arm flexed in front of body
– right leg flexed toward abdomen
– used for enema administration

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14.3 Discuss moving, turning,
positioning and lifting residents.

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 Moving, Turning, Positioning
And Lifting
• Good body mechanics necessary
– Prevents injury to resident
– Protects nurse aide from injury
– Good body alignment promotes
comfort for resident

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 Moving, Turning, Positioning
And Lifting
(continued)
• Safety major consideration
– Get help if needed
– Receive directions from supervisor
regarding any restrictions for
positioning or movement

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 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 comfortable working
level
DHSR Approved Curriculum-Unit 14 39
 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 40
 Moving, Turning, Positioning
And Lifting
(continued)
• Use postural supports as directed:
– Rolled blankets
– Pillows
– Rolled towels
– Footboards
– Bed cradles
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 Moving, Turning, Positioning
And Lifting
(continued)
• Reposition at least every two hours or
as directed
– Eliminates pressure on bony areas
– Provides comfort
– Exercises muscles
– Moves joints
– Stimulates circulation
DHSR Approved Curriculum-Unit 14 42
 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 themselves as
much as possible

DHSR Approved Curriculum-Unit 14 43

 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

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DHSR Approved Curriculum-Unit 14 45
14.4 Demonstrate the procedure for
moving the resident up in bed.

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14.5 Demonstrate the procedure for
moving a resident up in bed using
a turning sheet.

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14.6 Demonstrate the procedure for
positioning a resident on side.

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14.7 Discuss repositioning the resident
in a chair or wheelchair.

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 Repositioning Resident In Chair
Or Wheelchair
• Reasons for changing position
every two hours or as directed
– Promotes comfort
– Reduces pressure
– Increases circulation
– Exercises joints
– Promotes muscle tone
DHSR Approved Curriculum-Unit 14 51
 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
covered, with use of pressure-
relieving cushion preferred
• Pillows or soft blankets used for
support
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 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

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