What are the elements of a comprehensive care plan for effective prevention or pressure injuries (pressure ulcers)?

Updated: Mar 26, 2020
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Effective prevention of pressure injuries depends on a comprehensive care plan that includes strategies and practices aimed at reducing or eliminating the risk of these injuries. Elements of such a plan may include the following:

  • Scheduled turning and body repositioning - Although numerous factors are known to contribute to the development of pressure injuries, it remains essential to establish a regimen in which pressure is completely relieved on all areas of the body at regular intervals [174, 175]
  • Appropriate bed positioning - Patients can benefit from lying prone; shearing forces can be minimized by keeping the head of the bed lower than 45°
  • Protection of vulnerable bony prominences - Positioning devices such as pillows or foam wedges (not donut-type devices [108] ) should be used to prevent direct contact between bony prominences (eg, knees and ankles); massage of body prominences should be avoided [9, 10, 113]
  • Skin care - Removal of skin secretions and excretions; avoidance of hot water; use of nonirritating, nondrying skin-cleansing agents; use of moisturizers; use of topical agents such as moisture barriers; use of dry, wrinkle-free sheets
  • Alertness for skin changes that might indicate an impending breakdown (eg, inflammation of the skin that blanches on application of digital pressure [9] ), particularly in elderly or immunocompromised patients
  • Control of spasticity and prevention of contractures
  • Use of support surfaces and specialty beds (see Pressure Reduction)
  • Nutritional support as required - This may involve enteral or parenteral nutrition or vitamin therapy
  • Maintenance of current levels of activity, mobility, and range of motion; persons who use a wheelchair should be taught to perform pushup exercises and to lean side to side for pressure relief

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