Notes on Pressure Injuries and Their Prevention

Pressure Injuries and Related Risk Factors

  • Causes of Pressure Injuries

    • Prolonged pressure on bony prominences leads to compression of the skin and underlying tissues.
    • Common locations for pressure injuries: back of the head, ears, heels, and coccyx.

  • Risk Factors

    • Medical Conditions:
    • Diabetes: Leads to neuropathy, causing a lack of sensation in feet making injuries unnoticed. Also affects blood perfusion due to damage in blood vessels.
    • Decreased Mobility: Increased risk due to limited movement, leading to pressure accumulations.
    • Malnutrition: Inadequate protein intake, particularly albumin, hinders tissue healing.

  • Mechanical Factors

    • Friction: Caused during repositioning in bed or adjusting the head of the bed.
    • Devices contributing to friction: CPAP masks, pulse oximeters, and NG tubes can cause localized injuries through constant pressure.

  • Symptoms of Pressure Injuries

    • Redness, swelling, warmth, and pain in affected areas. Signs of infection may include increased warmth and drainage.

Prevention Strategies

  • Reducing Risks
    • Use heel protectors or cushions to reduce hard surface contact.
    • Incorporate frequent repositioning and movement for all patients, especially those at risk.
    • Ensure a holistic approach, including hygiene and nutrition, as well as psychological awareness to alert patients about positional changes.
  • Regular Monitoring
    • Assess skin regularly for any signs of pressure injury development. Check pulses, capillary refill time, skin color, and temperature.

Complications Associated with Pressure Injuries

  • Infections

    • Infection can occur if skin integrity is breached. Types include cellulitis and osteomyelitis (often seen with IV drug users due to repeated punctures).
    • Serious systemic infection: Sepsis, characterized by fever, increased heart rate, and potential organ failure. It has a high fatality rate if untreated.

  • Types of Wounds

    • Classification based on tissue layers involved: Stage one through four, using descriptions like slough, eschar, and granulation tissue. Tunneling and undermining are key identifiers in wound assessments.

Assessment Techniques

  • Wound Assessment

    • Document size in centimeters, assess surrounding tissue for signs of maceration or infection, and implementation of the "Coca" method to note color, odor, consistency, and amount of drainage.
    • Use a scale for risk assessment (like the Braden scale), where a score of 18 or below indicates higher risk for developing pressure injuries.

  • Intervention Evaluation

    • If interventions fail, it may necessitate consultation with a physician for alternative strategies or treatments.

Nutritional Considerations

  • Importance of Nutrition
    • Adequate protein intake is crucial for wound healing. Assess albumin levels to evaluate nutritional status.
    • Encourage consumption of high-protein foods and hydration as part of nutritional intervention strategies.