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Reducing a Veteran’s Risk for Pressure Ulcers/Injuries

There is no single preventive for pressure ulcers/injuries. Give priority to pressure relief. Reduce other risks to help maintain a healthy flow of nutrients to the patient’s skin.

Tips to promote good nutrition

  • Feed the patient more frequently.

  • Order foods high in protein and calories.

  • Give vitamin supplements, if necessary.

  • Use tube feedings, if necessary.

  • Give adequate fluids to prevent dehydration.

Promote good nutrition

Prevention starts with eating a healthy diet and maintaining muscle. Weight loss causes muscle loss. Contact a dietitian at your facility if your patient is experiencing unplanned weight loss or are eating poorly because their appetite has decreased. If you feel your patient’s weight is stable, it is a good practice to encourage monthly weights and record the weight. If you notice a weight change, encourage or monitor the patient’s weight weekly. If the patient is unable to weigh themselves, have the patient record how their clothes are fitting or any changes in the size of their clothes. Also, remind patients to bring their recorded weights to their appointments.

Encourage the following to reduce your patient’s risk to developing a pressure injury/ulcer:

  • Eat healthy diet with plenty of water and add snacks between meals if you are losing weight.

  • Eat high protein foods at every meal (high quality whole muscle meats, eggs, fish, and dairy).

  • A multivitamin/mineral supplement may be appropriate. Talk with your healthcare team.

Manage moisture

Keep skin clean and lubricated, but free of excess moisture. Put the patient on a regular toilet schedule. Use incontinent devices, if appropriate to minimize exposure of the skin to excessive moisture. Consult with a provider about using diarrhea medications.

  • Avoid the use of powders.

  • Use moisture barrier creams.

  • Place thin, soft cotton fabric (such a pillow case, t- shirt etc.) between skin folds.

  • Pat skin dry after bathing.

  • Lubricate skin with lotion, but avoid leaving excess lotion in skin folds or between toes.

Relieve pressure

You can relieve pressure and restore the skin’s blood supply by repositioning the patient and using special devices. Post a schedule to remind you to reposition the patient—from side to back or from stomach to side. Make minor position changes even more frequently. Specially designed pillows, foam wedges, beds,  mattresses, and seat cushions can also help reduce pressure.

In a bed

  • Use pillows (positioned the long way) under calves to elevate the legs from above the knees to the ankles.

  • Shift the angles of arms and legs to be more natural and prevent trapping a limb under the body or against a hard surface.

In a wheelchair

  • Have patients shift their weight slightly several times an hour or at least every 30 minutes.

  • Cushion the back and buttocks with pillows or wheelchair cushions, and pad the footrest.

Reduce shear and friction

Prevent skin breakdown by reducing friction and shear. Patients are less likely to slide down in bed if they’re supported by pillows and the head of the bed isn’t raised too high. During bed or wheelchair transfers, lift—don’t drag—the patient. If you can’t do this alone, get help. And be sure to use assistive devices, such as transfer or lifting devices (overhead or transfer equipment) whenever possible.

In a bed

  • Use draw-sheets or transfer boards to move patients.

  • Clean and smooth the bed surface.

  • Lift the head of the bed no more than 30°.

  • Raise the foot of the bed slightly.

  • Elevate heels (off bed or other surfaces)

In a wheelchair

  • Support the patient’s back with a pillow.

  • Use a foot extension, if necessary.

To learn more

For more information, go to the Pressure Ulcer/Injury Resource mobile app.

Author: StayWell Custom Communications
Last Annual Review Date: 8/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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