Assessing and managing pressure ulcers

 

Though there is no overall consensus on the optimum management of pressure ulcers, there is clinical support for specific prevention and treatment strategies.1 Prevention Assessment Management

PREVENTION OF PRESSURE ULCERS

Early intervention offers an opportunity for preventing pressure ulcers.1

Prevention strategies include:1

  • Assessing the risk of pressure ulcer development
  • Maintaining skin integrity
  • Limiting bed rest
  • Reducing pressure
  • Managing nutrition

Risk assessment tools, such as Waterlow, Norton and Braden scale, are commonly used to identify a patients' susceptibility to developing a pressure ulcer. These should act as a memory tool and should not replace clinical judgement.


ASSESSMENT OF PRESSURE ULCERS2

The 1st stage in management is assessment which should include:

  • Assessment of pressure ulcer:
    • Location, stage of healing, wound conditions (such as exudate level), integrity of surrounding skin, pain
    • Re-assessment of the pressure ulcer should be performed regularly
  • Assessment of the patient:
    • Nutritional status
    • Pain related to pressure ulcer or treatment
    • Psychosocial status

MANAGEMENT OF PRESSURE ULCERS1,2

There are many considerations for the management of pressure ulcers, a number of which are below:

  • Relieve pressure, shear and friction
    • Pressure relieving devices have a role to play, though there is no clear evidence supporting one device over another
    • Manual repositioning
  • Optimize wound healing through appropriate wound dressings
  • Debride the wound of necrotic tissue
  • Manage the bacterial burden in the wound
  • Ensure healthy nutritional status of patient

Closure of pressure ulcers through surgical intervention can help in the management of pressure ulcers. The main problem with this treatment strategy is related to patient tolerance.1


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