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When Pressure Persists:
Prevention of Pressure
Ulcers for Those at Risk
written by
Barbara Levine, PhD, CRNP
Gerontological Nursing Consultant
revised by
Ingrid Sidorov, MSN, RN
Gerontological Nursing Consultant
Geriatric Education Center of Greater Philadelphia
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When Pressure Persists:
Learning Objectives
Direct Care Staff will be able to:
 Identify the risk factors for pressure ulcers
 Discuss common reasons for pressure ulcers
 Discuss strategies to prevent these wounds
 Describe a team approach to pressure ulcer
prevention and care
 Describe a pressure ulcer prevention program
in long term care settings
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Pressure Ulcer:
Definition
A pressure ulcer is localized
injury to the skin and or
underlying tissue, usually over a
boney prominence, that happens
as a result of pressure and/or
friction/shear issues.
(NPAUP, 2007)
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Pressure Ulcers
 Occur
more commonly in older
people
 Can be prevented in many
residents
 Can be painful, lead to infection,
and are a marker for increased
risk of death
 Cost an enormous amount of
money
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What Causes Pressure
Ulcers?
– reduces blood flow to skin
 Friction – repeated rubbing causes a
break in the skin
 Shear – sideways pulling on the skin
layers until it breaks
 Moisture, especially from urine or
stool increases the risk of wounds
multifold
 Pressure
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Who’s at Risk?
Individuals who:
 Are bed or chair-bound
 Have contractures
 Are unable to sense discomfort
 Are incontinent
 Are poorly nourished
 Are dehydrated
 Suffer from an altered LOC or CI
 Are febrile or hypotensive
 Are chronically ill
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Pressure Points
 Back
of the head
 Back of shoulders
 Elbows
 Hip
 Buttocks
 Heels
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A Team Approach to
Prevention
Identify at-risk individuals
 Maintain and improve skin condition
 Protect against pressure and injury
 Assure adequate nutrition and hydration
 Encourage activity and mobility
 Educate older adults, families, and care
providers
 Early identification of skin injury

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Clean and Dry
Clean gently with warm water
 Prevent incontinence by
maintaining toileting schedule
 Help person off the bed pan or toilet
promptly
 Clean skin at time of soiling
 Absorbent underpads or briefs only
as needed – try to keep off to
promote healing
 Use of moisture barriers

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Beyond Clean and Dry
 Look
for and report any changes
 Clean skin and keep it well
lubricated
 Minimize dryness and avoid
excessive moisture
 Do not rub over reddened areas;
this only increases damage to
tissues.
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Skin Checks
 Check
all surfaces at least twice a
day
 Remove clothing and position for
visibility
 Check pressure points with every
position change
 If you note a reddened area,
reassess in 15 minutes
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Abnormal Skin Changes
Note location, size and degree of:
 Areas of redness or warmth in
fair skin
 Areas of duskiness, discoloration
and warmth in dark skin
 Areas of pain or discomfort
 Blisters – fluid-filled or broken
 Weeping or drainage
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Reducing Pressure
in Bed
 Turn
at least every two hours
 Prevent skin- to- skin contact
 Complete pressure relief for heels
 Elevate head of bed as little as possible
 Use lift sheets or trapeze
 Do not position directly on hip bone
 Do not rub or massage reddened areas
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30o Laterally Inclined
Position
 Weight
not on sacrum or
trochanter
 Support with pillows or foam
wedge
 Use pillows to protect vulnerable
areas
 Head of bed as low as possible
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Reducing Pressure
in Chairs
 Reposition
at least every hour
 Instruct to shift weight every 15
minutes
 May need cushion
 Do not use doughnuts or rings
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Nutrition
 Encourage
residents to
drink enough fluids
 Assist to eat enough
protein and calories
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You can make a
difference!
 Keep
your older adults moving
 Position immobile or dependent
individuals frequently and carefully
 Assist residents with meals and
snacks
 Provide plenty of fluids
 Keep those with incontinence clean
and dry
 Be alert to changes and report them
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Objectives Review
Can you now:
 Identify the risk factors for pressure
ulcers?
 Discuss common reasons for pressure
ulcers?
 Discuss strategies to prevent these
wounds?
 Describe a team approach to pressure
ulcer prevention and care?
 Describe a pressure ulcer prevention
program for long term care?
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Thank you for your
attention!
The End
Geriatric Education Center of Greater Philadelphia