Week 3 | Pressure Injury Management (17181-SP)

Photo of older patient being comforted by nurse.

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This mini-course includes the supplemental resource: Caring for Patients with Obesity (optional). 

Topics

Confirm pressure ulcer etiology

Establish management goals

  • Maintenance
  • Comfort
  • Healing

Pressure ulcer management principles

  • Control or eliminate causative factors
    • Implement pressure ulcer prevention guidelines
    • Pressure redistribution and offloading
    • Manage friction and shear
    • Manage moisture
  • Provide systemic support to reduce existing and potential cofactors.
    • Assess patient co-morbidities
    • Interventions to correct deficiencies
      • Optimize nutrition and hydration
      • Reduce edema
      • Control blood glucose
      • Promote blood flow
  • Maintain a physiologic local wound environment
    • Prevent and manage infection
      • Rule out osteomyelitis
    • Cleanse the wound
    • Remove non-viable tissue (maintain stable echar on heels)
      • Autolytic debridement
      • Chemical debridement
      • Biologic debridement
      • Mechanical debridement
      • Sharp debridement: surgical vs. conservative approach.
      • Guidelines for debridement in the OR
        • Presence of advancing cellulitis
        • Wound-related sepsis
        • Extensive necrotic tissue
        • Inability to establish degree of undermining and tunneling.
        • Infected bone or hardware that needs to be removed
    • Maintain appropriate level of moisture
    • Eliminate/fill dead space
    • Control odor
    • Eliminate or minimize pain
    • Protect the periwound skin
  • Pressure ulcer management
    • Consider adjunctive therapies
    • Evaluate for operative repair
    • Minimize recurrence
    • Educate patient/caregiver
  • Topical management
    • No evidence for one dressing over another
    • Prevent wound contamination
    • Consider topical antiseptic for pressure ulcers not expected to heal with critical colonization (NPUAP/EPUAP)
    • Limit use of topical antibiotics
  • Outcome monitoring
    • Stage II ulcers should show evidence of healing within 1-2 weeks.
    • A size reduction of Stage III and IV ulcers at 2 weeks predicts healing.
    • Note subtle signs of critical colonization
    • Monitoring tools: BWAT and PUSH
  • Case studies

Objectives for Learning Outcomes

After completing this session, you will be able to:

  1. Describe the principles of pressure ulcer management. 
  2. Given a case study, select an appropriate treatment plan for a pressure ulcer based on the setting and specific wound characteristics.
Course summary
Available: 
04/07/2017
Expires: 
12/08/2018

Renee Anderson, MSN, RN, CWON
Certified Wound Ostomy Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; President, Rainier Clinical Consultants, Inc, Seattle, WA

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