Pressure Injury Prevention and Care (Nursing)

00:04 Now, I've talked about nursing responsibilities initially, but what we really need to break this down into is three different categories and we're going to further explain each one.

00:15 So assessment of the risk, right? That's where those stages come in, we can kind of decide, okay, if this is stage one, we don't want this to progress and this is the treatment.

00:25 So assessment is key to start off and give us a point to monitor by.

00:32 Also, of course, prevention, prevention.

00:35 This is so easily prevented, guys.

00:37 Now we know there's certain populations we need to assess for, but prevention really is key to prevent this from happening.

00:45 And to be honest, guys, unfortunately, pressure injuries, they really are pretty easy to prevent.

00:52 Again, patient populations can put you at risk.

00:56 But if we know this population, we should be even more diligent to prevent.

01:02 And lastly, treatment.

01:03 If we do have a pressure injury occur, what are we going to do? How do we progress with treatment? And we'll discuss these.

01:12 So now let's take a look at that first category of nursing responsibilities Assessment.

01:18 Man, guys, assess, assess, assess, this is where it starts.

01:23 If we don't assess appropriately, how are we going to know that injury is there? And of course, if we don't assess and treat early, it could get worse.

01:31 So here are some things of how we do assessment.

01:34 We have awesome evidence-based screening tools to assess for skin breakdown and to implement our interventions.

01:43 Now, most of scoring systems you're going to see you're going to see different variations.

01:47 Usually you're going to see anything from a rating from mild, moderate, severe, for example.

01:53 Well, let's take a look at what we talk about these tools.

01:56 They usually have all of these different things that we're going to include.

02:01 So the first one is going to be sensory.

02:03 So kind of like we talked about with our diabetic patients or maybe even a patient with like a spinal cord injury who has lost sensation from maybe their neck down.

02:13 They cannot feel that there's pain or pressure.

02:16 So we need to assess their sensory function.

02:20 Also, moisture is actually a really big culprit, and this is especially important in our elderly patients.

02:26 If a patient has an incontinent episode, then a lot of times that moisture can stay on the skin.

02:32 It can get boggy and break down easily.

02:36 We want to assess the patient's activity.

02:38 Are they able to get up and down from the bed, move on their own as well as their mobility? That's really important.

02:45 Can they move their arms, their legs function for themselves? And again, here's that nutrition piece.

02:52 This seems like well it's just nutrition, isn't that going to be in place? But it's really important to support nutrition, especially with those higher injuries.

03:03 And lastly, friction.

03:05 So you may think, okay, well where does this come in? Think about those patients in the bed, for example, and sometimes we'll take a draw sheet and boost them up in bed.

03:15 If we're not careful, guys, just that shearing and that friction of the skin that can break down skin as well and cause injury.

03:24 Now, let's talk about the prevention piece.

03:27 We talked about how we assess by using those tools.

03:30 Now here are some big categories about what we need to look for as a goal for prevention.

03:36 So, of course, if we can restore circulation, however we decide to do that, it is appropriate for your patient, that's key.

03:43 And of course, because immobility is like a really big factor in creating a pressure injury, we want to promote that as much as possible.

03:52 If possible, we always want to look at the underlying condition.

03:57 So, again, here's a great example.

03:59 You may have a diabetic patient that has what we call neuropathy where maybe they can't feel in some of their extremities.

04:06 We have medications to help with that.

04:08 That also may help trigger the patient that, 'oh, there's some painful spots, etcetera' to report to the nurse.

04:15 And there's that nutrition guys again, nutrition and hydration to help support our integumentary system.

04:24 Now, let's talk about the treatment piece.

04:28 Here's the points that we really need to discuss, because again, guys, it's inevitable that you're going to run into this in the clinical setting.

04:38 But again, it's so preventable, but these are some treatment pieces that we really need to look at because, again, it's not if it's when you're going to encounter a pressure injury in clinical side or under your nursing care.

04:53 So by reducing those points, this is the best way to prevent or to treat.

04:59 So first of all, removing linens and or light drains under the patient's skin, Okay so you're like, "what are you talking about here?" So here's a great example.

05:09 I work in post op care.

05:11 My patients will be left in bed taking a nap, I'll walk in and their drain is like, all stuck underneath their back.

05:19 Some of these are soft, but some of these are really hard and they've been laying on that thing for hours.

05:25 So all of that pressure on the patient's skin can cause breakdown.

05:30 Don't forget as well about those I.V. lines.

05:33 That's really calm and the patient gets tangled up in their IV lines in bed.

05:37 That pressure and those points on the patient's skin can cause injury.

05:43 Now, here's another one, guys, man, I have a just personally, I've seen some really bad pressure injuries due to briefs, this is something that really if we can avoid as for care at all possible, we really need to do so.

06:04 So we want to limit the use of briefs and here's why.

06:08 If our patient urinates or has a fecal incontinence episode in the brief, think about wearing that, guys, that is going to go in contact with that patient's skin.

06:20 Think about even maybe your infant.

06:24 If an infant has a brief on and all that contact and that diaper rash they can get, it's the same thing with all skin.

06:31 All of that contact on a patient's skin can cause serious issues.

06:35 And many times if a patient's wearing a brief, we don't realize the patient's been soiled and we don't change them appropriately.

06:43 So please be really cautious about limiting the use of briefs.

06:48 Our final two strategies for reducing pressure injuries are: consider limiting the layers of linens on the patient and ensure the linens are smooth and wrinkle free.

06:59 Now, the more linens you have on the patient, the more potential for wrinkles in the linen and this can cause pressure, injury and injury to the skin.

07:09 The same thing goes for linens underneath the patient.

07:13 Let's talk about another huge component in regards to treatment, to pressure injuries, so this may seem a little odd, but guys here it goes back to that goal of offloading pressure.

07:25 So a lot of times you may see like this first image here of turning the patient every two hours.

07:32 Now, that can be from side to back to side and then repeat that process.

07:39 Guys, again, this seems so silly, but we actually in the hospital to prevent pressure injuries, you may even have an intervention called "turn teams" where you and a buddy pair up all of our patients who cannot turn themselves, we will make a list of who needs turn and just go on that hour and make sure everybody's turned.

08:00 This is how absolutely important this is.

08:03 Now next, if you have a patient that's in a wheelchair, for example, and they can get up, that's definitely helpful on their circulation, but we can't leave someone in a chair or wheelchair.

08:14 We're putting a lot for a long period of time because we're putting a lot of pressure on that coccyx, for example.

08:20 So it's a great idea just to kind of put a little bit of a pillow or have the patient reposition about every 15 minutes or so in the wheelchair.

08:29 And lastly, again, if the patient can get up, if they can stand every hour, that's even better.

08:35 So if your patient has the ability to do this, this is going to help with their leg strength, it's going to help offload pressure and this is an easy reminder for the patient.

08:45 Now, let's a look at some pressure reducing devices.

08:49 So we have a lot of neat things, guys, because again, this is such a preventable problem.

08:54 So one of these is draw sheets.

08:56 So we talked earlier a little bit about that assessment tool that talked about friction.

09:02 This is what we're addressing here.

09:04 So draw sheets are simply a sheet that goes underneath the patient.

09:09 This one's actually even in this image, it's got handles.

09:12 You hold on to this and with your team, you move up your patient.

09:17 So this is going to help us move the patient without shearing their skin across their own bed linen.

09:23 The draw sheet allows us to pick up the patient, which reduces friction and shearing.

09:29 So next, let's look at these fun things, they are called float boots.

09:32 But again, you should see these in every hospital and every hospital care, even patients at home.

09:39 So if you guys remember when we talked about this supine position, those heels, guys, the heels, the heels, the heels, assess those because I will tell you, those are one of the first places that patients break down.

09:53 So if you see this lovely boot here, this is really just to offload pressure.

09:59 Your patient's foot sets in the boot and oftentimes it's elevated in the boot.

10:04 That way, if the patients are mobile, there's not constant pressure on that heel.

10:08 So these are really widely used, again, throughout facilities.

10:14 Now, next, let's take a look at this one, this one's called an air mattress.

10:18 These are, I wish I would have a bed like these, these are genius.

10:22 So with the air mattress, this is usually put in place with someone really high risk for pressure injury, or they may already have a pretty severe pressure injury.

10:33 So with an air mattress, this is placed on top of the patient's bed.

10:37 What it's going to do is inflate, deflate, inflate, deflate at different points across that mattress.

10:44 What it's doing, moving circulation, offloading pressure points.

10:49 So this is a really cool device and really important with actually those patients with really severe stages of pressure ulcers.

10:58 So we're about halfway through these devices, guys, but these are all important.

11:03 So let's look at this particular one, the oxygen tubing padding.

11:07 This is one of the most overlooked places.

11:10 This may seem a little odd, but just let's pause and think a minute.

11:14 So if a patient has oxygen tubing, you've got that hard plastic that is sitting around your ears, Your patient's moving, it's getting tugged.

11:23 So many times, patients will get really bad pressure injuries here and it will be really uncomfortable.

11:30 Not only that, if I have that as a patient, probably not going to be very compliant.

11:35 I'll probably want to pull off my oxygen, right, because it hurts.

11:38 So we have these beautiful little padding devices that can go around that to help.

11:43 Next, your facility may have a positioning wedge.

11:46 Oh, man, these are nice.

11:48 So do you see this piece underneath the patient's back? Again, that's just kind of help support when we turn a patient.

11:56 And lastly, guys, if you don't have one of those really nice fancy positioning wedges, guys, we use pillows, these are readily available and all over the hospital.

12:05 Honestly, this is going to be the most common piece that you're going to use to reduce pressure.

12:11 Many times we'll tuck these underneath the patient's knees.

12:14 Also, when we turn the patient, we'll kind of roll these up and put it underneath the patient's back to support them in that position.

12:22 So, guys, I know that was a lot of information, but I cannot stress the importance enough of reducing pressure injuries for our patients.

12:30 Thank you for watching.