Stopping Pressure Ulcers-Before They Start | I Advance Senior Care Skip to content Skip to navigation

Stopping Pressure Ulcers-Before They Start

May 1, 2004
by root
| Reprints
Interview with Steve Mogensen and John Hertig
  • Pre-albumin levels (serum albumin levels accepted if available).
  • Prescribe multivitamin and mineral supplement.
  • Granulex spray or skin prep to heels bid with soap-and-water wash between applications.
  • Moisture barrier to buttocks after each brief change.
  • Bowel and bladder program for incontinent patients.
  • Float heels with popliteal wedges or heel-lift boots.
  • Evaluate support surface for "bottoming" with hand check and adjust accordingly.
  • OT or PT to provide appropriate wheelchair and wheelchair cushion.
  • Patient up in chair in a.m. for breakfast, remain up for therapy in a.m., back to bed after lunch in p.m. Up for supper.

Rescan in one (1) week; if stable, rescan every two (2) weeks for two (2) months. If condition remains stable, rescan every three (3) months and then D/C. If condition has worsened, go to Phase 3 protocols.


PHASE 3 PRE-ULCER

  • Pre-albumin level (serum albumin levels accepted if available).
  • Prescribe multivitamin and mineral supplement.
  • Prescribe dietary supplements (i.e., Ensure, Boost, etc.).
  • Granulex spray or skin prep to heels once per shift with soap-and-water wash between applications.
  • Popliteal wedge or heel-lift boots when in bed.
  • Evaluate support surface and order accordingly (alternating pressure, low-air-loss, etc.).
  • Barrier cream to buttocks at each brief change.
  • Bowel and bladder program for appropriate patients.
  • OT, PT, and Speech consult for positioning, swallowing, mobility, etc.
  • Patient up in a.m. after breakfast, back to bed after lunch, up in late p.m. for any remaining therapy and supper, back to bed after supper.
  • q2h turning schedules when in bed.
  • OT, PT to provide appropriate wheelchair and wheelchair cushion.

Rescan in 72 hours and then weekly for six (6) weeks. If condition persists, continue protocols and rescan every two (2) weeks until condition improves, then change to Phase 2 protocols.


PHASE F PRE-ULCER
Implement all measures as for Phase 3 PLUS:

  • Consider using Xenaderm« ointment (prescription) on buttocks or aggressive moisture barrier ointment to provide longer-lasting protection.
  • Evaluate for yeast infection and treat accordingly.
  • Implement aggressive incontinence procedures (Foley cath, bladder training, etc.).
  • Consider bladder ultrasound scan.
  • Once-per-shift skin checks to affected area by treatment nurse, wound nurse, or unit manager.
  • If ischials are the area of concern, limit sitting to 2-3 hours/day and ensure good wheelchair cushion support.
  • If sacrum or coccyx is area of concern, limit lying supine in bed.
  • Ensure that turning schedule is in place. Minimize friction and shear by keeping head of bed as low (30 degrees or less) as possible.
  • Evaluate for "nervous foot" movements and address additional protection as necessary.

Rescan 72 hours after initial scan and one (1) time per week for two (2) weeks. If condition persists, continue weekly scanning for four (4) weeks and then biweekly for two (2) months. If condition improves, scan on a biweekly basis for one (1) month and then monthly.

Reprinted with permission of Advanced Clinic Services. This form may not be reproduced without express written permission.


John Hertig is CEO and Steve Mogensen is President of Advanced Clinical Services, provider of the wound care management service using the Longport high-frequency ultrasound scanner. For more information, phone (612) 723-7200 or e-mail smogensen@comcast.net. To comment on this article, please e-mail zinn0504@nursinghomesmagazine.com. For reprints in quantities of 100 or more, call (866) 377-6454.

Pages

Topics