Week 2 Pressure Injury Interventions Flashcards
what is the best intervention for PI
prevention through education positioning mobility nutrition management of incontinence
how do we educate patients, caregivers and healthcare workers
daily skin checks with mirrors, and transfer techniques. position changes like every 2 hour at least, and incontinence management.
what is incontinence management
mild soap, pat dry and use moisture barriers. no diapers and talc based powders. also, don’t rub it and rip the skin with scrubbing
how can we use positioning in bed
- avoid side positioning, but rather 30 degrees lateral instead
- pillows and foam pads between bony parts
- HOB least degree of elevation
- clean and wrinkle free sheets
- pillows/wedges to prop the heels and head
- support surfaces
how can we position in a W/C
sitting in intervals, with change in position frequently, and using W/C ups and shifts
how can we use mobility
encourage and lengthen tubes and lines to allow for mobility and use pain control techniques without too much Pharma
can we use nutrition as prevention
yes
how can we manage incontinence to prevent
moisture barriers speedy and gently hygiene incontinence pads voiding and defecating schedule neuromuscular Re-ed call light within reach
what is the bates Jensen wound assessment tool (BWAT)
15 items the describe the wound the peri wound that correlates with the severity of the wound. The higher the number, the more severe
what is the pressure ulcer scale for healing (PUSH)
developed by NPUAP to monitor healing of ulcers
how do we cleanse a PI
normal saline, tap water and anti-septics if there is a confirmed or suspected infection, lots of debris or bacteria. and you clean the peri wound too
can you debride PI
if needed, when appropriate and if it is consistent with the goals. for the LE, you need vascular supply for it to heal properly.
TF: always debride dry stable eschar in ischemic limbs
false, never
what must we consider with dressing selection and PI
moisture balance, exudate, bio-burden, tissue condition in the wound and the peri wound, size, depth and location, tunneling and undermining and the goals.
