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INTRODUCTION

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

  1. Identify the factors leading to pressure injury and ulcer development.

  2. List strategies for prevention of pressure injuries.

  3. Complete a risk assessment scale to determine pressure injury risk.

  4. Effectively implement strategies for pressure load management.

  5. List and define the categories of bed types.

  6. Describe proper wheelchair positioning to prevent tissue injury.

  7. Define the NPUAP pressure injury and ulcer stages.

  8. Discuss the elements of proper pressure ulcer treatment.

There are many different wound etiologies that occur on patients and require medical intervention to achieve full healing. In the hospital and long-term care settings, the most common type of wound is the pressure injury, and the most common populations in which pressure injuries occur are the elderly and patients with spinal cord injury. In the spinal cord injury population, 25–40% of individuals will develop a pressure injury in their lifetime, and 70% of pressure injuries occur in patients over the age of 70.1,2

The National Pressure Ulcer Advisory Panel definition is as follows: a pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue.3 Unlike other types of wounds, pressure injuries and ulcers are often viewed as a visible sign of neglect, although there are situations in which development of skin breakdown is unavoidable. Pressure ulcers are a significant cause of morbidity and mortality and occur in all care settings, from the home to the intensive care unit. The annual cost of treating pressure ulcers in 2004 was noted to be £1.4–2.1 billion in the United Kingdom, which was equivalent to approximately 4% of the total National Health System budget, and $2.2–3.6 billion in the United States for the same time period.4,5 The cost of a single pressure ulcer has been estimated to increase the cost of a hospital stay by $2,000–$11,000.6

The population is rapidly aging, with the fastest growing segment of the population being individuals over the age of 80,7 thus it is expected that the number of pressure ulcers, and therefore the cost to the healthcare system, is going to increase dramatically in the next 20 years unless significant improvement can be made in prevention. Despite the many advances that have been made in the field of medicine, these advances have not significantly impacted the prevalence or incidence of pressure ulcers.

Editor's note: Because of the recent discussion about definitions of pressure damage, in this chapter ...

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