Chapter 10

Principles and Practices

of Rehabilitation

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Areas Susceptible to Pressure Ulcers

Figure 10-5
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors for Development
of Pressure Ulcers
Immobility
Impaired sensory perception or cognition
Decreased tissue perfusion
Decreased nutritional status
Friction, shear
Increased moisture

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Shear and Friction

Figure 10-6
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment for the Prevention of
Pressure Ulcers
Assessment of skin
Evaluate mobility
Evaluate circulatory status
Evaluate neurologic status
Evaluate nutrition, hydration
Braden scale

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interventions to Prevent Pressure Ulcer
Formation
Relieving pressure, pressure-reliving devices
Positioning patient, reducing friction, shear
Minimizing irritating moisture
Improving: mobility, sensory perception, tissue perfusion
Nutritional status

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers
Deep tissue injury
Immediate pressure relief to affected area
Stage I
Remove pressure
Prevent moisture, shear, friction
Promote proper nutrition, hydration

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers
(contd)

Stage II
Clean with sterile saline
Semipermeable occlusive dressings, hydrocolloid
dressings, or wet saline dressings provide moist
healing environment

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers
(contd)

Stages III and IV

Debridement to remove infected, necrotic tissues,
wet-to-damp dressing, enzyme preparations
Topical treatment to promote granulation of tissue
Surgical debridement, bone resection or skin grafting

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 Question
Which nutrient is responsible for collagen synthesis?
A. Vitamin A
B. Vitamin C
C. Water
D. Zinc

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
B. Vitamin C
Rationale: Vitamin C promotes collagen synthesis.
Vitamin A stimulates epithelial cells and immune
response. Water maintains homeostasis. Zinc sulfate is a
cofactor for collagen formation and protein synthesis.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interventions: Urinary Continence

Dependent on type of urinary incontinence

Do not restrict fluids; ensure 2 to 3 L daily
Bladder training
Habit training
Biofeedback
Kegel exercises
Intermittent catheterization
AVOID indwelling catheters

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Interventions: Bowel Continence

Consistency in implementing plan is essential

Toilet patients at same time daily
Natural time for defecation is 30 minutes after meal,
especially in morning
Positioning
Nutrition: high-fiber diet, 2 to 3 L fluid daily
Encourage physical exercise/activity

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Home and Community-Based Care
Impact of disability on physiologic functioning
Changes in lifestyle necessary to maintain health
Medications
Obtain medical supplies
Use of adaptive equipment

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Home and Community-Based Care
(contd)
Demonstrate mobility status
Demonstrate skin, bladder, and bowel care
Community resources
Access transportation

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins