Skill 60

Pressure Ulcer Treatment

The principles of managing patients with pressure ulcers include systematic support of patients, reduction or elimination of the cause of skin breakdown, and management of the wound that provides an environment conducive to healing. Once you find the cause of the pressure ulcer, take steps to control or eliminate it. Next assess the patient’s wound-healing abilities.

The principle that guides the selection and use of topical dressings is to provide a wound environment that supports healing (Rolstad, Bryant, and Nix, 2012). The best environment for wound healing is moist and free of necrotic tissue and infection. Choose interventions and dressings designed to support a clean, moist wound bed. Perform a thorough assessment of the wound and the periwound skin before initiating wound therapy.

Choose wound dressings to meet the characteristics of the wound bed (Rolstad et al., 2012). The choice of a wound dressing depends on the type of wound tissue in the base of the wound, the amount of wound drainage, the presence or absence of infection, the location of the wound, the size of the wound, the ease of use and cost-effectiveness of the dressing, and the comfort of the patient.

Delegation Considerations

The skill of treatment of pressure ulcers and dressing changes cannot be delegated to the nursing assistive personnel (NAP). The nurse instructs the NAP to:

▪ Report any wound drainage that might be on linens or intact skin, indicating the need to change the dressing or use an alternative dressing.

▪ Report any new areas of redness, blistering, or skin irritation.