Pressure Ulcers

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Pressure reducing devices
There are over 100 different pressure-reducing products available for bed-bound patients. Static devices consist of overlays and mattresses that are made of or contain gel, foam, air, or water. They work by distributing local pressure over a wider body surface area.
Dynamic support systems use a power source to alternate air currents in order to regulate or redistribute pressure against the body. A six-inch deep foam mattress can reduced the incidence of pressure ulcers among elderly patients with hip fractures from 68 to 24 percent. It is less clear how different products compare. Only a few well-designed comparative studies have been performed and they have usually not demonstrated one product to be better than another at preventing ulcers . The selection of an appropriate device for pressure ulcer prevention must balance a variety of considerations including cost ease of use, risk of ulcer development, and other patient characteristics.

Other interventions
Other interventions to prevent pressure ulcers are targeted toward individual patients based upon findings from the comprehensive evaluation.
Patients immobilized from a hip fracture or stroke may benefit from physical
therapy. Severe spasticity may be relieved with muscle relaxant drugs or a nerve block. Medica-tions contributing to immobility (eg, sedatives) should be stopped. Proper skin care should be provided, including cleansing at regular intervals and minimizing
exposure to moisture. Practices for managing urinary incontinence have been described. In general, underpads or briefs are adequate for prevention. A Foley catheter is sometimes needed when treating an ulcer. Massage over bony prominences should be avoided. Friction may be limited by using proper positioning techniques so that patients are not dragged in bed.
Adequate nutrition should be provided. These interventions appear to represent good care, although few have been validated in randomized clinical trials.
Education and healthcare organization are two additional key elements in preventing pressure ulcers. Education should be directed toward the clinical staff, patients, and families. It should include information regarding the causes of pressure ulcers and how they may be prevented.

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