Bedridden patients, elderly dementia patients, individuals with spinal cord injuries, patients with loss of sensory perception due to diabetic neuropathy, and individuals with nutritional deficits are all at risk for developing pressure injuries if exposed to pressure, shear, friction, and moisture.
While there are many ways to prevent pressure injuries, most professionals rely on the Braden skin assessment using Braden Scale to measure the risk of developing pressure ulcers.
The Braden Scale is an evidence-based tool developed by Barbara Braden and Nancy Bergstrom in 1988 to examine the risk of developing pressure ulcers. It consists of six sub-scales for measurement: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
This is a measurement of the patient's ability to detect and respond to discomfort or pain related to pressure on any part of their body. Based on the level of consciousness of the patient and/or the patient’s ability to feel cutaneous sensation due to neuropathy, SCI, or dementia, the professional assesses their ability to cognitively react to pressure-related discomfort. Scale grading 1- 4.
Excessive and continuous skin moisture compromises the integrity of the skin and increases the risk for epidermal erosion. Moisture may surface from several sources, such as perspiration, urine incontinence, stool incontinence, or wound drainage. Professionals assess the degree of moisture the skin is exposed to and apply it on a scale of 1- 4.
Evaluation of the patient's level of physical activity is critical to assessment since very little or no activity can encourage atrophy of muscles and breakdown of tissue. The level of activity is defined by how many times the patient can get out of the bed without being hurt, move into a chair, or ambulate with or without help. Assessment is done on a scale of 1- 4.
Evaluation of the patient's ability to adjust their body position independently, such as changing the position of the body by rolling over in bed, shifting weight in a chair after sitting too long, or moving their extremities. The professionals assess the physical competency to move and determine the client's willingness to move on a scale of 1- 4.
Adequate nutrition and fluid intake is quintessential for maintaining healthy skin. Protein intake, in particular, is very important for healthy skin and wound healing. The assessment of the patient's patterns of daily nutrition and any abnormality indicates an elevated risk in this category and is indicated on a scale of 1- 4.
Friction and shear look at the amount of assistance a patient needs to move and the degree of sliding on beds or chairs that they experience. The rubbing of skin against the bed and chair can cause shear resulting in the breakdown of cell membranes. This category is evaluated on a scale of 1-3.
A lower Braden scale score indicates higher levels of risk for pressure ulcer development.
The above 6 sub-scale scores combine for a possible total of 23 points, with a score of 23 being the lowest risk of developing a pressure ulcer. The lowest possible score of 6 points represents the severest risk for developing a pressure ulcer.
Once the evaluation is done, depending on what area the patient needs intervention, here are some interventions that can be made using the right products.
Frequent surveillance, use of protective briefs, overnight high absorbency diapers, absorbent under pads, removal of wet or soiled linens, and use of protective skin barriers reduce this risk factor.
Daily supplements like Medtrition ArgiMent AT for Healing and Pre-Protein 15 Liquid Predigested Protein help in providing the patient with adequate nutrition and protein intake for faster wound healing.
Alternating pressure mattresses, combination therapy mattresses, lateral rotation mattresses, and low air loss mattresses can be used to prevent friction and shear for bedridden patients. For wheelchair-bound patients alternating air wheelchair cushions may help.
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