Off Loading Flashcards
What is the definition of a support surface, and what are the types?
- Definition:
- A specialized device for pressure redistribution designed for managing tissue loads, microclimate, and other therapeutic functions.
- Types:
- mattresses
- integrated bed systems
- mattress replacements
- mattress overlays
- seat cushions
What is interface pressure, and what is the breakdown pressure for tissue?
Interface pressure:
- The force per unit area that acts perpendicularly between the patient’s body and the support surface.
Breakdown pressure:
- 32 mm Hg is considered the threshold for tissue breakdown due to pressure.
What is the difference between pressure-reducing and pressure-relieving devices, and what are examples of the latter?
Pressure-reducing devices:
- Reduce pressure to 23–32 mm Hg.
Pressure-relieving devices:
- Decrease pressure below 23 mm Hg.
Examples:
- low-air-loss mattresses
- aternating pressure mattresses
- lateral rotation beds
What is the purpose of pressure mapping, and how is it performed?
Purpose: To assess how interface pressure affects tissue loading.
Performance: Sensors approximate pressure on tissues by measuring the force per unit area acting perpendicularly.
What are the indications for Class 1 support surfaces, and what are examples?
Indications:
- For patients who cannot turn or move themselves to relieve pressure on bony prominences or have a pressure ulcer on the pelvis or trunk with additional risk factors like impaired nutrition, incontinence, or altered sensory perception.
Examples:
- gel overlays
- standard foam mattresses (3–5 inches thick)
- egg crate mattresses
What are the indications for Class 2 support surfaces, and what are examples?
Indications: For patients with…
- multiple pressure ulcers on the pelvis or trunk
- large stage III or IV ulcers
- recent skin grafting/myocutaneous flap surgery
Examples:
- low-air-loss mattresses
- alternating pressure mattresses
- lateral rotation beds
What are the indications for Class 3 support surfaces, and what is their primary function?
Indications:
- For bedridden or chair-bound patients with stage III or IV pressure ulcers who have not improved with Class 2 surfaces after at least 30 days of conservative treatment.
Function:
- Air Fluid Beds: Redistribute pressure via a fluid-like medium created by forcing air through beads, allowing immersion and envelopment.
What are the primary considerations for selecting a support surface?
Considerations: Pressure redistribution, shear reduction, continence, temperature and moisture control, patient mobility, body weight, and tissue condition.
What is the recommended schedule for turning or repositioning immobile patients, and how can a ‘turn clock’ help?
Schedule: Reposition every 1–2 hours, or every 4 hours if using a viscoelastic foam mattress.
Turn clock: A visual reminder to ensure consistent repositioning for pressure relief.
What are three methods for wheelchair pressure relief, and how often should they be performed?
Methods:
- Push-up relief (off-loads the buttocks)
- Forward lean (reduces pressure on ischial tuberosities)
- Side lean (off-loads one side, performed bilaterally)
Frequency: Every 15–30 minutes for at least 30–90 seconds.
What is the definition of a support surface, and what are the types?
Definition: A specialized device for pressure redistribution designed for managing tissue loads, microclimate, and other therapeutic functions.
Types: Mattresses, integrated bed systems, mattress replacements, mattress overlays, and seat cushions.
What is interface pressure, and what is the breakdown pressure for tissue?
Interface pressure: The force per unit area that acts perpendicularly between the patient’s body and the support surface.
Breakdown pressure: 32 mm Hg is considered the threshold for tissue breakdown due to pressure.
What is the difference between pressure-reducing and pressure-relieving devices, and what are examples of the latter?
Pressure-reducing devices: Reduce pressure to 23–32 mm Hg.
Pressure-relieving devices: Decrease pressure below 23 mm Hg.
Examples: Low-air-loss mattresses, alternating pressure mattresses, and lateral rotation beds.
What is the purpose of pressure mapping, and how is it performed?
Purpose: To assess how interface pressure affects tissue loading.
Performance: Sensors approximate pressure on tissues by measuring the force per unit area acting perpendicularly.
What are the indications for Class 1 support surfaces, and what are examples?
Indications: For patients who cannot turn or move themselves to relieve pressure on bony prominences or have a pressure ulcer on the pelvis or trunk with additional risk factors like impaired nutrition, incontinence, or altered sensory perception.
Examples: Gel overlays, standard foam mattresses (3–5 inches thick), and egg crate mattresses.
What are the indications for Class 2 support surfaces, and what are examples?
Indications: For patients with multiple pressure ulcers on the pelvis or trunk, large stage III or IV ulcers, or recent skin grafting/myocutaneous flap surgery.
Examples:
- low-air-loss mattresses
- alternating pressure mattresses
- lateral rotation beds
What are the indications for Class 3 support surfaces, and what is their primary function?
Indications: For bedridden or chair-bound patients with stage III or IV pressure ulcers who have not improved with Class 2 surfaces after at least 30 days of conservative treatment.
Function: Redistribute pressure via a fluid-like medium created by forcing air through beads, allowing immersion and envelopment.
What are the primary considerations for selecting a support surface?
Considerations: Pressure redistribution, shear reduction, continence, temperature and moisture control, patient mobility, body weight, and tissue condition.
What is the recommended schedule for turning or repositioning immobile patients, and how can a ‘turn clock’ help?
Schedule: Reposition every 1–2 hours, or every 4 hours if using a viscoelastic foam mattress.
Turn clock: A visual reminder to ensure consistent repositioning for pressure relief.
What are three methods for wheelchair pressure relief, and how often should they be performed?
Methods:
- Push-up relief (off-loads the buttocks)
- Forward lean (reduces pressure on ischial tuberosities)
- Side lean (off-loads one side, performed bilaterally)
Frequency: Every 15–30 minutes for at least 30–90 seconds.
What are the benefits and limitations of viscoelastic foam in support surfaces?
Benefits: Conforms to the body under load, providing effective pressure redistribution.
Limitations: Elastic response diminishes over time, requiring replacement for sustained performance.
What is the purpose of low-air-loss and alternating pressure support surfaces, and how do they differ?
Low-air-loss: Manages heat and moisture using a continuous flow of air within air-filled compartments.
Alternating pressure: Redistributes pressure through cyclic inflation and deflation of chambers to shift body weight.
What is lateral rotation support, and why is it not typically recommended for pressure ulcer prevention?
Purpose: Moves the patient in a regular pattern for pulmonary therapy, positioning one lung higher than the other to prevent pneumonia.
Limitation: Increases risk of shear injuries, making it unsuitable for pressure ulcer prevention.
How should pillows and towels be used to protect bony prominences during positioning?
Place pillows and towels under vulnerable areas such as the heels, sacrum, and coccyx to off-load pressure and reduce the risk of skin breakdown.
What are the key factors in positioning to reduce pressure injuries during bed rest?
- avoid 90-degree side-lying and semi-recumbent positions
- use a 30-degree tilted side-lying position
- limit head-of-bed elevation to 30 degrees unless contraindicated
What OFF-LOADING interventions are necessary for a patient post-skin grafting for a stage IV sacral ulcer?
- air-fluidized bed for pressure redistribution
- maintain proper positioning
- monitor wound healing
- ensure caregiver education for comprehensive care
What is the rationale for frequent repositioning in immobile patients?
Repositioning relieves pressure on bony prominences, improves circulation, and reduces the risk of pressure ulcer formation and skin breakdown.
What are the essential components of conservative treatment for pressure ulcer management?
Components: Frequent repositioning, appropriate support surface use, nutritional optimization, infection control, moist wound healing, and caregiver education.
What are the indications for air-fluidized beds in Group 3 support surfaces?
Indicated for patients with stage III or IV pressure ulcers, severely limited mobility, and failure of conservative treatment after 30 days, when institutionalization would otherwise be required.
What should be evaluated if a patient experiences recurring pressure ulcers despite treatment?
Assess compliance with the care plan, nutritional status, adequacy of support surfaces, caregiver education, and wound care practices.
