Preventions and Support Surfaces

Question 1

Explain the rationale for use of a research-based risk assessment tool, and identify risk assessment tools that are research-based

Answer 1

tested for reliability and validity

Braden Scale for Predicting Pressure Sore Risk
Sensory Perception
Moisture 
Activity
Mobility
Nutrition
Friction & Shear

moderate risk 12-18
high risk <12

Question 2

List major risk factors p.52

Answer 2

1. reduced mobility/activity
2. friction/shear
3. moisture/maceration/temperature (microclimate)

Nutritional Status
Perfusion Status
Aging

Question 3

Indications for low-intermediate level and for high-level support surfaces and know the categories/types of products that are considered high and low level

Answer 3

Pressure reduction/pressure redistribution

low-intermediate surfaces (foam based)

• mid-level pressure distribution
• some devices (shear & friction control)

Indications for Low-Mid Level Therapeutic Support
keep off breakdown area (1 spot)
no breakdown or breakdown on 1 surface can be offloaded w/ moderate risk pt >12
Shear, moisture >2
eg. therapeutic mattress overlays, purchase replacement mattress, simple alternating pressure devices

High-level support surfaces (air support surfaces)

• high level pressure redistribution
• shear & friction control (Goretex)
• microclimate control

Indications for High level support
breakdown 2 or more surfaces
no breakdown w. high risk pt
cannot be turned, sever pain
cannot be consistently/effectively offloaded
Braden score >12
shear/friction, moisture >3

Question 4

Explain the importance of checking for bottoming out on a overlay and be able to describe the procedure

Answer 4

place hand between overlay and underlying mattress, if can feel bony prominence, then insufficient support

Question 5

Discuss the issues related to heel protection even on high-level surfaces

Answer 5

heels need to be protected and float off the bed

insufficient pressure support from mattress even on high-level surface

Question 6

Given a patient scenario, be able to develop a positioning program that minimizes the risk of further breakdown

Answer 6

Braden scale, individualize for at risk pt 10-12
schedule guidelines for turning and repositioning
pressure redistribution devices eg. bed/chair
reduce shear and friction (goretex, lit sheet, low friction surfaces)
control incontinence/maceration
nutritional Ax/interventions
daily Ax & documentation on skin status