Q:
What is a Pressure Ulcer?
A: A pressure ulcer is a
localised area of dead tissue. It is primarily caused by
unrelieved pressure, for example when a patient lies in one
position for too long, although there are many other factors
which influence their development, such as incontinence and
poor nutrition. The areas of the body most at risk of pressure
ulcer development are the bony prominences, such as the
ischial tuberosities and sacrum.
Q: Who is Most at Risk of Pressure
Ulcer Development?
A: The elderly, people with
neurological conditions, and orthopaedic patients are most at
risk, as they frequently have reduced mobility, and are
therefore less able to change their position. Hospitals use
Risk Assessment scores in order to determine which patients
are most at risk of pressure ulcer development. The most
commonly used score is the Waterlow Score (1985).
Q: When Should a Patient have a
Waterlow Risk Assessment?
A: All patients should
have their pressure ulcer assessed on admission, for example
in A & E, and should be reassessed whenever their
condition changes, for example if their condition
deteriorates.
Q: How Can Pressure Ulcers Be
Prevented?
A: The most effective method of
preventing ulcers is the provision of suitable
pressure-reducing equipment, such as a mattress and seat
cushion. These support the maximum surface area of the body,
which therefore lowers the pressures under the bony
prominences.
Q: What is the Difference Between
Pressure-Relieving Equipment and Pressure-Reducing Equipment?
A: Pressure-reducing equipment aims to provide
maximum support of the body surface area, thereby reducing
interface pressures over bony prominences. Such equipment is
normally referred to as static equipment. The Pressurease
mattress is a static mattress.
Pressure-relieving equipment aims to give pressure relief
over small areas of the body at a time. This is achieved by
inflating and deflating air cells alternately. This type of
equipment is usually referred to as dynamic equipment.
Therefore pressure-reducing equipment gives uniform
pressures throughout the whole body, whereas conversely
pressure-relieving equipment intermittently relieves pressure
under individual areas of the body.
Normally, pressure-reducing equipment is provided for
patients who are known to be at risk of pressure ulcer
development. Dynamic mattresses are provided for patients with
existing ulcers, or who are know to be at very high risk of
pressure ulcer development.
Q: When Should Pressure-Reducing
Equipment be Provided?
A: Pressure-reducing
equipment should be provided as soon as the patient is deemed
to be at risk. Trolleys in A & E, and Operating Tables
should therefore be used in conjunction with suitable
pressure-reducing mattresses, in addition to the mattress on
the patient's bed and cushion on their bedside chair.
Q: What is the Pressurease
Mattress?
A: The Pressurease mattress has been
manufactured from a visco-elastic polymer foam. This type of
foam is sensitive to the heat of the body, and as the foam is
gradually warmed, it conforms to the body shape. The mattress
therefore reduces peak pressure points by supporting the load
over a wide surface area.
Due to the high degree of conformity achieved with the
Pressurease mattress, the effects of shear forces and friction
are reduced.
In addition to the pressure-reducing qualities of the
Pressurease mattress, patients who are nursed on these
mattresses frequently comment on their comfort.
Q: Can the Pressurease Mattress be
used with Profiling Beds?
A: Yes. The combination of
the Pressurease mattress and a profiling bed provided both
excellent pressure reduction and ease of position change.
Q: Does the Pressurease Mattress
Require Regular Turning?
A: The Pressurease mattress
has been designed so that it does not require turning or
rotation.
Q: Is it Unnecessary to Turn the
Pressurease?
A: The Pressurease mattress is
constructed from two layers, each of which has a particular
function. The top layer of the mattress is constructed from
visco-elastic polymer, and this is the layer that is in
contact with the patient. It reduces interface pressure by
conforming to the shape of the body. The base foam acts as the
supporting structure.
Q: Does the Pressurease Mattress have
a Special Area for the Heels?
A: Yes. The mattress
has a special heel care section that reduces the initial force
on the spur of the heel, thereby lessening the risk of
pressure damage.
Q: Do Patients Require Regular
Repositioning on the Pressurease Mattress, if at Risk of
Pressure Ulcer Development?
A: All patients should
be repositioned for eating, toileting and for provision of
comfort. In general terms, if there is a sign of blanching
hyperaemia, the patient may require increased frequency of
repositioning or placing on an alternating pressure-relieving
mattress.
Q: How Should Patients be Positioned
in Order to Reduce Pressure over the Sacrum and
Heels?
A: Patients should be repositioned in the 30°
tilt, as this loads the gluteal area of the body, thereby
lessening weight taken over the bony prominences such as the
sacrum.
Q: Do Patients with a Waterlow Score
of Over 15 Require their Pressure Areas Examining During Each
Nursing Shift?
A: Patients with Waterlow scores of
over 15 require regular skin assessment, even if they have
been provided with a pressure reducing mattress. If any signs
of persistent redness are noticed, then the frequency of
repositioning should be increased, or an alternating
pressure-relieving system provided.
The special heel care panel of the Pressurease mattress
reduces the possibility of damage to the skin over the heels,
slthough they require regular reassessment in order to
identify any damage caused.
Q: What Should I do if the Patient
has Reddened Areas?
A: Firstly the frequency of
re-positioning should be increased. The patient should be
re-assessed, and if necessary provided with an alternating
pressure-relieving system such as the Airform Core Flotation
Therapy System.
Q: Should Bottom Sheets be Tucked-In
to Ensure that there are no Wrinkles?
A: If a tight
sheet is provided, the mattress will be unable to contour to
the patient. This consequently reduces the pressure reduction
provided by the mattress, and is known as "hammocking".
When making the bed, it is important to obtain the correct
tension on the sheets, allowing immersion into the mattress
and preventing hammocking, but without allowing the sheet to
wrinkle.
Q: Should the Top Sheet be Tucked-in
Loosely or Folded, to Ensure that there is no Pressure on the
Toes or Heels?
A: A fold in the sheet near to the
heel section of the mattress will ensure that the surplus
sheet material does not apply pressure to the bony
prominences. Alternatively, a bed cradle may prove more
comfortable.
Q: Does the Conformity of the
Mattress Inhibit Patient Transfers?
A: Not normally.
However, moving and handling equipment such as sliding boards
and sheets can easily be used with the mattress.
Q: How Should the Mattress be
Cleaned?
A: The mattress can be simply cleaned
between patient use with soap and water, providing that there
has been no spillage of bodily fluids.
If a spillage of bodily fluids has occurred, then the
mattress should be cleaned according to the hospital's
decontamination policy.
REFERENCES: Waterlow, J. (1985) A Risk Assessment Card,
Nursing Times, 81: 49 - 55
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