Institute of Health and
Biomedical Innovation

6B: Management

Once you have identified the stage or category of a pressure ulcer, you then need to determine the correct treatment. Key evidence based management strategies for pressure injury may include the following:

Perform a risk assessment In order to identify clients at risk of pressure injuries, they must all be screened for risk using an acceptable pressure injury risk assessment tool such as the Waterlow, Braden or Norton tools.
Classify the pressure injury All pressure injuries should be classified or staged according to the depth of tissue damage.
Use pressure relieving surfaces and strategies Pressure-relieving surfaces and strategies such as mobilising and regular repositioning should be in place 24 hours per day for clients with pressure injuries.

A high-specification foam mattress or cushion, combined with close observation and a documented repositioning regime, should be in place for clients with a Stage 1 - 2 pressure injury.

If there is no progress in healing or a Stage 3 - 4 pressure injury is present (including unstageable ulcers), an alternating, low-air-loss, continuous low pressure system or air-fluidised bed should be used.

A dynamic (i.e. alternating pressures) support surface may be more appropriate for clients who cannot move freely, or who ‘bottom out’.

Avoid vigorous rubbing or massaging over bony prominences and pressure injuries.

Use appropriate positioning Avoid positioning the client directly on the pressure injuries or bony prominences. If possible, you should also limit the amount of time with the head of the bed elevated as this will contribute to increased pressure to the buttocks and heels and increase the risk of shear (i.e. the client sliding down the bed).
Ensure the wound care approach and dressings are suitable Clean the injury with warm normal saline or sterile water. Dressings used to treat pressure injury will vary depending on the condition of the injury and goals of treatment (see Guidelines Summary for Pressure Injuries in 6E: Module Resources).

Topical negative pressure therapy may benefit Stage 3 - 4 pressure injuries that are slow to respond to normal treatment.

Provide nutritional support Nutritional support should be given to clients who are undernourished and reviewed by a dietitian.

Now that you have learned how to recognise the stages or categories of pressure injuries and some evidence-based management strategies, you are ready to learn about how to prevent pressure injuries from recurring.

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