Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 29

CLINICAL PRACTICE GUIDELINE

tactile skin inspections (Burman, 1993). Daily
inspection of skin areas of the body has been
found to be associated with decreased risk of
pressure ulcers. Those who perform daily skin
inspection are able to detect pressure or shear
damage early and modify their self-management
routine accordingly (Raghavan et al., 2003).
Individuals should learn to describe the most
frequently affected body locations and the
normally accepted descriptions of pressure ulcer
stages, so that more accurately reported
information can be communicated should a
problem occur after the individual has been
discharged to a home or community setting. The
more accurately a person is able to describe a
skin area, the more likely it is that the person
receiving the report can make appropriate
recommendations for actions to be taken (Garber
et al., 1996).
An individual's poor understanding of health
behavior instructions could result from many
sources: lack of education, cognitive impairment,
inadequate education from health professionals,
distraction due to psychological distress, and/or
distorted and biased processing of unwelcome
information (Liberman and Chaiken, 1992).
Assessing an individual's understanding of health
behavior recommendations through direct,
specific questions is thought to be an effective
approach. Additionally, identifying points needing
clarification and providing explanations and
giving special attention to changes in lifestyles
and daily routines should be incorporated into
any intervention. Krouskop et al. (1983)
observed a decreased yearly incidence of
pressure ulcers among individuals of a large SCI
outpatient clinic following application of a
systematic prevention program; rates dropped
again by half when components of psychological
counseling and patient/family education were
introduced. Peer support groups can help
persons better understand their needs through
peers and education, when available, they should
be offered. Well-timed and recurrent education
and support will help persons with SCI be more
successful in self-management.
What distinguishes persons with SCI who
have pressure ulcers from other vulnerable
populations, is the fact that persons with SCI are
encouraged to take responsibility for self care,
either directly or indirectly. Certainly, persons
with paraplegia are able to perform
independently many of of their activities of daily
living. Persons with tetraplegia are strongly
encouraged to be active in directing another
person in managing their many needs. This is

especially important with regard to skin
inspection and the early detection of potential
pressure ulcers (Garber, et al., 1996).

Assessment and
Reassessment
Following Pressure
Ulcer Onset
Assessment of the Individual
with a Pressure Ulcer
11. Perform an initial comprehensive assessment
of the individual with a pressure ulcer, to
include the following:


Complete history and physical
examination



Complete skin assessment



Laboratory tests (evaluate for infection,
anemia, diabetes, and nutritional status)



Psychological health, behavior, cognitive
status, and social and financial resources



Availability and utilization of personal
care assistance (family, caregiver
support, financial)



Positioning, posture, and all durable
medical equipment



Nutritional status



Activities of daily living (ADLs),
mobility, and transfer skills, as related
to maintaining skin integrity

(Scientific evidence-N/A; Grade of recommendation-N/A;
Strength of panel opinion-Strong)

Individuals with SCI who present with
pressure ulcers should have a complete history
and physical examination. The etiology and
mechanism of ulcer development should be
determined and risk factors should be assessed
(see recommendation 1). The contribution of
underlying disease processes and co-morbidities
should be evaluated.
Initial evaluation should also include a
psychosocial assessment of cognitive status,
depression, substance abuse, other potentially
contributory psychological disorders, as well as
an evaluation of psychosocial support systems.
Generally, these are part of the facility-specific
admission protocol following the onset of a
pressure ulcer.

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Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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