Pressure Ulcers
8.1(A)RNAO Best Practice Guideline: Risk Assessment & Prevention of Pressure Ulcers, Guideline Supplement. Registered Nurses Association of Ontario. 2011. 1-49.


(B)NPUAP-EPUAP International Guideline Prevention of Pressure Ulcers Quick
Version and NPUAP-EPUAP International Guideline Treatment of Pressure
Ulcers Quick Version available at

Note: Students should select whichever of the above pressure ulcer practice guideline is most applicable in their country practice setting and use it to answer question 8.1

Question:8.1-Select either the RNAO or the NPUAP-EPUAP Clinical guideline and use it to answer the following:
Identify appropriate strategies and state from which pressure ulcer clinical guidelineis your basis in the assessment and management of a patient with a stage III pressure ulcer. Consider factors that are applicable to your practice setting.
8.2Braden BJ, Blanchard S. Risk assessment in pressure ulcer prevention.
In Krasner DL, Rodeheaver GT, Sibbald RG, editors. Chronic Wound Care: A
Clinical Source Book for Healthcare Professionals. 4th ed. Malvern, Pa: HMP
Communications, 2007:593-608.

Question:8.2-Review and discuss thepressure ulcer risk assessment tool and how it is part of the total current risk assessment protocol currently in use in your practice setting or a setting you are familiar with.Elaborate on its strengths and weaknesses.
8.3(A)Brown DL, Kasten SJ, Smith Jr DJ. Surgical management of pressure ulcers.
In Krasner DL, Rodeheaver GT, Sibbald RG, editors. Chronic Wound Care: A
Clinical Source Book for Healthcare Professionals. 4th ed. Malvern, Pa: HMP
Communications, 2007:653-662.

8.3 (B)Jackson J, Carlson M, Rubayi S, et al. Qualitative study of principles pertaining to
lifestyle and pressure ulcer risk in adults with spinal cord injury. Disability
and Rehabilitation.2010;32(7):567-578.

Question: 8.3-Up to 75 percent of surgically treated pressure ulcers recur. Discuss why pressure ulcers recur in this patient population and how programs can be designed to improve patient outcomes.
8.4(A)Zagoren AJ, Johnson DR, Amick N. Nutritional assessment and intervention
in the adult with a chronic wound. In Krasner DL, Rodeheaver GT, Sibbald
RG, editors. Chronic Wound Care: A Clinical Source Book for Healthcare
Professionals. 4th ed. Malvern, Pa: HMP Communications, 2007:127-136.

8.4(B) Dorner B, Posthauer ME, Thomas D, National Pressure Ulcer Advisory Panel.
Therole of nutrition in pressure ulcer prevention and treatment: National
pressure ulcer advisory panel white paper. Adv Skin Wound Care. 2009;

Question:8.4-Discuss and critique clinical assessment to determine nutritional status of a patient with a pressure ulcer. What interventions would you recommend to improve nutritional status?
8.5(A)Defloor T, Schoonhoven L, Fletcher J, et al. Statement of the European pressure
ulcer advisory panel-Pressure ulcer classification. J WOCN. 2005; 32(5):302-

8.5 (B) Sibbald RG, Krasner DL, Woo KY.Pressure ulcer staging revisited:
Superficial skin changes & deep pressure ulcer framework. Adv Skin Wound
Care. 2011:24(12):1-10.
8.5 (C)Gray,M., Black, J., Baharestani, al. Mositure associated skin damage-
Overview and pathophysiology. JWOCN. 2011;38(3):233-241.

Question:8.5-What is a moisture-related skin lesion? How do you incorporate this concept into clinical practice?

(A) NPUAP-EPUAP Staging/Classification Definitions. Available at and www.

(B) Reddy M, Keast D, Fowler E, Sibbald RG. Pain in pressure ulcers. Ostomy
WoundManagement Suppl. 2003;49(4Asuppl):30-36.

(C) Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers. JAMA. 2006;296:974

(D) Woodbury GM, Houghton PE.Prevalence of pressure ulcers in Canadian
healthcare settings.Ostomy Wound Management. 2004;50(10): 22-38.

(E) Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. Best Practice
Recommendations for the Prevention and Treatment of Pressure Ulcers:
Update 2006. Wound Care Canada. 2006;4:31-43
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