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November 2004, Volume 34 Number 11 , p 17 - 17





  • Who's at risk?

  • Preventive strategies


    BECAUSE OF ITS THIN LAYER of subcutaneous tissue between the skin and bone, the heel is the second most common site for pressure ulcer development (after the sacrum). Heel ulcers are costly and, if not treated promptly and properly, may lead to osteomyelitis and even limb amputation. In this article, I'll describe how to assess patients for risk and take preventive measures. In a future article, I'll describe how to manage ulcers if they develop.

    Who's at risk?

    Focus your preventive interventions on the Braden scale categories in which the patient has a low score (the lower the score, the higher the risk). Keep in mind, however, that even patients whose total score indicates low risk of pressure ulcer development can develop heel pressure ulcers.

    Three groups of patients are at greatest risk for heel pressure ulcers:

    * Patients with immobile legs due to health care problems such as fractured hips, joint replacement surgery, spinal cord injury, Guillain-Barré syndrome, or stroke don't move their legs because of paralysis, weakness, or pain. If the foot of the bed is elevated to reduce edema, remember to elevate the patient's knee too, or his leg will be suspended by the heel. Bending the knee provides a level plane of leg elevation, prevents hyperextension of the knee, and relieves pressure on the heels.

    * Patients with diabetes may have peripheral neuropathy, which prevents them from feeling pressure or injuries to the feet. Immobile patients with diabetes also may have trouble moving their legs. Carefully monitor these patients and assess their heels twice daily.

    * Patients with leg spasms, those in pain, and those who are confused may rub their heels on the bed and abrade the heel. Patients may also dig their heels into the mattress to keep from sliding down in ...

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