What nursing and physical therapy strategies can prevent pressure sores and complications in an 11-year-old patient with an explosive injury, resulting in a posterior flap from foot to thigh, fragile and raw buttocks area, bilateral femur fractures, and an external fixator on the right leg?

From the Guidelines

To prevent pressure sores and complications in this 11-year-old patient with extensive injuries, implement a comprehensive care plan that includes early mobilization, regular repositioning, and use of high-level prevention supports, as recommended by the most recent guidelines 1.

Key Interventions

• Early mobilization as soon as the spine is stabilized, to reduce the risk of pressure ulcers and promote healing 1.
• Visual and tactile checks of all areas at risk at least once a day, to identify potential pressure sores early and prevent further complications.
• Repositioning every 2-4 hours with pressure zone checks, to reduce pressure on vulnerable areas and promote blood flow.
• Use of tools for discharge, such as cushions, foam, and pillows, to avoid interosseous contact and reduce pressure on the skin.
• Use of high-level prevention supports, such as air-loss mattresses or dynamic mattresses, to distribute pressure evenly and reduce the risk of pressure ulcers.

Additional Considerations

• Monitor nutrition closely, ensuring adequate protein intake and sufficient calories, vitamins, and minerals, to promote wound healing and overall health.
• Keep the skin clean and dry, using barrier creams on intact skin near wound edges, to prevent infection and promote healing.
• Manage pain effectively with scheduled medications, administered 30 minutes before dressing changes or repositioning, to reduce discomfort and promote mobility.
• Implement early physical therapy with gentle range-of-motion exercises for unaffected limbs and gradual weight-bearing as permitted by the orthopedic team, to promote mobility and reduce the risk of complications.

Importance of Multidisciplinary Care

• A multidisciplinary approach to care, including input from surgeons, nurses, physical therapists, and nutritionists, is crucial to preventing pressure sores and promoting healing in patients with extensive injuries 1.
• Regular communication and collaboration among healthcare team members can help identify potential complications early and prevent further problems.
• Patient and caregiver education is also essential, to promote adherence to the care plan and prevent pressure injury recurrence or development of new pressure injuries at distant sites 1.

From the Research

Nursing Strategies to Prevent Pressure Sores

• Identify at-risk persons and implement specific prevention measures, such as following a patient repositioning schedule and keeping the head of the bed at the lowest safe elevation to prevent shear 2
• Use pressure-reducing surfaces to reduce the risk of pressure ulcers 3, 4
• Assess nutrition and provide supplementation if needed to promote wound healing 2
• Keep the wound bed continuously moist, use non-toxic dressings, and keep the surrounding intact skin dry 5

Physical Therapy Strategies to Prevent Pressure Sores

• Regularly reposition the patient to reduce pressure on vulnerable areas 2
• Use support surfaces, such as low-air-loss beds or air suspension beds, to redistribute pressure 3, 4
• Consider using sheepskin or other overlays to reduce friction and shear 3, 4
• Encourage patient mobility and activity to promote blood flow and reduce pressure on vulnerable areas 2

Complications Prevention

• Monitor for signs of infection, such as redness, swelling, or increased drainage, and report any concerns to the healthcare team 2
• Use topical antibiotics if there is no improvement in healing after 14 days 2
• Consider using protease-modulating dressings or other advanced dressings to promote healing 6
• Collaborate with the healthcare team to develop a comprehensive plan to prevent and manage pressure ulcers 2, 6, 3, 4, 5