Child pressure injury

Nursing diagnoses play a pivotal role in shaping the care provided to individuals, particularly when addressing complex health issues such as child pressure injuries. A nursing diagnosis is a clinical judgment that highlights individual or community responses to health problems or life processes, forming the foundation for nursing interventions aimed at achieving favorable outcomes.

In this exploration, we will delve into the specifics of child pressure injuries, defined as localized damage to the skin and underlying tissues due to sustained pressure. Understanding this condition is critical as it impacts children aged from 29 days to 18 years and can lead to severe complications if not addressed timely and effectively.

We will examine the defining characteristics of child pressure injuries, including observable signs that indicate the presence of tissue damage, as well as the various external and internal factors contributing to the risk of injury. By recognizing these elements, healthcare providers can better tailor their care strategies to enhance skin integrity and minimize the occurrence of pressure injuries.

Furthermore, this discussion will highlight the significance of identifying at-risk populations and the associated conditions that may exacerbate the risk and severity of pressure injuries. Understanding these complexities is essential for nurses and caregivers, enabling them to foster effective interventions and provide comprehensive care tailored to the unique needs of each child.

Definition of Nursing Diagnosis

A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems or life processes. It provides the basis for the selection of nursing interventions to achieve outcomes for which the nurse is accountable.

Child Pressure Injury

Child pressure injury is defined as localized damage to the skin and/or underlying tissue of an individual aged 29 days to 18 years, resulting from pressure, or pressure in combination with shear.

Defining Characteristics

Defining characteristics of child pressure injury include observable signs that indicate the presence of tissue damage or injury, which nurses can assess during evaluation.

• Blood-filled blister: Presence of a blister filled with blood indicates damage and potential risk of deeper tissue injury.
• Erythema: Redness of the skin, often indicating inflammation and potential pressure injury.
• Full thickness tissue loss: Indicates extensive damage where the skin is eroded, and underlying tissue is exposed.
• Full thickness tissue loss with exposed bone: Severe injury where bone tissue is visible, indicating a critical state of pressure injury.
• Full thickness tissue loss with exposed muscle: Shows serious damage, as muscle tissue becomes visible due to loss of skin and underlying tissue.
• Full thickness tissue loss with exposed tendon: Indicates a significant injury where tendons are exposed due to the loss of surrounding structures.
• Localized heat in relation to surrounding tissue: Increased temperature around a potential injury site suggests inflammation and tissue damage.
• Pain at pressure points: Complaints of pain when pressure is applied, indicating sensitive areas potential for injury.
• Partial thickness loss of dermis: Indicates some skin layers are damaged while deeper layers may still be intact.
• Purple localized area of discolored intact skin: Indicates pressure injury risk, where skin is intact but shows discoloration.
• Ulcer is covered by eschar: Dead tissue plugs an ulcer, indicating a significant wound; requires careful management.
• Ulcer is covered by slough: Yellow or gray tissue present in the wound bed suggests necrotic tissue and complicates healing.

Related Factors

Related factors encompass external and internal influences which may contribute to the occurrence of pressure injuries, guiding preventative and therapeutic measures.

External factors

External factors are conditions surrounding the patient that may increase the risk of developing pressure injuries.

• Altered microclimate between skin and supporting surface: Conditions that affect skin integrity, such as moisture accumulation.
• Difficulty for caregiver to lift patient completely off bed: Challenges in repositioning can lead to sustained pressure on skin.
• Inadequate access to appropriate equipment: Lack of specialized support surfaces might increase injury risk.
• Inadequate access to appropriate health services: Limited healthcare options may delay preventive interventions.
• Inadequate access to appropriate supplies: Lack of essential supplies can hinder care strategies for prevention.
• Inadequate access to equipment for overweight child: Specialized equipment is necessary for safe handling of heavier individuals.
• Inadequate caregiver knowledge of appropriate methods for stabilizing devices: Insufficient training can result in inappropriate use of equipment.
• Inadequate caregiver knowledge of appropriate use of adhesive materials: Misuse can lead to skin irritation and injury.
• Inadequate caregiver knowledge of modifiable factors: Lack of understanding of changeable risks may lead to injury development.
• Inadequate caregiver knowledge of pressure injury prevention strategies: Insufficient education contributes to higher injury incidence.
• Inappropriate skin moisture level: Excess moisture can weaken the skin, while dryness can aggravate conditions that lead to injuries.
• Increased magnitude of mechanical load: Higher pressure applied to tissue heightens risk of injury.
• Pressure over bony prominence: Prolonged pressure on bony areas is a common cause for pressure ulcers.
• Shearing forces: Friction from moving can lead to skin tears and pressure damage.
• Surface friction: Rubbing against surfaces can disrupt skin integrity.
• Sustained mechanical load: Constant pressure can lead to tissue ischemia and injury.
• Use of linen with inadequate moisture wicking property: Poor bedding can trap moisture, affecting skin health.

Internal factors

Internal factors are intrinsic characteristics or conditions of the child that may predispose them to developing pressure injuries.

• Decreased physical activity: Reduced mobility increases the risk of pressure injury due to lack of repositioning.
• Difficulty assisting caregiver with moving self: Impaired mobility makes it hard for the child to change positions, increasing pressure areas.
• Difficulty maintaining position in bed: Inability to shift positions may lead to prolonged pressure on specific areas of the body.
• Difficulty maintaining position in chair: Challenges in staying in an optimal posture can contribute to skin breakdown.
• Dry skin: Skin integrity is compromised when moisture levels are low, increasing injury risk.
• Hyperthermia: Elevated body temperatures can increase sweat, putting skin at risk for injury.
• Impaired physical mobility: Significant impact on the ability to move increases vulnerability to pressure injuries.
• Inadequate adherence to incontinence treatment regimen: Neglecting care increases risks of skin breakdown.
• Inadequate adherence to pressure injury prevention plan: Lack of compliance can result in higher injury likelihood.
• Inadequate fluid volume: Dehydration can impact skin health and its ability to resist injury.
• Inadequate knowledge of appropriate methods for stabilizing devices: Lack of expertise can lead to improper use which risks injury.
• Inadequate knowledge of appropriate use of adhesive materials: Mismanagement can cause skin damage.
• Protein-energy malnutrition: Insufficient nutrition can weaken skin and impair healing processes.
• Water-electrolyte imbalance: Dysregulation can affect tissue hydration and health, increasing injury risk.

At Risk Population

Identifying populations at risk allows targeted prevention strategies to minimize the occurrence of pressure injuries among vulnerable groups.

• Children in intensive care units: High medical needs and limited mobility put these children at greater risk.
• Children in long-term care facilities: Extended periods of immobility often contribute to injury development.
• Children in palliative care settings: Comfort care needs may limit mobility, increasing the risk of pressure injuries.
• Children in rehabilitation settings: Change in mobility capabilities may leave them vulnerable to skin breakdown.
• Children in transit to or between clinical care settings: Transfer periods may not always allow for appropriate repositioning.
• Children receiving home-based care: Limited resources at home may hinder effective prevention strategies.
• Children with body mass index above normal range for age and gender: Higher body mass can increase pressure on vulnerable areas.
• Children with body mass index below normal range for age and gender: Underweight children may have less padding to protect bony prominences.
• Children with developmental issues: Challenges with movement or cognition may lead to increased risk of injury.
• Children with growth issues: Rapid growth may lead to skin stretching, increasing susceptibility to injuries.
• Children with large head circumference: An increased head size may lead to more significant pressure points when lying down.
• Children with large skin surface area: Greater surface area can lead to pressure accumulation over localized areas.

Associated Conditions

Associated conditions that may compound the risk and severity of pressure injuries are important to consider for effective management and intervention.

• Alkaline skin pH: Changes in pH can impact the skin's barrier function.
• Altered cutaneous structure: Any changes to skin structure can increase vulnerability to injury.
• Anemia: Reduced blood supply can impair healing and skin health.
• Cardiovascular diseases: Poor circulation can limit blood flow necessary for tissue integrity.
• Decreased level of consciousness: Impaired awareness increases the risk of pressure injuries from immobility.
• Decreased serum albumin level: A low albumin level can affect skin integrity and healing capacity.
• Decreased tissue oxygenation: Without adequate oxygen, tissues are at greater risk for damage.
• Decreased tissue perfusion: Poor blood flow to tissues heightens risk of hypoxia and subsequent injury.
• Diabetes mellitus: Impaired healing and risk of neuropathy increase the likelihood of skin injury.
• Edema: Fluid accumulation can stretch skin and weaken its integrity, promoting injury.
• Elevated C-reactive protein: Indicates inflammation that may compromise tissue health.
• Frequent invasive procedures: Repeated interventions can damage the skin and increase pressure injury risk.
• Hemodynamic instability: Fluctuations in blood flow can compromise tissue perfusion and healing.
• Immobilization: Lack of movement is a primary risk factor for developing pressure injuries.
• Impaired circulation: Inadequate blood flow increases the risk of pressure injury development.
• Intellectual disability: Cognitive impairments may hinder self-care and increase pressure injury risk.
• Medical devices: Equipment used on patients can create pressure points contributing to injury.
• Pharmaceutical preparations: Certain medications may have side effects that affect skin integrity or healing.
• Physical trauma: Existing injuries can compromise skin health and predispose individuals to further injury.
• Prolonged duration of surgical procedure: Extended operations may increase pressure injury risk during recovery.
• Sensation disorders: Reduced ability to feel pressure or pain can lead to overlooked injuries.
• Spinal cord injuries: Impaired sensation and mobility greatly increase the risk for pressure injuries.

NOC Outcomes

The Nursing Outcomes Classification (NOC) outcomes for child pressure injury focus on enhancing the individual’s ability to prevent tissue damage and improve overall skin integrity. These outcomes not only measure the effectiveness of interventions but also empower caregivers and healthcare professionals to provide targeted care and education in order to facilitate meaningful recovery and enhance well-being.

By assessing the patient’s condition regularly, healthcare providers can identify potential risks for pressure injuries early. The NOC outcomes also emphasize the importance of collaboration between healthcare team members, families, and the children themselves, ensuring a comprehensive approach to prevention and management strategies that are tailored to the child’s specific needs.

• Skin integrity: The assessment of the skin's overall condition and ability to remain intact, which is crucial for preventing pressure injuries.
• Knowledge of pressure injury prevention: The understanding and awareness of methods and strategies required to prevent pressure injuries, including repositioning techniques and proper skin care.
• Comfort level: The patient's subjective perception of physical comfort, as improved comfort can enhance mobility and reduce the risk of pressure injuries.
• Wound healing: Monitoring the healing process of any existing wounds to ensure effective treatment and avoidance of further complications.
• Family engagement: The involvement of family members in the care plan to ensure they have the necessary knowledge and skills to assist with pressure injury prevention at home.
• Mobility improvement: The enhancement of the child's ability to move independently, reducing the risk of prolonged pressure on specific body areas.

Goals and Evaluation Criteria

Establishing clear goals and evaluation criteria is essential for the effective management of child pressure injuries. These targets guide healthcare professionals in delivering focused care and facilitate the monitoring of patient progress. Well-defined goals should aim to minimize the risk of further injuries and maximize healing potential, ensuring a holistic approach to the child's health and wellbeing.

Evaluation criteria serve as benchmarks to measure the effectiveness of the implemented interventions. Regular assessments allow healthcare providers to adjust care plans as necessary, ensuring that each child's unique needs are met. By continuously evaluating both the goals and outcomes, healthcare teams can work collaboratively to achieve optimal results in the prevention and management of pressure injuries.

• Reduce incidence of pressure injuries: Aim to decrease the occurrence of new pressure injuries by implementing preventive measures such as regular repositioning and use of specialized support surfaces.
• Improve skin integrity: Focus on enhancing the overall condition of the skin through adequate hydration, nutrition, and appropriate skincare routines.
• Enhance caregiver education: Ensure caregivers are well-informed of pressure injury prevention strategies and provide training in proper techniques for body positioning and equipment usage.
• Document and track healing progress: Maintain accurate records of injury assessments and healing stages to evaluate the effectiveness of interventions and make informed adjustments to care plans.
• Promote multidisciplinary collaboration: Facilitate communication among healthcare professionals including nurses, physicians, and nutritionists to develop comprehensive care plans tailored to the child's individual needs.

NIC Interventions

Nursing Interventions Classifications (NIC) play a crucial role in addressing the needs of children at risk for pressure injuries. These interventions involve a variety of practices aimed at promoting skin integrity, enhancing mobility, and educating caregivers to prevent the development of injuries. Implementing these strategies can help mitigate risks associated with high-pressure areas and foster better health outcomes for children.

It is essential for nurses to engage in continuous assessment and individualized care planning. This not only involves providing direct interventions but also education for caregivers on how to effectively manage the child's condition. By fostering a collaborative approach, nurses can empower caregivers with the knowledge and resources needed to implement preventive measures at home and in healthcare settings.

• Daily skin assessments: Conducting thorough evaluations of the child's skin, particularly over bony prominences, helps in the early identification of potential pressure injuries before they worsen.
• Positioning and mobility assistance: Encouraging regular repositioning and providing assistance in movement can significantly reduce prolonged pressure on vulnerable areas, thus minimizing the risk of injuries.
• Education on pressure injury prevention: Offering educational resources to caregivers on the importance of maintaining skin integrity, recognizing signs of injury, and proper use of medical equipment can enhance preventive efforts.
• Moisture management: Educating about skin care routines that balance moisture levels can prevent maceration and dryness, both of which contribute to skin breakdown.
• Nutrition consultation: Collaborating with dietary specialists to ensure the child's nutritional needs are met supports skin health and overall well-being, reducing the risk of pressure injuries.
• Use of specialized support surfaces: Recommending and providing access to pressure-relieving mattresses or cushions can distribute pressure more evenly, significantly lowering injury risk.

Nursing Activities

Nursing activities involve a comprehensive approach to assess, plan, implement, and evaluate care aimed at preventing and managing pressure injuries in children. These activities are essential for promoting skin integrity and overall well-being, particularly in populations at increased risk of these injuries.

Effective nursing practices in this context revolve around conducting thorough assessments, educating caregivers, and implementing preventive measures. Nurses play a pivotal role in identifying risk factors, recognizing early signs of pressure injury, and providing evidence-based interventions to mitigate potential harm.

• Conducting comprehensive skin assessments: This involves regularly examining the patient's skin, especially over bony prominences, to identify any early signs of pressure injury. Noting changes in color, temperature, and moisture levels can help nurses intervene proactively.
• Educating caregivers and families: Nurses provide education on pressure injury prevention strategies, including repositioning techniques and the importance of maintaining skin hygiene, to empower families in caring for at-risk children.
• Implementing pressure-relieving strategies: Utilizing specialized mattresses, cushions, and supports to distribute weight evenly and reduce the risk of prolonged pressure on vulnerable areas is key in nursing care.
• Monitoring nutritional status: Assessing and addressing the child’s nutritional needs, including protein intake, to promote skin health and healing is essential in reducing the risk of pressure injuries.
• Collaborating with the healthcare team: Working closely with physicians, dietitians, and physical therapists to develop and implement a multidisciplinary approach ensures that all aspects of the child's care, including mobility and nutrition, are addressed effectively.

Related Nursing Diagnoses

Several nursing diagnoses are closely linked to child pressure injuries, highlighting the multifaceted nature of care involved in managing at-risk populations. Understanding these related diagnoses can lead to improved treatment plans and prevention strategies tailored to each child's specific needs.

• Impaired Skin Integrity: This diagnosis directly relates to the presence of pressure injuries. It emphasizes the need for consistent assessment and interventions to protect the skin and promote healing in children who are vulnerable to developing injuries due to immobility or other risk factors.
• Risk for Infection: Children with pressure injuries are at heightened risk for infection due to the breakdown of skin barriers. This diagnosis requires vigilant monitoring for signs of infection and proactive measures to maintain skin hygiene and care.
• Impaired Mobility: This diagnosis pertains to the restrictions in a child's movement that contribute to pressure injuries. Addressing the underlying causes of impaired mobility through therapeutic exercises and assistive devices is essential for reducing the risk of further skin damage.
• Chronic Pain: Many children with pressure injuries experience pain, which can hinder their rehabilitation and recovery. Proper pain management strategies are necessary to ensure the child's comfort and compliance with treatment regimes.
• Knowledge Deficit: Often, caregivers may lack the necessary information regarding pressure injury prevention or management. Providing education on proper techniques for repositioning, hygiene maintenance, and nutrition can empower caregivers and reduce injury incidence.

Suggestions for Use

When managing child pressure injuries, it is crucial for healthcare providers to implement systematic assessment protocols. These protocols should include regular skin checks, focusing specifically on areas at higher risk due to mobility constraints or prolonged pressure from medical devices. Identifying early signs of pressure injuries allows for timely intervention, which is essential for effective healing and prevention of further damage.

Additionally, fostering a multidisciplinary approach involving nurses, caregivers, and physical therapists can significantly enhance care strategies. Training caregivers in proper repositioning techniques and the use of specialized equipment ensures that pressure injuries are prevented effectively. Creating individualized care plans that consider the child’s specific needs, risks, and lifestyle can further reduce the incidence of pressure injuries and promote healing.

• Regular skin assessments: Conducting frequent evaluations of at-risk areas can help identify early signs of pressure injuries, allowing for prompt intervention before the injury progresses.
• Education for caregivers: Providing comprehensive training on repositioning techniques and the proper use of medical equipment is essential for effective care, reducing the likelihood of sustained pressure and skin damage.
• Use of specialized support surfaces: Implementing pressure-relieving mattresses and cushions can significantly decrease pressure on bony prominences, protecting vulnerable areas from injury.
• Encouragement of mobility: Engaging children in routine physical activity, as appropriate, can enhance circulation and skin integrity, reducing the risk of pressure injuries.
• Individualized care plans: Creating tailored plans that address the specific risks and needs of each child allows for targeted interventions, enhancing the effectiveness of prevention strategies.
• Collaboration with a multidisciplinary team: Collaborating with various healthcare professionals fosters a comprehensive approach to care, ensuring that all factors influencing pressure injury risk are addressed and managed effectively.

Examples of Patients for Nursing Diagnosis

This section provides examples of diverse patient profiles that may require assessment and interventions related to the nursing diagnosis of child pressure injury. Each example underscores unique backgrounds, conditions, and individual needs.

• Patient Profile 1: Pediatric Cancer Patient

  A 10-year-old girl undergoing chemotherapy for leukemia has experienced prolonged periods of immobility due to fatigue and weakness. Her background includes frequent hospital stays where she receives treatment. She has developing erythema on her sacral area. Her unique needs include education for her parents on repositioning techniques and collaboration with the dietitian to ensure she is well-nourished to support skin integrity as she battles her illness.

• Patient Profile 2: Postsurgical Recovery from Spinal Surgery

  A 15-year-old boy recently underwent spinal surgery due to scoliosis. His mobility is significantly decreased, and he struggles with pain management. He is at high risk for pressure injuries, particularly on bony prominences. His desires include understanding pain management strategies and receiving comprehensive care to facilitate safe repositioning. The nursing interventions aim to provide education on mobilization and coordinate with physical therapy to enhance his recovery.

• Patient Profile 3: Child with Intellectual Disability

  A 12-year-old child with cerebral palsy and moderate intellectual disability has limited ability to change position independently, placing him at risk for pressure injuries. His parents express a desire for training in preventing skin breakdown and utilizing adaptive equipment. The nursing care plan will focus on educating caregivers on routine repositioning, optimal use of specialized mattresses, and ensuring adequate hydration and nutrition.

• Patient Profile 4: Underweight Child with Eating Disorder

  A 14-year-old girl diagnosed with anorexia nervosa presents with low body weight and dry skin, indicating compromised skin integrity. She has a desire to regain her health while grappling with body image issues. Nursing interventions will include a comprehensive nutritional plan, psychological support to address her mental health needs, and guidance for her family on how to help her maintain position changes to protect against pressure injury.

• Patient Profile 5: Child in Palliative Care

  A 6-year-old boy in palliative care for advanced neuroblastoma requires comfort and pain management. His limited movement and prolonged bed rest increase his risk for pressure injuries, particularly on his heels. The family expresses a desire for interventions that prioritize comfort while addressing skin integrity. The nursing team can implement regular skin assessments, gentle repositioning techniques, and collaborate with a palliative care specialist to ensure the child's comfort remains paramount.