Pressure Injury Wound care plan Assessment for Pressure Injury ● ● ● ● ● ● ● -Wound Location -Wound Tissue: bone, tendon, necrosis, slough, granulation, epithelium -Dimensions: length, width, depth, tunnelling and sinuses -Exudate: amount and type -Wound edges: raised, rolled, undermined. -Surrounding skin characteristic: induration, erythema, maceration, discolouration -Pain Stages of PI ● -Classified by the depth of tissue damage present. Key elements of PI management ● ● ● ● ● ● ● ● ● -Relieving or reducing the pressure, friction and shear -Minimising or eliminating the contributing factor -Treating the pressure injury -Education Selection of Support Surface -Replacement mattresses and overlays -Seating -Comfort/adjunct device -Specialty beds Treatment Goal of pressure injury ● ● ● ● -Promotion of granulation, wound contraction, and epithelialisation -Management of pain -Prevention of infection -Protection and cushioning of the wound and skin Dressing option for PI management● ● ● Stage I-Topical cream (Moisturiser, barrier cream), Protective dressing (Allevyn, Foam), Hydrocolloid Stage II-Hydrogel, Hydrocolloid, Foam, Calcium Alginate, Hydrofibre, Combination dressing Stage III & IV-Hydrogel, Interactive wet dressing, foam, calcium alginate, hydrofibre, combination dressing, Negative pressure wound dressing