Child pressure injury

Domain 11. Safety-protection
Class 2. Physical injury
Diagnostic Code: 00313
Nanda label: Child pressure injury
Diagnostic focus: Pressure injury

When it comes to providing care for children, healthcare professionals must always be aware of the potential for patient injury. One of the most common injuries in pediatrics, particularly among hospitalized children and those with severe illnesses, is a pressure injury. For nurses and other healthcare professionals, understanding how to assess for, diagnose, and prevent pressure injuries is an important part of pediatric patient safety.

NANDA Nursing Diagnosis Definition

A child pressure injury, as defined by the National Association of Neurological Disorders and Stroke (NANDA), is when a child experiences a reversible or irreversible detrimental effect caused by chronic exposure to intense or prolonged pressure over soft tissue. It can affect the skin, underlying tissue and even involve muscle, bone, nerves, and even major organs if severe enough. Common causes of pressure injuries in children include long-term immobility, physically demanding activities, skin integrity impairment, and poorly managed medical devices like braces and positioning systems.

Defining Characteristics list

The defining characteristics associated with child pressure injuries vary depending on the severity of the condition.

Subjective

Common signs and symptoms reported by the child can include:

• Pain
• Itching
• Discomfort
• A burning sensation
• Tingling

Objective

Caregivers may observe:

• Redness of skin
• Swelling
• Erythema
• Cracking of the skin
• Blisters or sores
• Open wounds or ulcerations

Related Factors

The factors associated with the development of a pressure injury in a child are connected to external factors such as impaired mobility, lack of physical activity, poor nutrition, improper medical device fitting, and skin integrity issues. In addition, there may be certain underlying medical conditions that contribute to a greater risk as well.

• Immobility - Immobility increases the pressure over bony prominences and other areas of soft tissue that could cause damage over time. It includes anything that limits the movement of body parts, such as casts, splints, tight bandages, and medical equipment.
• Inadequate physical activity - Long periods of rest or sedentary behavior can also increase the risk of developing a pressure injury. Decreased physical activity reduces the circulation of blood and oxygen to tissues and slows the healing process.
• Poor nutrition - Nutritional deficiencies can also contribute to a greater risk as it affects the body’s ability to heal itself and maintain healthy tissue.
• Improper fitting of medical device - Medical devices such as braces, slings, and Positioning aids should fit correctly or they can apply too much pressure over a certain area of the body and interfere with the circulation of blood and oxygen to tissues.
• Skin integrity - Skin integrity issues such as dryness, cracking, and flaking can also put a child at a greater risk for developing a pressure injury.

At Risk Population

Given the nature of pressure injuries, there is a wide range of individuals who may be more vulnerable than others. Those who are more at risk include premature infants and newborns, the elderly, and those with chronic illnesses or disabilities. Other patients at risk of developing a pressure injury include those with impaired mobility due to paralysis or neuromuscular disorders, those with neurological injuries, those receiving home health care, those who are bedridden, and anyone who spends long hours in a wheelchair.

Associated Conditions

Children with certain medical conditions or diagnoses may also be at greater risk for developing a pressure injury. These conditions include respiratory or cardiovascular illness, any serious infection, poor nutrition, kidney or liver disease, diabetes, urinary incontinence, cancer, and any severe trauma or injury.

Suggestions for Use

It is essential for healthcare professionals to understand the warning signs and risk factors associated with pressure injuries in children in order to address issues before they become a problem. By identifying and addressing areas at risk, caregivers can work towards proactive strategies and preventative measures, while also recognizing when treatment is necessary.

Suggested Alternative Nanda Nursing Diagnoses

There are several alternative NANDA nursing diagnoses that may be applicable to pressure injuries in children. These include:

• Ineffective Tissue Perfusion - related to circulatory alterations
• Risk for Impaired Skin Integrity - related to external factors
• Impaired Comfort - related to inflammatory process
• Risk for Infection - related to compromised skin integrity
• Pain, Acute/ Chronic - related to pathology of pressure area

Usage Tips

When assessing for, diagnosing and treating a pressure injury in a child, healthcare professionals should pay close attention to individual risk factors, the severity of the pressure injury, the surface area affected, and underlying medical issues which may increase the likelihood of developing a pressure injury. The use of preventive measures, along with thorough assessments, can help reduce the incidence of pressure injuries in the pediatric population.

NOC Outcomes

The following NOC Outcomes can be used when assessing and caring for a child with a pressure injury:

• Immobility Tolerance - ability of the patient to tolerate periods of immobilization
• Quality of Mobility - patient’s ability to move independently
• Skin Integrity - ability of the patient’s skin to protect underlying tissue from injury and infection
• Breathing Pattern - rate, depth, ease of breathing
• Comfort Level - patient’s level of physical, emotional, and mental comfort

Evaluation Objectives and Criteria

It is important for healthcare professionals to properly assess and evaluate the skin’s condition when evaluating for a pressure injury. Signs of a potential injury include the presence of redness, swelling, tenderness, and changes in the texture or color of the skin. The clinician must also consider the patient’s age, underlying health issues, degree of immobility ad other factors that could influence the development of a pressure injury.

NIC Interventions

Interventions that may help prevent or slow the progression of pressure injuries in a child include:

• Positioning and Supportive Devices - Optimize the body position and use special cushions to decrease the forces against the skin. Supportive devices such as slings and casts can be used to improve stability.
• Repositioning - Moving the patient frequently and providing consistent turning protocols will reduce the risk of injury.
• Encouraging Activity - Moderate levels of activity can help promote healing and keep the bones and muscles strong.
• Providing Skin Care - The use of creams and lotions to keep the skin moist and prevent dryness can help protect the skin from further damage.
• Nutritional Support - Provide adequate nutrition, vitamin and mineral supplements and plenty of fluids to help maintain healthy tissue and promote healing.

Nursing Activities

The role of the nurse is to provide comprehensive care for patients suffering from a pressure injury. This includes assessing for, monitoring, and managing the patient's condition, as well as providing education, support and guidance to the patient, family and other healthcare providers. Nurses should also develop and implement interventions to reduce the risk of developing further injury.

Conclusion

Children are particularly vulnerable to developing pressure injuries due to their delicate skin and the various medical conditions they may have. Understanding the causes, risk factors and warning signs of a pressure injury is key to prevention. By recognizing and addressing these issues in a timely manner, healthcare providers can take necessary steps to reduce the occurrence and development of pressure injuries in children.

FAQs

• What is a pressure injury in a child? A pressure injury in a child is when a adverse effects occur due to chronic or intense pressure over soft tissue, including the skin, underlying tissue, and even the bone, nerves and major organs in severe cases. Common causes of pressure injuries in pediatric patients include long-term immobility, physically demanding activities, skin integrity impairment, and improper fitting of medical devices like braces and positioning systems.
• Who is at risk for developing a pressure injury in a child? Those who are more at risk for developing a pressure injury include premature infants and newborns, the elderly, and those with chronic illnesses or disabilities. Other patients at risk include those with impaired mobility due to paralysis or neuromuscular disorders, those with neurological injuries, those receiving home health care, those who are bedridden, and anyone who spends long hours in a wheelchair.
• What should I look for when assessing a child for a pressure injury?When assessing for a pressure injury in a child, it is important to pay close attention to individual risk factors, the severity of the pressure injury, the surface area affected, and underlying medical issues. Warning signs include the presence of redness, swelling, tenderness, and changes in the texture or color of the skin.
• Are there preventive measures that can help reduce the risk of pressure injuries? Yes, there are several preventive measures that can help reduce the risk of pressure injuries in children. These include optimizing the body’s position and using special cushions to decrease the forces against the skin, repositioning the patient regularly, encouraging moderate levels of activity, providing skin care, and offering nutritional support.
• What interventions should healthcare professionals provide to treat a pressure injury? When caring for a patient with a pressure injury, healthcare professionals should provide supportive devices such as slings and casts, optimize positioning, encourage activity, implement skin care, and offer nutritional support. It is also essential to monitor the patient’s condition and provide education, support and guidance to everyone involved.