Pressure Ulcer Awareness - Pressure Injury Prevention Points and Nutrition Intervention

The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education, and research. The objective of STOP logo 2017 World Wide Pressure Injury Prevention Day is to increase national awareness for pressure injury prevention and to educate the public on this topic. NPUAP has developed an extensive media materials package appropriate for all healthcare settings and organizations.

It is important to identify individuals who are prone to pressure injuries. I have a son with cerebral palsy. He is in a wheelchair and lacks movement without assistance. He receives a body check twice a day, but even with my constant supervision, an ulcer can creep up quickly. My son's feet had become swollen and hot. The doctor placed him on antibiotics, but his left foot continued to get worse. A few days later, I took a photo of my son's wound and showed it to the doctor. The doctor immediately contacted a wound care nurse and his ankle was diagnosed as a stage II pressure ulcer. The wound healed eventually. It took about 6 weeks. Be your family and/or friend's advocate.

Skin Care

1. Inspect all of the skin upon admission as soon as possible (but within 8 hours).
2.  Inspect the skin at least daily for signs of pressure injury, especially nonblanchable erythema.
3. Assess pressure points, such as the sacrum, coccyx, buttocks, heels, ischium, trochanters, elbows, and beneath medical devices.

4.  When inspecting darkly pigmented skin, look for changes in skin tone, skin temperature, and tissue consistency compared to adjacent skin. Moistening the skin assists in identifying changes in color.

5. Cleanse the skin promptly after episodes of incontinence.

6. Use skin cleansers that are pH balanced for the skin. 
7. Use skin moisturizers daily on dry skin.

8.  Avoid positioning an individual on an area of erythema or pressure injury.

Nutrition
1.  Consider hospitalized individuals to be at risk for undernutrition and malnutrition from their illness or being NPO for diagnostic testing.

2.  Use a valid and reliable screening tool to determine the risk of malnutrition, such as the Mini Nutritional Assessment.

3.  Refer all individuals at risk for pressure injury from malnutrition to a registered dietitian/nutritionist. 

4. Assist the individual at mealtimes to increase oral intake. 

5.  Encourage all individuals at risk for pressure injury to consume adequate fluids and a balanced diet.

6.  Assess weight changes over time.

7.  Assess the adequacy of oral, enteral and parenteral intake.

8. Provide nutritional supplements between meals and with oral medications, unless contraindicated.

Repositioning and Mobilization
1. Turn and reposition all individuals at risk for pressure injury, unless contraindicated due to medical conditions or medical treatments. 

2.  Choose a frequency for turning based on the support surface in use, the tolerance of skin for pressure and the individual’s preferences.

3.  Consider lengthening the turning schedule during the night to allow for uninterrupted sleep.

4.  Turn the individual into a 30-degree side-lying position, and use your hand to determine if the sacrum is off the bed

5.  Avoid positioning the individual on body areas with pressure injury.

6. Ensure that the heels are free from the bed.

7.  Consider the level of immobility, exposure to shear, skin moisture, perfusion, body size, and weight of the individual when choosing a support surface.

8. Continue to reposition an individual when placed on any support surface.

9.  Use a breathable incontinence pad when using microclimate management surfaces.

10.  Use a pressure-redistributing chair cushion for individuals sitting in chairs or wheelchairs.

11. Reposition weak or immobile individuals in chairs hourly.

12.  If the individual cannot be moved or is positioned with the head of the bed elevated over 30°, place a polyurethane foam dressing on the sacrum.

13.  Use heel offloading devices or polyurethane foam dressings on individuals at high-risk for heel ulcers

14,  Place thin foam or breathable dressings under medical devices.

Education
1. Teach the individual and family about risk for pressure injury

2.  Engage individual and family in risk reduction interventions

Staging Pressure Injury

A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other devices. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.

Stage 1 Pressure Injury: Non-blanchable erythema of intact skin. Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. The presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.

Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis. Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel.  This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).

Stage 3 Pressure Injury: Full-thickness skin loss. Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds.  Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Stage 4 Pressure Injury: Full-thickness skin and tissue loss. Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss. Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.  If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.

Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration. Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood-filled blister. Pain and temperature changes often precede skin color changes. Discoloration may appear differently in darkly pigmented skin.  This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.  The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle, or other underlying structures are visible, this indicates a full-thickness pressure injury (Unstageable, Stage 3, or Stage 4).

References
1. The National Pressure Ulcer Advisory Panel - NPUAP - Resources

November 15, America Recycles Day and Clean Out Your Refrigerator Day

November 15, America Recycles Day and  

Clean Out Your Refrigerator Day

America Recycles Day is dedicated to the promotion of recycling programs in the United States. Since 1997, communities across the country have come together on November 15th to celebrate America Recycles Day.

Keep America Beautiful believes each of us holds an obligation to preserve and protect our environment. Through our everyday choices and actions, we collectively have a huge impact on our world. Keep America Beautiful follows a practical approach that unites citizens, businesses, and government to find solutions for preventing litter, reducing waste, and beautifying communities.

America Recycles Day.
The four “R”s: Refuse, Reuse, Recycle, Reduce.
Get involved to help reach Zero Waste.   https://kab.org/recycling/

Reduce, Reuse, Recycle

According to the U.S. EPA (US Environmental Protection Agency), recycling:
*Conserves natural resources to help sustain the environment.
*Reduces the need for landfilling and incineration.
*Saves energy and prevents pollution.

Recycle Guys in the Supermarket

How You Can Help

1. Each community has different standards for what can be recycled and how to do it. Visit Keep America Beautiful and enter your zip code for your local information and resources.

2. Plastic. Look for the recycling symbol on plastic packaging or containers. #1 and #2 plastics should be accepted by almost every recycler.

3. Cans. Aluminum and steel cans are always welcomed by recyclers, and most metals can be recycled infinitely with no loss of quality.

4. Recycling and Traveling. Keep two trash bags in your vehicle - one bag for garbage, and one for recyclables. Pre-sorting makes it easier to transfer your recyclables to the proper container once you’ve reached your destination.

5. Recycle your wireless phone. Millions of out-of-service phones are waiting to be reused or recycled. Find a local charity with a phone recycling program, or visit http://www.kab.org/  to download a postage-paid mailing label and return your unused phones.

6. Paper. In addition to newspaper recycling, most communities will accept corrugated cardboard, and some will even accept junk mail, catalogs and phone books.

7. Electronics. Never throw old computers, monitors, TV’s, printers, or other electronics in the landfill. Instead, donate them to a local charity for reuse, or find out about your local e-cycling programs.

8. Reduce the amount of trash you throw away and reuse products before you throw them out or recycle them. This creates the least impact on the planet and our resources.

Clean Out Your Refrigerator Day
Before food goes bad consider preparing meals in advance and freezing for later use. The food will last longer - Less Waste

National Pickle Day - Nutrition and Pickling

                      Quick Pickles - Everyday Food with Sarah Carey

Nutrition

World Diabetes Day - The Family and Diabetes

World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization. World Diabetes Day became an official United Nations Day in 2007. The campaign draws attention to the issues of importance to the diabetes world and keeps diabetes in the public spotlight. 

World Diabetes Day (WDD) is celebrated every year on November 14th. The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its association members. It joins millions of people worldwide in diabetes advocacy and awareness.

The Family and Diabetes

To mark diabetes awareness month and World Diabetes Day on November 14, the International Diabetes Federation (IDF) is urging families to learn more about the warning signs of diabetes. New research from IDF has discovered that parents would struggle to spot this serious life-long disease in their own children. Despite the majority of people surveyed having a family member with diabetes, alarming four-in-five parents would have trouble recognizing the warning signs. One-in-three wouldn’t spot them at all.

The findings underline the need for education and awareness to help people spot the diabetes warning signs early.

The warning signs can include excessive thirst, frequent urination, a lack of energy, blurred vision, slow-healing wounds, and numbness in the feet and/or hands.

This November, IDF is urging people to test their diabetes knowledge and learn more. IDF has made an awareness assessment available online at http://discoverdiabetes.idf.org/

Meet Toby Smithson, RDN, LDN, CDE

Toby Smithson is a Registered Dietitian, a Certified Diabetes Educator, a national spokesperson for the American Dietetic Association, and holds a certification in adult weight management. Toby was diagnosed with Type 1 diabetes in October 1968 and has managed diabetes personally every single day since with no hint of complications. Toby founded DiabetesEveryDay to share her insights into successful diabetes self-management.

DiabetesEveryDay.com members enjoy 24/7 access to weekly menu selections, recipes (developed by dietitians for heart health and carbohydrate management), grocery lists, and a unique library of video clips featuring Toby Smithson. New content is added weekly, Toby draws upon her own extraordinary diabetes management success to make this overwhelming responsibility for self-care both understandable and practical. She explores not only the nuts and bolts…. medical issues, food, and physical activity…. but also everyday lifestyle, emotional challenges, stress, and life-changing motivation; the real keys to success. To learn more, visit DiabetesEveryDay.com

Blue Circle Dance

About 500 employees, families, and friends of Novo Nordisk from all around the world filmed themselves while dancing to 'Move your feet' by Junior Senior. The idea is to generate awareness for diabetes on World Diabetes Day on 14 November.

World Kindness Day Health Benefits of Kindness

Random Act of Kindness: A selfless act performed by a person or persons wishing to either assist or cheer up an individual or, in some cases, an animal. There is no reason other than to make people smile or be happier. Random acts of kindness are encouraged by various communities, either spontaneous or planned in advance.

Health Benefits of Kindness

The Random Acts of Kindness Foundation

Established in 1995 as a nonprofit organization, The Random Acts of Kindness Foundation is a resource for people committed to spreading kindness. The Random Acts of Kindness™ Foundation inspires people to practice kindness and to “pass it on” to others. They provide a wide variety of materials on their website, including activity ideas, lesson plans, project plans, teacher’s guide, project planning guide, publicity guide and workplace resources - all free of charge. 

The Random Acts of Kindness Foundation is the United States delegate to the World Kindness Movement, an organization that includes various nations. People in these countries promote kindness within their countries’ borders and are creating a global network of kindness and compassion. As people from different cultures and from all walks of life are joining to spread kindness, they are creating a powerful, synergistic action throughout the world.

Reach Out and Touch Somebody's Hand

Studies have shown acts of kindness can result in physical and mental health benefits.
• Kindness can bring a sense of richness and fulfillment to our lives, and promote good health and longevity.
• Helping others can decrease the effect of diseases.
• After performing an act of kindness, many experience a feeling of euphoria followed by a period of calm.
• Acts of kindness have been shown to reduce feelings of stress, depression, loneliness, overeating, etc.
• Helping others increases self-worth, happiness, and optimism.
• A person feels more energetic after performing an act of kindness
• A more optimistic and happier outlook on life

Kindness benefits us and has a positive effect on the community.

Try Some Kindness (The Letter K Song)

As people tap into their own generous human spirit and share kindness with one another, they discover for themselves the power of kindness to effect positive change in their lives and the lives around them. When kindness is expressed, healthy relationships are created, community connections are nourished, and people are inspired to pass kindness on.

National Hunger & Homeless Awareness Week

This is National Hunger and Homeless Awareness Week. How You Can Help... 

I've heard about Chicken Soup for the Soul but have not read any books. I browsed the site and was fascinated and inspired by the stories. I came across one specific story devoted to Hunger and how a group sold pizza for $1.00 to raise money for the hungry.

New York City's Biggest Pizza Party
Helps Feed The Hungry


National Hunger & Homeless Awareness Week 

No one should worry about whether they will have food on their plates or a roof over their heads. But the reality is that hunger and homelessness are widespread problems that affect far too many people. Many Americans live on the edge, forced to choose between basic necessities like purchasing food, paying rent, or going to the doctor.

Needed items and services might include:

• Clothing. The lack of clean, well-fitting clothes and shoes causes great hardship beyond exposure to the elements—it hurts one's self-image and chance to get ahead. People experiencing homelessness must travel light, with few opportunities to safely store or adequately clean what they can't carry. In job interviews, a poorly dressed person has little chance for success. Give your clean clothes to those who could use them. Before you give your clothes or start a clothing drive, talk to your local shelter and find out what items they need. Most have limited storage space and can't use winter clothes in summer or vice versa. Some serve only a specific group of people. Please clean the clothes before you donate them.

• In-kind services and materials. Service providers may use copying, printing, food, transportation, marketing assistance, computer equipment and assistance, electrical work, building materials, plumbing, etc.

• Household goods or other items. Service providers may need kitchen utensils, furniture, books, toys, games, stuffed animals, dolls, diapers, etc.

• Books. People experiencing homelessness may have limited access to a library and find that there is little for them to do when spending a night at a shelter. Find out if your local shelter would appreciate donations of books. Consider organizing a book drive to create a small library at the shelter if there is not one already.

• Computers. Many non-profit organizations need help purchasing expensive but essential equipment such as computers. A local shelter or service provider might greatly appreciate the donation if you have a machine you no longer need. Shelter guests might also enjoy donating devices for their use, although you should check if a shelter would have space to set up public computers.

• Homeless "survival kits." Create and distribute kits that include cups, pots, pans, soap, shampoo, toothpaste, toothbrushes, and cosmetics. (Try coordinating this through a group that gives out meals from a van, for example.)  During cold weather, organize drives for blankets, coats, hats, scarves, mittens, socks, etc.

• Phone calls. Help people experiencing homelessness contact loved ones by offering the opportunity to make free long-distance calls on holidays. Donate to or organize a cell phone drive for the homeless.

• Job opportunities. Encourage your company, school, or place of worship to hire people experiencing homelessness (if they are not already working). Most unemployed, homeless adults desperately want to work but need an employer to give them a chance.

• Support for a homeless person or family. As people move out of a shelter or transitional housing program, consider raising money to contribute for a security deposit or assist by contributing household goods, babysitting, or moral support. See if your local shelter has a partnering program.

   

National Hunger & Homeless Awareness Week

Chicken Soup for the Soul

National Indian Pudding Day

Indian Pudding

Modified from @AFamilyFeast

Prep Time: 20 mins
Cook Time: 1 hour 30 mins
Total Time: 1 hour 50 minutes
Yield: 10 servings

INGREDIENTS

2 eggs
4 cups 2% milk
½ cup cornmeal
2 tablespoons unsalted butter
½ cup molasses
¼ cup maple syrup
¼ cup brown sugar
1/2 teaspoon salt
½ teaspoon cinnamon
½ teaspoon dry ginger
¼ teaspoon allspice
pinch of nutmeg
1/2 cup golden raisins
½ teaspoon vanilla extract
Spray pan with nonstick cooking spray
1/4 cup Vanilla ice cream per serving 

INSTRUCTIONS

1. Preheat oven to 325 degrees.
2. Beat eggs in a small bowl and set aside.
3. In a 6-quart pot, heat milk to hot, do not boil. Slowly add in cornmeal and whisk continually until all of the cornmeal is added. Cook for 10 minutes on a low simmer, stirring occasionally. Be careful that it does not stick and burn to the bottom of the pan.
4. Remove from heat and add all other ingredients except the beaten eggs. Mix to combine.
5. Temper the eggs by slowly adding some of the hot pudding a little at a time to the eggs, stirring as you go (about a cup total). Then add the egg mixture to the pot and stir.
6. Pour mixture into a 6-cup casserole dish and place the casserole dish in a water bath. Bake for about one hour and 30 minutes.
7. The pudding should be set up and somewhat firm. If the center is a bit loose, that is okay.
8. Let the pudding rest for 15 minutes, then serve hot with a scoop of vanilla ice cream.

Cappuccino: A Taste of Art and History

Cappuccino: A Taste 

of Art & History

A cappuccino is an Italian coffee drink traditionally prepared with a double espresso and steamed milk foam. Variations of the drink involve using cream instead of milk and flavoring with cinnamon or chocolate powder. Wikipedia.

Chocolate Cappuccino, modified
Yield: 4 servings

Ingredients

1/2 cup chocolate liqueur

1 tablespoon maple syrup

1 cup hot brewed espresso

3/4 cup scalded milk, 1%

1/8 teaspoon ground cinnamon

Chocolate shavings (optional)

Directions

1.         Combine liqueur and syrup in a microwave-safe dish.

2.         Heat on HIGH for 30 seconds.

3.         Divide the liqueur mixture among 4 mugs

4.         Add 1/4 cup espresso to each.

5.         Froth milk; pour about 1/4 cup milk into each mug.

6.         Top with ground cinnamon; garnish with chocolate shavings, if desired. 

November 1 to 7, National Fig Week Figs, Civilizations Oldest Fruit

   The Fig

      How to Plant a Fig Tree

        Nutrition Information

        Edible Recipe Art

        Fig Art
        Side Effects 

        Resources

Selection. Look for figs that are soft and smell sweet. Handle carefully because their skins bruise easily. 
Storage. Fully ripened figs can be stored in the refrigerator for up to 2 days; bring to room temperature before serving.

How to Plant a Fig Tree

Nutrition Information

Figs are rich in fiber, potassium, phytonutrients, and antioxidants, such as carotene, lutein, tannins, and chlorogenic. 

Recipe: Peach & Fig Yogurt Flower

Dried figs can be used to substitute fat in baked goods. When using dried figs in baking to replace shortening or oil, do not over-mix or over-bake. In a recipe, use half the normal amount of shortening, margarine, butter, or oil when using dried puree. 

Fig Art

Side Effects from WebMD
Avoid prolonged sun exposure when taking fig leaf because it can cause the skin to become extra sensitive to the sun. Wear sunblock outside, especially if you are light-skinned. 

Skin contact with fig fruit or leaves can cause a rash in sensitive people.

Special Precautions & Warnings:
Pregnancy and breast-feeding: Fresh or dried fig fruit is safe in amounts found in food, but there’s not enough information to know if it’s safe in the larger amounts used as medicine.

Surgery: Fig might lower blood sugar levels. There is some concern that it might interfere with blood sugar control during and after surgery. Stop using fig as medicine at least 2 weeks before a scheduled surgery.

Resources
1. California Figs
2. Figs, Fresh, Fruits and Veggies More Matters 

3. Figs, Wikipedia® 

Celebrate National Nachos day with Two-Cheese Veggie Nachos

Two-Cheese Veggie Nachos Recipe |

Recipe by Michelle Klug We love the double-cheese contrast here: Shredded cheese melts into a bubbly blanket over the tortillas, while crumbly queso fresco covers the veggies with a salty kick. It's an impressive dish for coffee table dining--it's fun to

Ingredients

1 tablespoon canola oil
1 cup chopped red onion
2 garlic cloves, minced
1 cup chopped zucchini
1 cup fresh corn kernels
2 tablespoons thinly sliced jalapeño pepper
1/2 teaspoon ground cumin
1/4 teaspoon chili powder
1/4 teaspoon kosher salt
1 (14.5-ounce) can of organic black beans, rinsed and drained
8 (6-inch) corn tortillas, cut into wedges
Cooking spray
2 ounces shredded reduced-fat Mexican-blend cheese (about 1/2 cup)
3/4 cup diced peeled avocado (about 1 small)
2 ounces crumbled queso fresco (about 1/2 cup)
1/4 cup chopped fresh cilantro
1 medium tomato, diced
4 lime wedges

Instructions

• Preheat broiler to high.
• Heat a large skillet over medium-high heat. Add oil to pan; swirl to coat. Add onion; sauté 5 minutes or until tender. Add garlic; sauté 30 seconds. Add zucchini and next 5 ingredients (through salt); cook 5 minutes or until crisp-tender. Add beans; cook for 2 minutes or until thoroughly heated.
• Arrange tortilla wedges in a single layer on a large jelly-roll pan coated with cooking spray. Lightly coat tortilla wedges with cooking spray. Broil 2 minutes on each side or until lightly browned and crisp. Sprinkle shredded Mexican cheese evenly over tortillas. Broil 1 minute or until cheese melts.
• Top chips evenly with bean mixture, avocado, queso fresco, cilantro, and tomato. Serve with lime wedges.

Sandwich Day - Use Your Creativity

 November 3rd is National Sandwich Day. The sandwich was named after John Montagu, the fourth Earl of Sandwich. In the 1700s, John Montagu created the sandwich because he wanted to eat his meal with one hand.

Resource: Build a Better Sandwich, @Healthyfamprj

 

Greatest Movie Sandwiches

National Deviled Egg Day - Recipes

The traditional deviled eggs are hard-boiled, shelled, cut in half, and the egg yolk removed. The yolk is mixed with other ingredients, such as mayonnaise and mustard, and placed in the hard-boiled egg white. Deviled eggs are customarily served cold as a side dish, appetizer, or main course. 

Recipes
The following recipes are modified for low cholesterol and variety.

Egg Whites with Tomatoes,
Parsley and Bulgur

Serves 2

Ingredients

2 Eggs, hard-boiled, yolks removed
4 Tablespoons Diced Tomatoes, Parsley, and Bulgur, prepared
Directions

Fill egg whites with diced tomatoes, parsley, and bulgur. Serve

Nutrition Information

Egg Whites filled with Diced Tomatoes,
Zucchini and Feta Cheese

Ingredients
1 Egg White, cut in half
1/2 cup Diced Tomatoes
1/3 cup Diced Zucchini
1/3 ounce Feta Cheese
Directions
Fill egg whites with ingredients. Serve

Resources and References
1. Wikipedia: Deviled Egg  This article is licensed under the GNU Free Documentation License
2. Consumer Reports, Deviled Eggs are a Healthier Snack

Nutrient Analysis Services
Ensure accurate nutritional analysis for your recipes utilizing an extensive research database and over 35 years of experience. A valuable service for Media, Cookbook Publishers, Writers, Chefs, Recipe Websites, and the Recipe Blogger. Your readers will benefit from the Nutrition information and a Registered Dietitian. Contact: Sandra Frank, Ed.D, RDN, FAND at recipenews@gmail.com or call 954-294-6300