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

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.

National Pickle Day - Nutrition and Pickling

                      Quick Pickles - Everyday Food with Sarah Carey

Nutrition

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

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. Either spontaneous or planned in advance, random acts of kindness are encouraged by various communities.

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 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 is not only something that has positive benefits for ourselves, it is something that 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 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.

National Sundae Day - Frozen Vanilla Greek Yogurt with a Variety of Fruit

Ingredients
1/2 cup (102 g) Frozen Vanilla Greek Yogurt
Variety of Fresh Fruits. 1 Tablespoon of each: Orange, Strawberries, Blueberries, Kiwi, Raspberries, & Mango

Happy Birthday Sesame Street Super Healthy Heroes

Sesame Street premiered on Public Broadcasting Service (PBS) stations on November 10, 1969. 

Sesame Street: Healthy Habits with Grover PSA| #CaringForEachOther

To celebrate Sesame Street's commitment and dedication to children's education we created our Sesame Street Friends out of nutritious foods. Can you find the Artichoke Leaves, Blackberries, Blueberries, Broccoli, Celery, Corn, Cottage Cheese, Eggs, Figs, Grapefruits, Green Beans, Guavas, Mushrooms, Onions, Orange, Parsley, Prunes, Raisins, Raspberries, Red Peppers, Strawberries, Tomatoes, and Watermelon?

The Sesame Street sign is made from cottage cheese,
spinach, corn, and white beans.

Do you know other foods that are Green?

Can you name the foods that match
the letters in Happy Birthday?

To learn more about the Sesame Workshop, visit http://www.sesameworkshop.org/. Sesame Street is a production of Sesame Workshop, a nonprofit educational organization making a meaningful difference in the lives of children worldwide by developing innovative and engaging educational content delivered in various ways.

National Family Caregivers Month

National Family Caregivers Month celebrates caregivers everywhere. What caregivers do every day requires superpowers, and though we may not tell them often enough – the care they give matters to all of us.

We know you're focused on the health and well-being of others, but it's important to remember to take care of you. Caring for yourself isn't selfish; it's an essential part of making sure you can give your best every day.

Staying strong as a caregiver

*Stay healthy with proper nutrition

*Eating healthy is the best way to maintain your strength, energy, stamina, and immune system. It's also one of the most powerful things you can do to stay positive.

*Good nutrition for your care receiver helps make care easier

*Up to half of all older adults are at risk for malnutrition; that's why it's important to make sure those you care for have a healthy diet. It helps prevent muscle loss and supports Rest. Recharge. Respite.

*Make sure to take some time away to re-energize or ask for help. Caregiving can be stressful, and taking a breather ensures that you'll be ready to take on the challenges Find out if you and your care receiver are getting the right amount of nutrients. Complete this nutrition assessment and see how you are doing.

10 Tips for Family Caregivers

1. Seek support from other caregivers.  You are not alone!
2. Take care of your own health to be strong enough to care for your loved one.
3. Accept offers of help and suggest specific things people can do to help you.
4. Learn how to communicate effectively with doctors.
5. Caregiving is hard work so take respite breaks often.
6. Watch out for signs of depression, and don't delay getting professional help when needed.
7. Be open to new technologies to help you care for your loved one.
8. Organize medical information so it's up-to-date and easy to find.
9. Make sure legal documents are in order.
10. Give yourself credit for doing the best you can in one of the toughest jobs there is!

nutritionDay - Improve Patient Safety and Quality of Care

The mission of nutritionDay is to improve patient safety and quality of care by raising awareness and increasing knowledge about disease-related malnutrition.

Malnutrition - Another Weight Problem

nutritionDay 
Mission: To improve patient safety and quality of care by raising awareness and increasing knowledge about disease-related malnutrition.

Vision: To provide the healthcare community, including acute care facilities, rehabilitation facilities, home healthcare, and nursing homes, with a full spectrum of resources to assess and ultimately minimize healthcare-related malnutrition.

To learn more about nutritionDay in the U.S. 

Website: www.nutritionDayUS.org  

The worldwide website for nutritionDay is at http://www.nutritionday.org/

The websites contain valuable resources to improve patient safety and quality of care.

Cook Something Bold and Pungent Day - Chili with Gorgonzola Cheese

Chili with Gorgonzola Cheese

Ingredients/Directions
1 cup Chili with Beans
1 Tablespoon Gorgonzola Cheese

Heat chili. Top with cheese.

Nutrition Information

Nutritional Analysis Services

Ensure accurate and cost-effective nutritional analysis for your recipes and menus utilizing an extensive research database. A great service for the Media, Cookbook Publishers, Writers, Chefs, Recipe Websites, and Blogs. Your readers will enjoy and benefit from the Nutrition information.

For more information, visit Dietitians-Online Nutritional Analysis Services
contact:
Sandra Frank, Ed.D, RDN, FAND
recipenews@gmail.com  
954-293-6300

National Cappuccino Day

A cappuccino is an Italian coffee drink that is 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.