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Support Surface

By Haryanto, S.KEP, Ns, ETN

1. Identify therapeutic feature that can be provide by support surface.
Answer: Support surface will be reduce tissue interface pressure over the bony
prominences by maximizing contact and redistribusting weight over a large area,
to reduce or relief shear and friction, moisture control or kinetic therapy.
2. Explain the relevance of capilarry closing pressure in selection of
support surface
Answer:The capillary closing pressure (12 to 32 mmHg) is used as measure of
the effectiveness of support surface. It`s implied that as the skin resting surface
interface pressure near capillary closing pressure, the support surface is more
effective and less likely to interrupt or occlude capillary blood flow.
3. Distinguish between the three categories of support surface: overlay,
replacement matress and specialty bed.
Overlay Replacement Mattress Specialty bed
1. To reduce 1. To reduce pressure 1. Reduce tissue interface
2. To distribute the load pressure below capillary
3. Utilizing foam, air, water closure, to provide relief,
or gel eliminate shear and friction
and decrease moisture
2. Categories are low air
loss, high air loss, and
kinetic therapy ( Continous
passive motion disigned to
counteract the negative
effects of immobility

4. Identify four cirteria for the use of theraputic foam
 Base height is the height of the foam from the base to where the convolution
begin (not to the peak of the convolution)
 Density is the weight per cubic foot, is a measurement of the amount of foam

 Indentation Load Deflection (ILD) is a measurement of the firmness of the foam and is determined by the number of pounds required to indent a sample of foam with a circular plate to a depth of 25% of the thickness of the foam. 25% ILD of about 30 pounds 4. Ratio of 60% ILD to 25% ILD of 2.3 to 1.  Countour is describe the surface the foam pad ( egg crate.6 pounds per cubic foot 3. Compare and Contrast the following in the terms of advantages and disadventages Answer: Advantages Disadvantages Foam Overlays  One time charge  May be hot and trap  No setup fee perspiration  Light weight  Washing removes flame  Cannot be punctured by retardance coating needle or metal traction  Foam has a limited life  Available in many size  Plastic protective sheet  Required no necessary for protection maintenance from incontinent episodes Advantages Disadvantages Water Overlays  Readily available in  Required water heater to community maintain comfortable  Baffle system available water temperature to control motion effect  Fluid motion makes  Easy to clean procedure difficult  Patient transfers may be difficult Inadvertent needle punctures will create leaks  Water leaks can create . Density of 1.and reflects the foam`s ability to support the person`s weight. features in therapeutic foam overlay are recommended are: 1. Base height of 3 to 4 inches 2. smooth and so on) In Summary.5 or greater 5. slashed.

safety hazards  Maintenance is needed to prevent microorganism growth  Heavy  Cannot raise head of bed unless mattres has compartments  Can be overfilled or underfilled Advantages Disadvantages Gel Filled Overlays  Low maintenance  Heavy  Easy to clean  Expensive  Multipatient use  Limited research on  Impermeable to effectiveness puncture with needles Advantages Disadvantages Static Air Filled  Easy to clean  Can be damaged by Overlay  Multipatient use sharp objects products available  Required regular  Low maintenance monitoring to determine  Repair of some product proper inflation is possible  Durable Advantages Disadvantages Low Air Loss  Easy to clean  Can be damaged by Overlays  Maintains a constant sharp objects inflation  Noisy  Setup provided by company  Moisture control .

 Do not add height to which may be misplaced mattress  May not control moisture  Provides certain level of  Potential for excessive pressure reduction delay in using other automatically support surface  Multiple patient use  No objective method for  Easy to clean determining when or if  Uses standard hospital product loses linens effectiveness  Low maintenance Advantages Disadvantages HIgh Air Loss  Less frequent  Continuous circulation of Specialty Bed repositioning required warm. Advantages Disadvantages Alternating Air  Easy to clean  Assembly required Filled Overlays  Pump is reusable  Sensation of inflation and  Quick deflation for deflation may bother emergencie patient  Required electricity  Motor may be noisy Advantages Disadvantages Replacement  Reduce use of overlay  Initial expence high Mattresses mattresses  Some mattresses have  Reduce staff time removable sections. dry air may  Improved patient dehydrate patient compfort  Bed may be hot or make  Traction can be applied room hot  Procedure can be  Additional wound care facilitated by turning the measure are necessary bed off to prevent wound  Quickly become firm for desiccation cardiopulmonary  Coughing is less resuscitation and effective in mobilizing .

monitoring and patients or patients with a on call services contracture  Height of bed makes some nursing care difficult and a step is needed to facilitate care  Transfer of patient out of bed is difficult  Bed is heavy and not easily transferrable  Some patients become disoriented or complain of feeling weightless  Dependent drainage of chatheters may be comprimised because the patient is immersed in the bed  The head of the bed cannot be raised. semi Fowler`s position is achieved by use of a series of foam wedges  Size may be too large for most homes Advantages Disadvantages Low Air Loss  Head and foot of bed  Portable motor are quite Specialty Bed can be raised and noisy . procedures secretions  Reduce shear. friction  Leakage of beads and edema to site (microspheres) may  May facilitate irritate the eyes and management of copious respiratory tract and wound drainage or make floor slippery incontinence  Width of bed may  Sales force can provide preclude care to obese setup.

donuts. Indication for to prevent skin breakdown who cannot be turned. Establish two criteria for use of each of the following: a. lowered  Bed surface material is  Transfers in and out of quite slippery and bed easily accomplished caution must be used so  Portable motor available that patients do not slide to maintain inflation down or out of bed when during bed transfers being transferred 6. Kinetic therapy device to counteract the effects of immobility byt continuous by continuous passive motion or oscillation therapy (provide mobilization of respiratory secreation. to prevent further skin breakdown. prevent urinary stasis. repositioning Answer: . Describe the effect of the following on interface pressure: sheepskin. Kinetic therapy device Answer: a. Pressure relief device as those consistently reduce pressure ulcer below capillary closing pressure. Pressure reduction device b. Pressure reduction device as those lower pressure as compared to a standard hospital mattress or chair surface but do not consistently reduce pressure to less than capillary closing pressure. to promote healing who already has skin breakdwon involving multiple surface c. reduce venous stasis and risk of deep vein thrombosis and pulmonary emboli) 7. Pressure relief device c. must be use with a turning schedule that is tailored for the individual patient b.

Reference: Bryant.) Additionally. Donut is never indicated to relieve pressure because it actually concentrate the intensity of the pressure to the surrounding tissue c. avoid the side lying position when repositiong because this position exerts such intense pressure directly over the trochanter. RA ( ) Acute and chronic wounds: nursing management. Degree of position is 30 degree wtih the supine position ( Seiler and Stahelin). frequency of repositioning to every 2 hour (Kosiak.a. Sheepskin has no effect on pressure and so is inappropriate for pressure prevention b.. Heel can be protected from pressure with use pillow. AHCPR... Repositioning does not reduce intensity of pressure but it does reduce theb more critical element of pressure ulcer formation. 1961. .