Help with Braden Scale

[Blackheartednurse]

So I started to do admissions on my own (I work home health care) I dont have too much problem with completing the nursing assement documentation but I found myself struggling with documenting Braden scale.I have some patients who are diabetic.So dont they automatically clasify under the the risk category for pressure ulcers,since a lot of them experience neuropathy? Also do all patients hospitalized are at some risk for developing pressure ulcers or people who are homebound? Thanks!!!

[bshaw96]

I would say your diabetic patients are more at risk for diabetic ulcers, or infected/trauma type wounds, but not necessarily pressure. (Although depending on other factors, they could very well also develop pressure areas) Also, being recently hospitalized does not necessarily make you at risk for pressure ulcers. It's more about mobility, and nutritional status. Do they require alot of assist to move or shift position? Or they in one position frequently? Or they incontinent? Does their equipment properly fit (wheelchairs/casts/etc.). There are so many factors, and congrats on getting comfortable with the admits. I just left a job where i was the oasis/admissions nurse. Tough and lots of paperwork, uggghhhh!!!

[Blackheartednurse]

I would say your diabetic patients are more at risk for diabetic ulcers, or infected/trauma type wounds, but not necessarily pressure. (Although depending on other factors, they could very well also develop pressure areas) Also, being recently hospitalized does not necessarily make you at risk for pressure ulcers. It's more about mobility, and nutritional status. Do they require alot of assist to move or shift position? Or they in one position frequently? Or they incontinent? Does their equipment properly fit (wheelchairs/casts/etc.). There are so many factors, and congrats on getting comfortable with the admits. I just left a job where i was the oasis/admissions nurse. Tough and lots of paperwork, uggghhhh!!!

So can they be like not at all at risk for pressure ulcers even though they are older?! I noticed that a nurse who trained me marked on Oasis that a diabetic pt (who we admitted) was not at risk for pressure ulcers but she (the pt) was only 50 something.

[mamamerlee, LPN]

Of course the clients with neuropathy will score higher, and that puts them at a higher risk. Be sure to put 'direct observation of feet & legs' as often as you feel necessary.

[tewdles, RN]

The Braden scale considers multiple factors...sensory perception, moisture, activity, mobility, nutrition, friction and shear.

A homebound person is not necessarily at risk but a chairbound person likely is. Similarly a hospitalized patient will have a lower Braden score and be at higher risk as his mobility decreases and he becomes more dependent.

Braden Scale

[bshaw96]

OK, maybe I misunderstood your question? I thought you were asking if diabetes made a patient automatically at risk for pressure ulcers. Not necessarily, depending on the other factors mentioned. I have admitted many patients who have diabetes as a comorbidity but that is not their chief problem, and it is well managed. We do education as needed on monitoring feet and legs daily for discolorations or open areas, etc. But if they are up and mobile and continent with good nutrition I do not consider them at risk for pressure ulcers even with diabetes. But if I admit a patient without diabetes who has suffered a CVA and is wc bound and incontinent, they are gonna be much more at risk for pressure ulcers and will need education on repositioning, incontinence care, offloading, nutrition, skin monitoring by themselves/family, etc. Most of the skin problems I have seen with my diabetics has been diabetic or stasis ulcers with poor healing. I've also had several trauma wounds because the patients had injured their feet and never felt it. One guy walked around with a nail in his foot for a week! Ouch! I hope you enjoy your new job, it can be very rewarding once you get the work/home balance worked out

[nicole109]

As one of the other posters stated, the Braden score assesses several different areas--I have some diabetic patients who are mobile, and even well into their 80s that are not at risk for pressure ulcers, because they are mobile, however...whenever I do a risk assessment for a diabetic patient, I always assess them at a 3 (or worse) for Sensory Perception "Slightly Limited-responds to verbal commands but cannot always communicate discomfort or need to be turned OR has some sensory impairment, which limits ability to feel pain or discomfort in 1 or 2 extremities" Because all diabetics are at risk for developing neuropathy, the last part of this applies to them. The rest of the braden score will be determined by each individual person, how dry their skin is, how well they eat, what their activity level is, how mobile they are and lastly how much friction their skin is subject to when they do move.

[Blackheartednurse]

Thanks.

[SitcomNurse, BSN, MSN, EdD, RN]

here is the thing, no matter what a score on a piece of paper says, you have clinical judgement. i frequently have to document my clinical judgement, and do so by stating... despite a braden score of >18, the patient is at high risk due to xxxxxx. risk to be modified by xxxxxxxx actions. or despite a fall risk score of >12 , patient is at high risk because xxxxxxxxx. risk reduction measures include: xxxxxxxxx.

ultimately, if the event happens, you are covered, and if it dosent happen.. you did everything right!

[ayla2004, ASN, RN]

Here is the thing, no matter what a score on a piece of paper says, you have clinical judgement.

sorry can't get a quote message.we use the waterlow score instead of norton/braden

diabetics do score for motor sensory impairment but nursing intervention in based not on a risk assessment number but on clinical judgement.