PATIENTS AT RISK HESI CASE STUDY
EVOLVE WITH RATIONALES
EARLY WARNING SIGNS PRIORITY
INTERVENTIONS AND PATIENT SAFETY
UPDATED 2026
Sally makes ongoing rounds, recommending prevention strategies and treatments for a
wide variety of wounds, including pressure ulcers. A pressure ulcer is a/an: -
Answer--Localized area of tissue necrosis
A pressure ulcer is a localized area of tissue necrosis (death), caused by ischemia
associated with prolonged, unrelieved pressure. Unrelieved pressure causes ischemia
(poor circulation) which deprives the affected area of oxygen and nutrients, potentially
leading to necrosis. Pressure ulcers usually develop in areas where soft tissue
capillaries are compressed between a bony area and an external surface. Both the
intensity and duration of pressure are important contributors to pressure ulcer risk.
Which of the following contribute to Mr. Esserman's risk for development of pressure
ulcers? - Answer--Paralysis of arm and leg
(Mr. Esserman's paralysis increases his risk for pressure ulcers. Any person who has
limited ability to move himself and change position is at risk for developing a pressure
ulcer. The person must rely on others to help move and change position to prevent
pressure ulcer development. Also, Mr. Esserman sits in his favorite chair for most of the
day. Being confined to a chair for a prolonged period of time can cause continuous
unrelieved pressure on the same areas. This can lead to pressure ulcer development.)
, Loss of sensation
(With loss of sensation, the normal ability of the nervous system to alert a person to
"numbness" that happens after being in one position for too long is no longer present.
Sensations of discomfort or pain may also be absent. Thus, skin damage can occur
without being noticed. Mr. Esserman has some sensation, but feeling is limited on his
affected side.)
Difficulty swallowing
(The inability to swallow properly can interfere with adequate food and fluid intake, and
lead to malnutrition. Malnutrition can starve the skin of adequate nutrients and decrease
tissue tolerance to pressure. Persons who are malnourished are at increased risk for
developing pressure ulcers.)
Slurred speech
(With slurred speech, Mr. Esserman may not be able to effectively communicate any
discomfort he might feel. This increases his risk for pressure ulcers.)
When moving Mr. Esserman, the person doing the moving should bend his/her knees
(Persons helping Mr. Esserman should be aware of proper body mechanics to use
when assisting with moving and positioning. Important principles of body mechanics
include working with the bed at a comfortable level, facing the direction of movement,
and using flexed knees when lifting. With flexed knees, the legs and hips are used,
instead of the back.)
You teach the Essermans that when Mr. Esserman is in bed his position should be
changed at least every: - Answer--2 hours
(When in bed, Mr. Esserman should change position at least every two hours, although
this schedule should be individualized based on his tolerance.)
When assessing a reddened area, it is important that it be checked for: -
Answer--blanching
EVOLVE WITH RATIONALES
EARLY WARNING SIGNS PRIORITY
INTERVENTIONS AND PATIENT SAFETY
UPDATED 2026
Sally makes ongoing rounds, recommending prevention strategies and treatments for a
wide variety of wounds, including pressure ulcers. A pressure ulcer is a/an: -
Answer--Localized area of tissue necrosis
A pressure ulcer is a localized area of tissue necrosis (death), caused by ischemia
associated with prolonged, unrelieved pressure. Unrelieved pressure causes ischemia
(poor circulation) which deprives the affected area of oxygen and nutrients, potentially
leading to necrosis. Pressure ulcers usually develop in areas where soft tissue
capillaries are compressed between a bony area and an external surface. Both the
intensity and duration of pressure are important contributors to pressure ulcer risk.
Which of the following contribute to Mr. Esserman's risk for development of pressure
ulcers? - Answer--Paralysis of arm and leg
(Mr. Esserman's paralysis increases his risk for pressure ulcers. Any person who has
limited ability to move himself and change position is at risk for developing a pressure
ulcer. The person must rely on others to help move and change position to prevent
pressure ulcer development. Also, Mr. Esserman sits in his favorite chair for most of the
day. Being confined to a chair for a prolonged period of time can cause continuous
unrelieved pressure on the same areas. This can lead to pressure ulcer development.)
, Loss of sensation
(With loss of sensation, the normal ability of the nervous system to alert a person to
"numbness" that happens after being in one position for too long is no longer present.
Sensations of discomfort or pain may also be absent. Thus, skin damage can occur
without being noticed. Mr. Esserman has some sensation, but feeling is limited on his
affected side.)
Difficulty swallowing
(The inability to swallow properly can interfere with adequate food and fluid intake, and
lead to malnutrition. Malnutrition can starve the skin of adequate nutrients and decrease
tissue tolerance to pressure. Persons who are malnourished are at increased risk for
developing pressure ulcers.)
Slurred speech
(With slurred speech, Mr. Esserman may not be able to effectively communicate any
discomfort he might feel. This increases his risk for pressure ulcers.)
When moving Mr. Esserman, the person doing the moving should bend his/her knees
(Persons helping Mr. Esserman should be aware of proper body mechanics to use
when assisting with moving and positioning. Important principles of body mechanics
include working with the bed at a comfortable level, facing the direction of movement,
and using flexed knees when lifting. With flexed knees, the legs and hips are used,
instead of the back.)
You teach the Essermans that when Mr. Esserman is in bed his position should be
changed at least every: - Answer--2 hours
(When in bed, Mr. Esserman should change position at least every two hours, although
this schedule should be individualized based on his tolerance.)
When assessing a reddened area, it is important that it be checked for: -
Answer--blanching
