View source for Braden Scale for Predicting Pressure Ulcer Risk

{{Short description|Clinical tool}}
{{Infobox diagnostic
| name            = Braden Scale for Predicting Pressure Ulcer Risk
| image           =
| alt             =
| caption         =
| pronounce       =
| purpose         =assess risk of pressure ulcer
| test of         =
| based on        =
| synonyms        =
}}
The '''Braden Scale for Predicting Pressure Ulcer Risk''', is a tool that was developed in 1987 by [[Barbara Braden]] and Nancy Bergstrom.<ref>
Kozier, Barbara, Glenora Erb, Shirlee Snyder, and Audrey Berman. Fundamentals of Nursing: Concepts, Process, and Practice. 8th ed. Upper Saddle Riveer, NJ: Pearson Education, 2008. 905-907. Print.</ref> The purpose of the scale is to help health professionals, especially nurses, assess a patient's risk of developing a [[pressure ulcer]].<ref>U.S. National Library of Medicine, Initials. (2009, May 20). 2009aa braden scale source information. Retrieved from https://www.nlm.nih.gov/research/umls/sourcereleasedocs/2009AA/LNC_BRADEN/</ref>
==Assessment using the Braden Scale==
The Braden Scale assesses a patient's risk of developing a pressure ulcer by examining six criteria:<ref>Cassell, Charisse. "Pressure Ulcer Risk Assessment: The Braden Scale for Prediction Pressure Sore Risk." Health Services Advisory Group of California, Inc., n.d. Web. 25 Feb 2011. <http://www.hsag.com/App_Resources/Documents/CA_HSAG_LS3_Risk_Cassell.pdf> {{webarchive |url=https://web.archive.org/web/20110712225753/http://www.hsag.com/App_Resources/Documents/CA_HSAG_LS3_Risk_Cassell.pdf |date=July 12, 2011 }}.</ref>
===Sensory perception===
This parameter measures a patient's ability to detect and respond to discomfort or [[pain]] that is related to pressure on parts of their body. The ability to sense pain itself plays into this category, as does the level of consciousness of a patient and therefore their ability to cognitively react to pressure-related discomfort.
===Moisture===
Excessive and continuous [[skin]] moisture can pose a risk to compromise the integrity of the skin by causing the skin tissue to become macerated and therefore be at risk for [[epidermis (skin)|epidermal]] erosion. So this category assesses the degree of moisture the skin is exposed to.
===Activity===
This category looks at a patient's level of physical activity since very little or no activity can encourage [[Muscle atrophy|atrophy of muscles]] and [[Necrosis|breakdown of tissue]].<ref>{{cite web|url=http://cwx.prenhall.com/bookbind/pubbooks/martinidemo/chapter10/medialib/CH10/html/ch10_5_3.html |title=Chapter 10: Muscle Tissue |access-date=2011-02-27 |url-status=dead |archive-url=https://web.archive.org/web/20110715112134/http://cwx.prenhall.com/bookbind/pubbooks/martinidemo/chapter10/medialib/CH10/html/ch10_5_3.html |archive-date=2011-07-15 }}</ref>
===Mobility===
This category looks at the capability of a patient to adjust their body position independently. This assesses the physical competency to move and can involve the clients willingness to move.
===Nutrition===
The assessment of a client's nutritional status looks at their normal patterns of daily [[nutrition]]. Eating only portions of meals or having imbalanced nutrition can indicate a high risk in this category.
===Friction and Shear===
Friction and shear looks at the amount of assistance a client needs to move and the degree of sliding on beds or chairs that they experience. This category is assessed because the sliding motion can cause shear which means the skin and bone are moving in opposite directions causing breakdown of cell membranes and [[capillaries]]. Moisture enhances the susceptibility of friction.<ref>"Bedsores (pressure sores)." Mayo Clinic, 30 Mar 2009. Web. 25 Feb 2011. http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=causes.</ref>
==Scoring with the Braden Scale==
Each category is rated on a scale of 1 to 4, excluding the 'friction and shear' category which is rated on a 1–3 scale. This combines for a possible total of 23 points, with a higher score meaning a lower risk of developing a pressure ulcer and vice versa. A score of 23 means there is no risk for developing a pressure ulcer while the lowest possible score of 6 points represents the severest risk for developing a pressure ulcer.<ref>{{cite journal |vauthors=Jiricka MK, Ryan P, Carvalho MA, Bukvich J |title=Pressure ulcer risk factors in an ICU population |journal=Am. J. Crit. Care |volume=4 |issue=5 |pages=361–7 |year=1995 |pmid=7489039 |doi= 10.4037/ajcc1995.4.5.361}}</ref>
The Braden Scale assessment score scale:
*Very High Risk: Total Score 9 or less
*High Risk: Total Score 10–12
*Moderate Risk: Total Score 13–14
*Mild Risk: Total Score 15–18
*No Risk:  Total Score 19–23
==See also==
* [[Pressure ulcer]]
* [[Wound healing]]
* [[Waterlow score]]
==References==
{{Reflist}}
==External links==
*[http://www.bradenscale.com/index.htm Braden Scale Official Website] {{Webarchive|url=https://web.archive.org/web/20120320151451/http://www.bradenscale.com/index.htm |date=2012-03-20 }}
*[https://web.archive.org/web/20131113165650/https://www.healthcare.uiowa.edu/igec/tools/pressureulcers/bradenScale.pdf Braden Scale Instruction sheet]
*[http://www.in.gov/isdh/files/Braden_Scale.pdf Braden Scale Assessment form]
[[Category:Nursing]]
[[Category:Medical scales]]