Pressure UlcersBethanie BubeEastern Gateway Community CollegeAbstractThis paper educates on what a pressure ulcer is and ways to prevent them. There are peer-reviewed sources and personal experience from my healthcare background listed. The Medical Surgical Nursing textbook goes into detail about other related problems that can lead to these. The Journal of the American Academy of Dermatology (JAAD) talks about the cost of treating pressure ulcers, and how many people they affect a year. US practice guidelines informs us how often a patient should be repositioned and the progression of pressure ulcers because of staffing ratios. Prevention and treatment with a wound care nurse is going to be critical in helping these patients with pressure ulcers. The worse they get the more infection and health problems patients are susceptible to. Some preventative measures are listed from the Internal Journal of Nursing Education for all healthcare workers to follow. This paper is well summarized in all the associated factors that go along with a pressure ulcer and it’s our job to help decreases the chances of these occurrences. Pressure UlcersA pressure Ulcer is injury to the skin or tissue, as a result of pressure that correlates with excessive moisture and shearing force to the skin when being repositioned in bed. Most common places for these are usually over a bony area of the body, like the sacrum and heels. “Risk factors for these pressure ulcers include advanced age, anemia, incontinence, obesity, impaired circulation, diabetes mellitus, contractures, pain, vascular disease, immobile and neurological disorders”(Lewis, Bucher, Heitkemper, Harding, 2017, p. 172). Pressure ulcers are the hidden disease. Health care workers and family rarely notice them because they are in places that are covered and once the degree of the ulcer gets so bad patients can no longer feel the pain.“Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while the associated costs of care continue to increase”( Mervis, Phillips, 2019). There are different ways we can categorize a pressure ulcer, the most common is staging. Stage 1 has superficial reddening of the skin and does not blanch, also has no breaks or tears in the skin but can be very painful. The skin may be warmer, or softer than the other skin surrounding it. Stage 2 the skin tears open and could potentially form an ulcer, it may look like a blister filled with clear fluid. This could very well be painful, unfortunately some of the skin may be too damaged for us to help fix it. Stage 3 is when the sore extends into the subcutaneous tissue beneath the skin, sometimes forming a large hole and tunneling. Stage 4 has exposed bone, tendon, or muscle with the wound going underneath what we can see. There may be no pain in stage 3 or 4 because of the tissue damage. I have personally in my experience in healthcare seen every stage of a pressure ulcer. It is sad and heartbreaking that these patients have to experience this discomfort in their lives. They become so embarrassed by it and we try to do everything to make them feel better. As healthcare workers, it is our job to do no harm and give our patients the best care they deserve. Unfortunately most of these pressure ulcers happen at the facility these patients are staying at, either it being a long term care facility, a hospital or a rehab facility. “According to U.S. practice guidelines, nursing home residents should be repositioned as frequently as their condition requires. Practice guidelines in Canada and the United States recommend that individuals at high risk of pressure ulcers be repositioned every 2 hours. The cost of pressure ulcer prevention can be substantial, because some elements of prevention consume a large amount of human resources. A policy of frequent turning requires that nurses or personal support workers devote a large part of each working day to this task”(Pechlivanoglou, Pham, Wong, Krahn, Paulden, Horn, 2018). Unfortunately, these facilities do not have the staff to accommodate every patient that requires this frequent care so they are neglected and form these pressure ulcers.Prevention of these pressure ulcers are key in protecting our patients from the pain, infection and future problems related to pressure ulcers. It is not just the nurses assistants jobs to protect these patients it also relies on the nurses, wound care, dietitians, physical and occupational therapy, and anyone else involved in the care. I used to work on a floor in a hospital that had many sick elderly people so they were unable to get out of bed. It was our job to make sure these patients were turned and repositioned every 1 hour or more frequently if their condition required it. To prevent skin shearing we were able to order patients special air mattresses that helped us reposition them and to move them up in bed safer. These patient told us everyday how much they loved these plus they added some extra comfort on top of the hospital mattresses. We also had to advocate for our patients, meaning calling the doctor when they are in pain to try and get them something for the pain. These patients are not in the comfort of their own homes the last problem they need is to be in pain. According to the International Journal of Nursing Education there are some preventative measures that can be taken to help prevent or decrease pressure ulcers. “Inspect the skin at least once a shift, keep the bed sheets wrinkle free, and dry, ensure the patient’s hydration status is maintained, gently massage bony prominences, and turning and repositioning every 2 hours”(Amoldeep, Baby, Khurana, Pooja, Reshu, Saloni, Sarin, 2019). There are many goals for these patients are few being, to have no increase in deterioration of the pressure ulcer, reduce risk factors, improve mobility and circulation, improve nutritional status, and not to develop any further pressure ulcers. To monitor the progression of pressure ulcers most healthcare facilities have a camera and measuring tools to take pictures of these ulcers. I work in a facility that has a work only camera, when we take pictures it must include a ruler, the patients identification sticker, the date, time, the initials of the person taking the picture and the location of the wound. It is also important that we get all the information in the picture and that we get 2 pictures for each photo. This helps the wound care nurse monitor the progression of the wound so we can find the best treatment for these patients. As a nurse a lot of teaching must be done with these patients and their families especially if they want to stay at home and not go to a nursing facility. It’s very important to teach the caregiver the proper way to help clean the patient up, make sure we are turning them, and what signs and symptoms of a wound to monitor for. Teach to inspect the skin daily, the importance of good nutrition and also the proper way to change the dressing. Don’t try to do this all on your own there are other options to help assist with your family member, there is home health, meals on wheels and lots of other resources out there.In conclusion “Pressure ulcers are mostly preventable events, so it is important to adopt methods and practices that potentiate prevention, which is initiated by an individualized risk assessment. Pressure injuries afflict and discourage patients, and constitute an infection door, hindering to recover and increase hospitalization time and, consequently, costs. Pressure ulcers follow as a serious and routine problems in the health services, due to the high incidence, increased mortality and costs arising from it”(Benevides 2017). As I said previously I have seen pressure ulcers, in all severity. It is our job as healthcare workers to protect our patients and help them get better, whether it’s the dietary department to make sure the patient is getting a high protein diet, or our nurses and nursing assistant making sure our patients are clean, dry and repositioned, we all play an important part in their care. ReferencesLewis, S. M., Bucher, L., Heitkemper, M. M. L., & Harding, M. M. (2017). Medical-surgical nursing: Pressure ulcers. St. Louis, MO: Elsevier.Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Prevention and management. Journal of the American Academy of Dermatology, 81(4), 893–902.Pechlivanoglou, P., Paulden, M., Wong, J., Horn, S. D., Krahn, M., & Ba. (2018, April 20). Turning High‐Risk Individuals: An Economic Evaluation of Repositioning Frequency in Long‐Term Care. Pechlivanoglou, P., Paulden, M., Wong, J., Horn, S. D., Krahn, M., & Ba. (2018, April 20). Turning High‐Risk Individuals: An Economic Evaluation of Repositioning Frequency in Long‐Term Care.Benevides, J. L., Coutinho, J. F. V., Tomé, M. A. B. G., Fabiane, Gubert, A., Castro, T. B. de, … Oliveira, S. K. P. de. (n.d.). Nursing strategies for the prevention of pressure ulcers in intensive therapy.
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