Arterial Ulcer Analysis

Wound management is one of the cornerstones for nursing care however, effective wound care extends far beyond the application of the wound itself. Nurses may be required to assess, plan, implement, and evaluate wound care; therefore, order to fill these roles it’s critical to have an understanding of the several different areas of wound care such as, integumentary system, classification of wounds, wound procedures, and documentation. Knowledge in each of these areas will allow nurses to make well informed decisions about wound care, and as a result play an active part in wound healing.

I have significantly developed my skill in wound care assessment and dressing, in developing this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer assessment it provides a basis for deciding the effectiveness of the current treatment.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

Jane presented with a wound to her lower left leg which, following a holistic assessment (appendix 2), was diagnosed as a venous leg ulcer. The assessment was conducted in accordance with Local PCT Leg Ulcer Guidelines (appendix 3) as well as RCN Guidelines (RCN 2006) to rule out other possible aetiology such as arterial ulceration, diabetes or malignancy (Moloney and Grace 2004). Although traditionally considered uncommon, recent studies suggest that malignant ulcers are more prevalent than previously thought (Miller et al 2003, Taylor 1998) therefore even though initial assessment suggests an uncomplicated venous ulcer, if Jane’s wound fails to heal following appropriate treatment then specialist advice will be sought. Between 17% and 65% of people with a leg ulcer experience severe or continuous pain with a major impact on quality of life (Briggs and Nelson, 2003) and effective pain relief is important to maximise quality of life, to enable mobilisation and improve appetite to facilitate wound healing. Fortunately, Jane experienced no pain from the leg ulcer prior to or at the time of assessment. However, careful review and monitoring of any pain will be important throughout the treatment process as the first line of treatment for uncomplicated venous leg ulcers are compression systems (RCN 2006) and although compression counteracts the harmful effects of venous hypertension and

venous leg ulcers and diabetic foot ulcers. Canadian Association of Wound Care (CAWC) has published

Living with annoying venous painful wound leg ulcers is so miserable, it seems it would be endless, leads you wanting to be alone and having unwanted life. In spite of current mountainous researches work in the management of this type of wound, still the problem persisted and continuously affecting certain populations. Venous legs ulcer has great impact in life; physically, mentally and psychosocially.

Pressure ulcer has caused thousands of deaths in Australia every year. It is very common in elderly people due to poor nutrition intake, fragile skin, reduced mobility and illnesses. Sally is an 82 year old resident who has been under affected by diabetes for years and has recently developed a leg ulcer. Her leg ulcer has become a serious health problem and is causing Sally a lot of pain while decreasing her quality of life. Sally’s leg ulcer has made her no longer socialize like she used to; she could barely move or leave the house and also suffered lot of pain in her lower leg. Emotionally, she become harder for her husband to deal with, she get anger more easily and enjoy her life less. Physically, it is harder for her to do her daily living

Upon admission to a hospital, a patient may be at risk for numerous hospital-acquired conditions. Pressure ulcers, also known as pressure sores or “bed sores”, are a type of hospital-acquired condition that may develop during a hospital admission if proper risk assessment is not performed by a registered nurse (RN). Pressure ulcers form over bony prominences, such as the back, heel, ischium, sacrum, and elbow, when circulation of these prominences is impaired (Jarvis, 2012). Pressure ulcers may develop when a person is confined to a bed or immobilized, which impedes proper delivery of oxygen and nutrients to the skin resulting in cell death (Jarvis, 2012). Pressure ulcers are divided into four stages. In stage I, a nonblanchable redness of intact skin appears that does not disappear for 24 hours after pressure is relieved. In stage II, there is partial-thickness erosion of the epidermis or the dermis layer of the skin. Full-thickness pressure ulcers are a stage III ulcer, which extend into subcutaneous tissue. Lastly, stage IV pressure ulcers involve all skin layers and may expose muscle, tendon or bone. Pressure ulcers can be prevented if risk assessment is performed and at-risk individuals are identified (DeLaune & Ladner, 2011).

Pressure ulcers are the priority health issues that immobilized patients, their families and care givers are facing with high occurrence rate. It is no doubt very costly and imposes a great impact in health care delivery system because of the supplies needed to prevent further complications. Pressure ulcer is a localized injury to the skin and other underlying tissue, usually over a body prominence, as a result of pressure, or pressure in combination with shear or friction, or both (Potter & Perry, 2010, p.1240). One of the intrinsic factors for pressure ulcer development is reduced or impaired mobility. Standard protocol for pressure ulcer prevention mainly the use of barrier cream, has been widely used since its existence. Although numerous

After reviewing the dialogue between the nurses and the surgeons, it was necessary to delve into the quality management method that were utilized in the hospital. Anytime a patient develops pressure ulcers, it is a sign of negligence in most cases. The surgeons are knowledgeable in knowing that the skin will breakdown with prolonged decreased bed mobility. Consequently, having a meeting to discuss changes in the quality assurance management methods is an indicator that there were some deficits in the delivery of healthcare. The fact that the Never Event occurred shows there was a breakdown in the quality assurance process in the hospital.

The Healthy Skin Project was initiated as a result of increasing cost for the treatment and diagnosis of pressure ulcers. The number of patients needing hospitalization and health care for this condition was rising by a large and alarming rate. Another need for this study came into play as a health care priority when in 2008 the Centers for Medicare and Medicaid Services stopped honoring payment for many types of hospital- acquired conditions, one being pressure ulcers.

The National Institute for Health and Care Excellence (NICE) defines leg ulcer as the loss of skin on the leg below the knee or foot, which takes more than 2 weeks to heal. Venous leg ulceration is due to sustained venous hypertension, which results from chronic venous insufficiency and/or an impaired calf muscle pump. Venous leg ulcers

Nursing care is always evolving as new discoveries are made, so recurring nursing education is essential in providing modern, up-to-date care. Studies suggest that improved identification of pressure ulcers decreases the risk of HAPUs (Bergquist-Beringer et al., 2009). In 2006, the National Database of Nursing Quality Indicators (NDNQI) developed a pressure ulcer training program to help nurses identify and accurately stage pressure ulcers and accurately collect data for NDNQI pressure ulcer surveys. This program includes four modules. Module I, titled “Pressure Ulcers and Staging,” explains each stage of pressure ulcers and common pressure ulcer locations. Module II, titled “Other Wound Types and Skin Injuries,” covers different types of wounds and skin injuries that are commonly misclassified as pressure ulcers. Module III, titled “Prevalence Study Protocol,” covers accurate data collection, suggested pressure ulcer training, and pressure ulcer risk assessment and prevention. Module IV, titled “Community vs. Hospital/Unit-Acquired Pressure Ulcers,” covers the difference between community-acquired pressure ulcers and HAPUs. Five thousand two hundred individuals completed the NDNQI training program between November 2006 and April 2007 for continuing education credit. Those who left reviews most often commented on their positive learning experience and appreciated the use of multiple pictures of ulcers

When we find an enclosed damage to our skin as well as tissue that is usually over the skeletal protuberance caused by some sort of pressure, we call it a pressure ulcer. This may be caused by some sort of pressurized rubbing or cut. This type of ulcer is a chronic type that inherently carries impaired healing at physiological level. In this paper I am going to discuss the prevention measures of this ulcer and treatment options.