Pressure Ulcers: A Case Study

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

However, only 10% of nurses actually complete accurate inspections of the skin during their initial physical assessments of the patients (Lahmann et al., 2010). As a result, patients who are at risk of developing pressure ulcers are often overlooked by nursing staff.

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

In this scenario the hospital in order to advance the quality of care, could have shared the information about the incident with the nursing personnel. The hospital could provide the best quality of care to the patients and achieve the patients’ satisfaction, by sharing the data. Advancing the quality of care would have positive effect on both patient satisfaction and nursing care. Knowledge of nursing care empowers the nursing staff in such cases. In this scenario the knowledge of pressure ulcers, restraints and patient care is significant. On the other hand the nursing care in this scenario could have been better and the family/patient could have been cared better if the nursing staff had gotten the best patient care knowledge.

The healthcare team honored the patients’ wishes as best as possible; the only time we bothered the patient was when we changed the dressings on the pressure ulcers located on the anterior portion of the left foot and right buttocks and when we provided the patient with PRN pain medications. Since this is a Medical Surgical floor, we were required to do one assessment, and that occurred during the time the health care team went in as a group to clump all of the care up and do it at one time. The only negative experience that had occurred was when the patient was expressing non-verbal signs of pain – and from that point, we worked quickly to give him his PRN pain medications to manage it.

It is important to ensure that the agreed care plan is followed to ensure that all precautions that are deemed necessary for the prevention or care of pressure ulcers are carried out, it is also important that the agreed care plan has been checked and agreed with the individual to ensure that any concerns that either the individual or the health care worker may have regarding the plan of care are addressed and where necessary any changes be made to the plan of care, and to ensure that valid consent has been obtained from the individual concerned..

J’s scenario is pressure ulcer. From analyzing Mr. J’s case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing-sensitive indicator in this case is restraints. As I have mentioned earlier the use of restraints in Mr. J’s case seems appropriate as he pose great fall risk which may further complicate his current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning, history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care throughout the hospital, the quality improvement department should scrutinize, and keep track of the

Pressure ulcer or bedsores as it is called is commonly referred to as very prevalent among high-risk patients, especially those confirm to hospital or long-term care setting. These individuals may be adults, elderly, frail, poorly nourished, and with comorbid illness. The objective of this assignment Is to Provide Awareness to my PICOT question which will be a quantitative research and will be supported by evidence-based research and obtained by systematic review from many database searches.

20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure

This paper will explore a clinical practice guideline from the National Guideline Clearinghouse and will focus on hospital-acquired- pressure ulcers. The development of hospital -acquired pressure ulcers are a great concern in today’s health care. Pressure ulcer treatment is costly, and the development of ulcers is prevented by the used of evidence-based nursing practice. According to the Centers for Medicare and Medicaid Services (2008), announces that they will no longer pay for additional costs incurred for hospital-acquired pressure ulcers. The development of stage 111 and the 1V ulcer is considered a “never event” Therefore, this new change has resulted in an increased focus on preventive measures and institutional scrutiny of pressure

A pressure ulcer is a localized injury to the skin usually over bony prominence, as a result of pressure, or pressure in combination with shear. It is estimated that 5 to 10 percent of patient admitted to the hospital acquire a pressure ulcer and it result in increased suffering, morbidity and mortality. The policy titled Pressure Ulcer Prevention and Managing Skin integrity provides direction for the nurses to prevent the development of pressure ulcer. It

Mr. J.’s daughter noticed a red mark on her father who then reported this to the nursing assistant and her concerns were immediately dismissed. If the nursing assistant was properly trained in the use of restraints and had knowledge of patient outcomes, this patient would not have developed a pressure ulcer. The nursing assistant should have immediately informed the nurse and measurements should have been taken to prevent further breakdown of the patient’s skin which was not done. It is evident in reading this case that Mr. J developed a Stage I pressure ulcer from being retrained in one position with no assessment or release for an undetermined amount of time.

It is important to count & track pressure ulcer rates as a major factor for quality improvement. Being able to track pressure ulcer rates, care can be altered to better improve medication interventions and ultimately decrease the rates of pressure ulcers. It also allows the interdisciplinary team members be able to gain perspective on data trends. Improvement efforts are ongoing basis and the AHRQ recommends that pressure ulcer incidence or prevalence rates be monitored to determine outcomes, utilization of at least one or two skin assessments, and determine responsibility for overseeing accuracy of skin assessments.

Pressure ulcers are; damage to the skin or underlying structures from either inadequate perfusion or tissue compression. (Taber’s Cyclopedic Medical Dictionary, 2009, p. 1889). Those at an increased risk for pressure ulcer formation: older adults, persons with spinal cord injury, surgical patients, obese patients, underweight patients, children and patients at end of life. (Ruth & Nix, 2012, p. 125). The Braden Scale, is a tool used to help identify a patient’s risk of developing a pressure ulcer.

problem. It not only cause pain, slow recovery from the sick skin condition and prolonged hospital stay but also increase health care costs and nursing time. It occurs in patients of all age group. According to the statistics, it cost $9.1-$11.6 billion and 2.5 million people affect Nation wild each year ( Are We Ready for This Change? | Agency for Healthcare ... n.d.). The skin lesions cause patient suffering from pain, and the risk for infection. In this essay, the student will present a pressure ulcer prevention program (PUPP). Discussing the purpose of the program, the target population, and the benefits of the program associated with the cost. At the final, the student will evaluate the possibility to implement the program.