Reflective Account On Pressure Ulcers

Treatment of a pressure ulcer costs the NHS more than £3.8 million, despite the progress and management of pressure ulcers 700,000 people are still affected this remains to be a significant problem for health care professionals (NHS Improvement, 2016). Therefore, this case study will enumerate the cause, treatment, prevention and risk factors of a pressure ulcer in relation to a patient who is suffering from a grade three-pressure ulcer to his sacrum and therefore requires long-term care from the district nurses. Pressure ulcers can occur more commonly on the sacrum or heels in any health care settings (Clarkson, 2007). Although more prevalent in the elderly, people of all ages are at risk of developing a pressure ulcer

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.

One of the greatest indicators for the quality of care is health care facilities is the amount of pressure ulcers acquired in patients. Approximately 1 million people develop hospital-acquired pressure ulcers each year affecting hospitalized patients in both acute and long term care settings. The incidence of pressure ulcers ranges from 0.4%-12% in acute care settings, along with the prevalence range from 12%-18%. Pressure ulcers cause increase pain, suffering, and decreased quality of life along with extended hospital stay. According to the national pressure ulcer advisory panel a pressure ulcer is defined as “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination

Pressure ulcers additionally called bedsores or pressure sores, are wounds to skin and fundamental tissue coming about because of delayed weight on the skin. A pressure ulcer is confined damage to the skin or basic tissue more often than not over a hard unmistakable quality, as a consequence of weight, or weight in blend with shear and contact. Since muscle and subcutaneous tissue are more defenseless to weight incited harm than skin, bedsores are regularly more awful than their introductory appearance. Pressure ulcers are then organized to direct clinical depiction of the profundity of detectable tissue demolition. It is assessed that these ulcers commonness in intense consideration is 15%, while frequency in intense consideration is 7%. It is evaluated that 2.5 million patients are treated for bedsores in US wellbeing acute care facilities every year. Pressure ulcers cause significant damage to patients, obstructing useful recuperation, often bringing on torment and the improvement of genuine diseases. They have additionally been connected with a broadened length of stay, sepsis, and mortality. Truth be told, about 60,000 US facility patients are assessed to pass away every year from complexities because of these ulcers. The evaluated expense of dealing with a solitary full thickness ulcer is as high as $70, 000, and the aggregate expense for treatment of pressure ulcers in the US is assessed at $11 billion every year.

Pressure Ulcers Prevention (PUP) is a national initiative for all hospitals. Medicare estimates an average of $146 million being spent annually for hospital acquired conditions which include pressure ulcers (Kandilov, Coomer, & Dalton, 2014). Hospital acquired pressure ulcers are among the top five adverse events reported today (Gillespie, Chaboyer, Kent, Whitty, & Thalib, 2014). Medicare will stop paying for hospital acquired conditions therefore prevention is the key (Kandilov, Coomer, & Dalton, 2014). Best practice guidelines advocate routine repositioning of patients however the studies were not based on RCT’s and were conducted well over 20 years ago, and before the improvement of mattress that are used in hospitals and long-term care facilities (Gillespie, Chaboyer, Kent, Whitty, & Thalib, 2014). The purpose of this assignment is to critique a problem (repositioning patients to prevent pressure ulcers) related to the nursing profession that will allow the reader to identify, appraise, and synthesize studies in order to draw a conclusion from the data collected. The systematic research review (SRR) “Repositioning for pressure ulcer prevention in adults” by Gillespie, Chaboyer, Kent, Whitty, & Thalib, (2014) will be critiqued in this paper by describing the relevance of preventing pressure ulcers; the rigor of the studies used; critiquing the levels of evidence of the studies; describe the clarity with which the studies are

Nurses are accountable for delivering safe pressure ulcer prevention for patients who are at risk. Pressure ulcers can cause considerable amount of pain and distress in patients with nutritional deficiencies and can also cause high healthcare expenses due to extended hospital stay. Marlene Varga defines a pressure ulcer as “a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” (Varga, 2015, p. 26). Significant to nursing practice, evidence-based pressure ulcer protocols are incorporated through research and clinical capability with the intention of aiding practitioners to make evaluations in accordance with current practices and studies (Chaves, Grypdonck, & Defloor, 2010). In hospitalized patients with nutritional imbalances, how would repositioning and turning the patient compared to the use of redistribution or patient positioning system devices manage existing pressure ulcers and prevent new ones from forming?

Research has shown that leading factor in the development of VAP is aspiration of oropharyngeal, nasopharyngeal secretions and stomach content that contains pathogenic bacteria (Klompas, 2010). A review completed Sedwick, Smith, Reeder & Nardi studying the effects of HOB elevation, demonstrated a direct correlation between back rest elevation of < 30’ and the incidence of aspiration. Furthermore, clinical trials established that there was a substantial decrease in the development of aspiration and subsequent pneumonia when patients were placed in a semi-recumbent position (2012). Elevation of the head of the bed is not without its potential complications. The greatest concerning complication is related to impaired skin integrity, specifically the development of decubitus ulcers. Nursing staff must be vigilant frequent skin assessment and patient repositioning to ensure that skin integrity is not compromised. Educating families of the importance of HOB elevation is also critical, as patients may potentially be very uncomfortable and desire to have the HOB lowered. Utilization of head of the bed alarms, signs and intervention documentation will provide as a continual reminder to ensure nurses are compliant in adhering to this aspect of the care

Pressure ulcers have a significant effecr on both patients and healthcare providers. Pressure ulcers also known as pressure sores, are major problems for individuals that are bedridden or for the individuals that have less mobility (Kockrow, 2011). It is most likely to occur in elderly and those with spinal cord injuries which causes less mobility. There are many risk factors that are contributed to pressure ulcer formations well as how they can be prevented. Pressure ulcers consist of various types of stages similarly to wound healing. Wound healing consists of different types of factors and stages. Both pressure ulcers and wound healing have different types of methods of recovering, different types of complications,

Lee worked to quantify the performance of support surfaces designed to prevent or resolve pressure ulcers. Once this performance could be quantified using objective measures, his goal was to improve upon them. Glenn and Mike recognized the imortance of his work and the mutual advantage of coming togehter to form a collaboration.

Pressure ulcers (PUs) usually develop over a bony prominence as a result of pressure, or pressure in combination with shear stress and/or friction. Additional contributing factors include immobilization and malnourishment. Groups known to have a high risk of developing PUs include bedridden patients, wheelchair-bound individuals, frail elderly persons with no or limited mobility, as well as individuals with diabetes, poor nutrition, and chronic blood-flow diseases. Pressure ulcers represent an enormous burden on our health care system and an enormous problem for health care providers. Pressure ulcers result in both an increased length of hospital stay and increased hospital costs. Once developed, PUs represents an acute health condition that

On page 574 in the right hand column under “pressure ulcer staging guidelines”, it is defined by the NPUAP Consensus Development Conference as “intact skin with non-blanchable redness of a localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from…”

The National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) offer the following recommendation for pressure reduction support surfaces include: Reposition bed-bound persons at least every two hours and chair-bound persons every hour consistent with overall goals of care. Use a written repositioning schedule. Place at-risk persons on pressure-redistributing mattress and chair cushion surfaces. Use pressure-redistributing devices in the operating room for individuals assessed to be at high risk for pressure ulcer development. Use pillows or foam wedges to keep bony prominences, such as knees and ankles, from direct contact with each other. Avoid positioning directly on the trochanter when using the side-lying position; use the 30° lateral inclined position. Minimize the amount of chronic moisture exposure from urinary or fecal incontinence or sweat. Optimize nutritional status including protein intake and hydration. Complete a Risk Assessment Instrument for Pressure Ulcers on admission and weekly in an inpatient setting. (Thomas & Compton, 2014, p,

The PICOT question that I wanted to identify was in the hospital setting how does repositioning patients compared to no repositioning reduce the risks of pressure ulcers over time. Pressure ulcers are increasing in some facilities due to not changing patients’ positions every two hours which causes skin break down. Patients are more at risk for skin infections and pain related to open skin exposure which leads to increased health care cost and negative patient outcomes. In researching what ways are effective in determining the effectiveness of repositioning to prevent pressure ulcers.

Repositioning of patients prone to pressure sores refers to turning these patients in order to promote aeration and prevent excessive pressure being exerted on one body part for a long time. Research has demonstrated that turning of these patients every 4 hours with foam mattresses developed from visco-elastic polyurethane has superiority in outcome compared with lack of turning of these patients. The same research indicated that turning these patients every 4 hours has better outcome in reducing risk of grade 1 and grade 2 bed sores than turning them once daily on the same foam mattresses. This 4-hour turning schedule also has been shown to have little significant results compared a 2-hour turning schedule on the foam mattresses made of visco-elastic polyurethane (Vanderwee, Grypdonck, De, & Defloor, 2007).

We have chosen this case to present because we were interested in it. We have studied this in our lecture in Medical-Surgical Nursing so we wanted to use this knowledge to the real-life setting and get used to it. We are willing to do this case to challenge our mind in analyzing the problem and to enhance our hidden knowledge, and also to gain new experiences which would bring new learning for the members of the group. We want to be able to achieve our objectives for this case study.