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Prevention of Pressure Ulcer
A pressure ulcer is a common skin problem caused by pressure or a combination of pressures with the fiction and share. The problem is also known as bedsores or decubitus ulcers. The problem mainly affects such places like knees, elbows, back of the cranium and ankles. The formula beyond the cause of pressure ulcer is the application of pressure to soft tissues causing the stoppage of a blood flow to such tissues. Another cause is sheers which pulls on the veins and vessels of blood supplying blood to the skin. The most being at risk individuals include the persons confined in a wheelchair or those who do not move. Pressure ulcer needs an early treatment and since it is very difficult to treat it during late stages. Many people have lost their lives due to the infection of pressure ulcers.
H1; Pressure ulcer causes the spear pain to patients.
The patients of pressure ulcers suffer a lot. They experience much pain which needs the treatment. As a result of the excessive pain many people have lost their lives. Pressure ulcer leaves the victims at most risk, since the pain extends to other parts of their body.
H2; The number of victims of pressure ulcer is increasing at the high rate.
The number of pressure ulcer’s victims is currently increasing due to the advancement of technology. Many people have been exposed to the dangers of contracting pressure ulcers.
H3; There is an advancement in pressure ulcer’s treatment.
Due to the increased pressure ulcer’s cases, the problem to people has found means for curing the problem. The treatment is difficult but with the advanced means of prevention this may be implemented.
Case Report and Analysis
A pressure ulcer being a decease caused by the frequent rubbing of certain places of skin can be prevented avoiding conditions which lead to such rubbing. In the third world countries, the issue has been at the increase. As compared to the third world countries, the developing countries have many cases of the problem. In the developed countries, like United States of America and the United Kingdom, almost 20 % of people have this disease. The third world countries have in average about 11 % of people with this problem. There different things which leads to contraction of pressure ulcer, and individuals should be aware of such problems in order to prevent the numbers (Miller, 2009).
There are four stages of pressure ulcer which follow each other. The four different steps have various symptoms. Each stage has different events to the human body. The stage 1 is marked by the intact skin with a bony prominence with non blanchable redness. Mostly, the blanching remains invisible in the dark skin. However, the color differs from the surrounding area of skin. As compared to adjacent tissues, the affected areas may remain warmer, soft, painfully soft and firm. The stage is difficult to detect among individuals with dark skin. The second stage, mainly called the stage two, is characterized by the loss of dermis with the partial thickness. The dermis is presented by the open ulcer marked by a bad red pink wound. It can also be presented as a form of a blister. This stage been the second one with many complications and much pain. The stage can be easily identified among individuals with the black and white skin (Miller, 2009).
The other two remaining stages have more complications. An ulcer which reaches the last two stages makes an individual to suffer and feel more pain. Most of individuals choose to commit suicide due to the pain and faced problems. The atage three is marked by the loss of the full thickness tissue. In this stage, the subcutaneous fat layer is exposed but the tendon, bones or muscles are not exposed. The location of the ulcer in these stages determines the depth. The parts which do not have the subcutaneous tissues like ears, nose, malleolus and occiput have the shallow depth in case of infection. As compared to the areas without subcutaneous tissues, those with the deep depth in which the bone is exposed. An individual suffering from this problem is faced with lots of pain in this stage. The last stage, the stage VI, is characterized by the loss of the full thick tissue and exposure of the tendon, mussels and bones. In many cases, some parts of the wound bed have slough or eschar. Just like the stage three, the depth of the pressure ulcer is determined by the anatomic location (Miller, 2009).
Many stages of pressure ulcer prolong the healing periods. Almost 70 % of the ulcer in the stage two take about 8 weeks to be healed. About 60 % of the stage four of the pressure ulcer may not be healed. So there is only 40 % of individuals with the stage four that the ulcer gets healed. The stage four of the ulcer which get healed takes a period of one year. After the treatment, the ulcers persist the next stage; but the healing process begins by narrowing of the ulcer’s depth. People should seek the medical attention in the early stages to avoid more complications. The level of pain increases with the advancements of stages. An individual with the stage I of the pressure ulcer do not suffer from much pain than the individual with the stage IV of this disease.
People should seek the medical attention or advice immediately after the contraction of pressure ulcers. This is because the treatment of the first stage is easier and cheaper than the treatment of the stage two and so forth. A medical specialist has the advanced and found means of treatment of each stage though is advisable to consult the medical aid in case of suspecting pressure ulcer in any part of skin. Though this problem is common to adults and old people, parents should take care of their children and ensure that they have got treatment in case of infection.
Causes of Ulcer
Pressure ulcer is the damage of tissues caused by the application of external forces which cause the injury to body cells. When any object which is heavy or light is placed over the body, it causes the pressure that affects the blood flow. The lack of the proper flow of blood results to the distortion of tissues. This causes ulcers. When the two forces are applied in one cell but to the same direction this is known as shear. The pressure that is produced causes the deformation of the cell which is known as the ulcer. Friction causes the cell’s damage known as the blisters. This cell injury is mechanical. This process produces a lot of heat which causes the trauma resulting to an ulcer.
The hyperemia reactive cycle causes pressure ulcer when it fails its duty. This results to the loss of sensory organs from performing their duty. Diseases that affect neurons cause the damage of cells as they affect the end of neurons. Hyperemia reactive tissues when they fail to recover from this condition cause pressure ulcer. Sharp objects play a major role in causing the pressure ulcer, especially those that are not disinfected against micro-organisms (Maklebust & & Sieggreen, 2011). Individuals with their reflex protected responses respond slowly. This may also cause the pressure in cells which results to the pressure ulcer. This occurs mainly due to the damage in the spinal injury rapture of aortic nerves and neurologic diseases.
Acute episodes can experience when chronic is susceptible. This results to the pressure ulcer. Infection that takes a long duration of time to heal in the urinary tract system results to ulcers. Individuals need to constantly seek health professionals about the situation that may result to pressure ulcer so as to avoid such situations. Up-to-date management measures should be kept near to ensure that one is not endangered by the ulcer that is developed from pressure (Maklebust & & Sieggreen, 2011).
Approaches to Solving the Problem of Pressure Ulcers
The problem of pressure ulcer is mostly prevalent when one does not take the physical fitness of the body with a high concern. This is through practices that are eminent to alter with the normal body functioning leading to the development of bad scores. The major causes that lead to the development of such scores are through the one becoming a lazy bone or staying sited or in a bed for the whole day. This largely reduces the blood supply to the areas which are over worked causing the skin tissues in that area to die (Miller, 2009). The other major issue that can lead to the development of the skin ulcer is eating too much that leads to the heavy weight. This largely increases the possibility of the one getting the problem of pressure ulcers. For this case, even the lack of eating and becoming underweight may concurrently lead to the one getting the bad scores which are mostly formed when the tissues die. The lLack of motion and staying in one place for a long duration of time can lead to the one forming these very dangerous ulcers (Miller, 2009). If the supportive muscles are not able to support the body they can in most cases lead to the formation of pressure ulcers. When there is the lack of sense of feeling in an area of the body, this is also a significant cause that causes these ulcers. Therefore, every person is inevitable to form these ulcers when he/she is open to the causes of ulcers. For that case, one has to take measures that will reduce the risk of attaining this disease. This calamity occurs in the stages that require the one to check on them on a daily basis if the one is in line of getting these ulcers.
In this case, the procedure that one should follow so as to harbor the formation of ulcer is the following. This is through keeping fit and maintaining the best position in physical fitness. Physical fitness in the person’s body will largely reduce the probability of the one getting the pressure ulcer. This will be achieved through exercising the body daily and feeding with the favorable diet that will not cause the effect to the body structure. An exercise is a tool that reduces the effect of getting various deformities in the body. Therefore, one should frequently exercise. The exercise also leads to the better blood flow that enables the body to stay fit leading to the better ways through which this disaster can be stopped or reduced.
The other way to reduce the formation of bad scores in the body of a human being is through the engagement of the person in the self-care activities. That will enable the person to stop the formation of pressure ulcers in the body of any person. This will be done through the assessment of the body by a caretaker from top to bottom of the body. One must pay more attention to the areas that the ulcers are prone to form. These ones are in the knees, hips, spines, elbows, shoulders and the back of the head and mostly on ears (Miller, 2009). Therefore, when the assessment is done , and there are some symptoms of ulcer’s formation seen, one should see a doctor for the immediate treatment of the disease. The symptoms that are extremely prone to the person with the ulcer are hard skin, bruises on the skin, high temperature in the skin of the person and the skin reddening. When these symptoms are found, the case should be reported to the doctor immediately for the person to receive the required medical attention.
The measures that can be applied by the person in order to reduce the effect of getting these bad scores is to wash the body with soft materials that will not scrub he body forming bruises (Miller, 2009). The use of deodorants that keep the body at ease will also keep the body free from bad scores which may be formed by the use of the oil that does not soften the body. For women, they should wash underneath their breasts so as to reduce the risk of forming bruises. This will reduce the friction that is caused by the breasts and the body. The proper use of oil will reduce the friction, therefore, reducing the probability of causing pressure ulcers in the body surfaces. They are inevitable to getting the bruises due to friction. Therefore, the proper cleaning and drying measures should be undertaken so as to reduce the effects and factors that cause bad scores in the body of human beings.
The other factor that can lead to the formation of ulcer is the lack of health eating. One is supposed to take water and enough calories in order to live a healthy life (Mannheim, 2008). Therefore, one is supposed to ensure that he/she takes enough calories and enough water that can keep the body of the person healthy, hence, reducing the probability of one getting the bad scores.
One should take major precautions from the clothes worn because they might lead to the formation of pressure ulcers in your body. Therefore if one wears tight clothes one can have a high probability of forming these ulcers. These are caused due to the lack of blood from reaching major skin tissues that might lead to the death of some and frictions to others leading to the formation of scalds. They are mainly very dangerous and can lead to pressure ulcers (Mannheim, 2008). During the processes of the one taking a short or long cell one should ensure that the surfaces are well cleaned and well dried so that the formation of bruises in the areas can be reduced in order to reduce the possibility of obtaining the bad scores. Therefore, one might consult the doctor in case the one is affected by the problem so that the doctor can explain more on the use of creams in order to protect the skin from getting these ulcers.
The body must be free from any stress and pressures from any factors such as tight clothes. This will enable the one to harbor the formation of ulcers. For the persons who use wheel chairs they should ensure that they are using wheel chairs which are highly comfortable for them to reduce the probability of getting the disease (Mannheim, 2008). On the other hand, the person must keep fit, and if he/she is prevalent to increasing in weight, he or she must ensure that the wheel chair is still comfortable for him/ her to keep the body at the relaxed state. The cushions that are sat on the wheel chair should be comfortable to sit on to reduce the risk that the friction can do to the body of any person.
For the person who is sleeping in a bed one must ensure that all the factors that cause pressure on the body while the one is being asleep are prevented and kept off. Thus, they can ensure that there are no main harms causing these pressure ulcers (Mannheim, 2008). But the changing of position in the bed will also improve some strategies to fight the formation of these ulcers. For this matter, the one should keep the body fitness high through the food that one takes and improve the ways of staying in one position for a long time. Ensure you exercise the body so as to prevent the factors that are driven through a poor body structure such as overweight.
Course of Actions Selected with the Rationale
When determining the measures of preventing the pressure ulcers, various actions are recommended along with the rationale behind those actions. These actions are carried out as a way of assessing the risks of developing pressure ulcers.
Patient Centered Care
This care provides patients with the required guidelines that are to be referenced whenever carrying out a care procedure. All patients are informed of the guidelines related to the prevention. The patients and maybe their families are normally involved into making decisions regarding the care of the pressure area. This also includes making the decision about the involvement of devices to prevent the pressure ulcers. The rationale or the basis for this kind of action is that patients ought to be informed about the risks accompanying pressure ulcers especially at hospitals. The patients have to participate in the process of making decisions especially when planning the prevention measures, while implementing them and finally evaluating the care to ensure the accurate measures taken (Kimpton, 2011).
It is recommended that for every care procedure episode of the patient, the adults are expected to undergo a mandatory structured risk assessment. This involves carrying out the skin evaluation through combining both the skin bundle as well as the Braden assessment. This should be carried out within four hours in which the patient has been admitted to the hospital. The admission assessment comprises of risk as well as skin assessment. Risk assessment evaluates the risk the patient has of developing ulcers while the skin assessment is done to detect whether there is any pressure ulcer existing. The rationale for this kind of action is to identify the risk factors of every individual patient and to implement and finally to outline the preventive measures of each patient (Kimpton, 2011).
In this assessment area, patients that are discovered to be prone to developing pressure ulcers are initiated into a prevention plan immediately. The rationale is to include details that indicate the equipment that will be supplied; for instance, foot protectors and patient advice in the prevention plan. It is recommended that the documentation of all formal assessment of risks to be done and exposed to members related to the multidisciplinary team. The rationale is to ensure a record of how the patient is progressing to keep for the purposes of accountability, risk management, responsibility and evaluation. In case these records are not updated accurately, it is viewed as a breach of the nurse’s care duty (Rycroft-Malone, 2001).
This is done whenever the patient is admitted or discharged and even when the patient is on transfer. The reassessment of the same is required daily for the patient to be admitted and also on those patients visiting the community as well as those the condition of which has changed while on the caseload. The action recommended is that the anti-embolic hosiery has to be removed at least daily or during every visit to the clinic. The patient whose skin is dark undergoes a special treatment to uncover the erythematic. It is normally darker than the skin. A skin tolerance test should be carried out. It involves lightly pressing a finger onto the turning point of the patient. The expected reaction of the skin is to turn white prior to returning the normal skin color. The rationale is that the skin assessment is a basis for preventing pressure ulcers. It also allows an early detection of the pressure damage. Any delay of color returns on the skin tolerance testing. This is an indication of damage of the micro-circulation (Kimpton, 2011).
Reporting of the Pressure Damage
The local reporting system for a clinical incident is adopted. Any grade 3 or 4 of the ulcer is investigated through the incorporation of a Root Cause Analysis system. The rationale is to identify any improvements that may be required when delivering the services. This is done by nurses (Rycroft-Malone, 2001).
Diminishing Extrinsic Risk Factors
These include pressure, friction, moisture lesions and shearing. The factors have to be removed through utilizing the skin care procedures or appropriate equipments. The rationale is that pressure causes the capillary occlusion while shearing occurs when patients are dragged up a chair or a bed or a slide down. Friction is caused by mechanical forces or poor handling of items. Moisture changes the skin Ph (Kimpton, 2011).
Analysis of Intrinsic Factors
They include the acute illness, the level of consciousness, the reduced mobility, medication, age extremes, dehydration ,vascular diseases and surgical intervention. Pressure ulcers can be caused by pyrexia, which increases the metabolic rates. The reduced ability to move can lead to the prolonged pressure which is can later cause pressure ulcers. Steroids or hypnotics could also cause them. The advancement of age is a major contributor to this disease due to the breakdown in the system functionality (Kimpton, 2011).
This should be adopted on the basis of a risk status of the patient. The rationale is that during the early stage of fighting with the damage, pressure reducing mattresses can be used. All those patients that have developed the same should access the pressure relieving surfaces, for instance cushions or mattresses. The rationale of this action is to outline the equipments that are supposed to be administered to specific patients. Equipments like the water filled gloves or foam filled overlays are not supposed to be used (Malone, 2001).
According to Krapfl and Gray (2011), when the patients are positioned well, the pressure prolonging on the bony parts is reduced. This also prevents the bony areas from contacting, hence, reducing friction as well as the shear damage. The devices that are handled manually have to be correctly used so as to minimize the friction damage. In case the heels troughs are unavailable, a pillow can be used instead. The rationale for this action is to minimize restlessness that normally causes blistering. The rationale is to avoid positioning patients or other individuals on the bony prominences. They are potentially sited for the development of pressure ulcers.
The assessment is done if a patient is found to be prone to developing pressure ulcers. It is recommended that a recognized tool be used to assess, for instance, MUST. The rationale is that a link exists between a poor nutrition and the occurrence of pressure ulcers. The support should be given for those patients with a nutritional deficiency. The good nutrition is essential for maintaining a skin function and preventing the pressure damage. Proteins are recommended for the purposes of cells’ metabolism (Kimpton, 2011).
According to Kimpton (2011), this is done to the staffs that are involved in taking risk and skin and all other types of assessment. It is recommended that they be competent and have received an adequate training regarding the management and prevention of ulcers. The training involves making them aware of the risk assessment of the tools’ limitation. They are supposed to use their professional judgment adequately. The rationale of this action is that the risk assessment tools can be confusing at times. Also, they need to have the appropriate knowledge to carry out their role. The staffs are required to have the proper knowledge when it comes to grading the pressure ulcers through the incorporation of EPUAP classification systems. The rationale is to assess the extent of the tissue damage accurately using the system being put in place. They are also expected to escalate their knowledge in the area related to clinics. The rationale is to improve their practice in clinical areas as well as raise awareness in the same areas (Kimpton, 2011).
Prevention of Pressure Ulcers
To implement a successful initiative on the ulcer prevention on a sustained basis, the hospital organization needs to address the changes based on the management, best practices in the pressure ulcer prevention on what should be used. Preventing the pressure ulcer can be a nursing intensive though the challenges being more difficult when there is the staff turned over and the shortages. The study has shown that the pressure ulcer prevention can be effective in all hospital set ups. The pressure ulcer prevention consists of the preventive intervention stratified at the risk level, with the implementation of a support protocol and turning of residents (Taylor et al., 2005).
Quality Improvement Models
The implantation strategies plan is examined on the effects and solutions program, which focus on the pressure ulcer prevention measures. The alleviating of the risk factor is identified in the two long term care facilities. The performance of a systematic risk assessment is upon the admission, accurate staging pressure ulcers, using pressure reducing mattresses and the continuation of education of staff. The implementation of quality care improvement models reduces the overall pressure of the ulcer incidence (Bolton, 2010). A nursing department should care of patients with a high quality procedure and best practices on the prevention side. Nursing home is based on the quality care whereby the incidence has the greatest improvement in the quality indicator scores in the low pressure ulcer than in the facilities with the least improvement in the quality indicator.
The care plan should give a specific example of the actions that should be performed and address the patients’ needs. Pressure ulcers remain a significant health problem affecting the approximately three million people in the world (Taylor et al., 2010). The pressure ulcers are costly in preventing them. Therefore, it should be a nursing concern as clinicians think that the pressure ulcers’ development is not the fault of the nursing care but a failure of the entire health care system. It is believed that it is a breakdown in the corporation and skills of the entire health care system which consists of nurses, physicians, among others. Before the beginning of the quality improvement, one needs to understand the current methods.
The implementation team identifies and defines the steps on the current process for the pressure ulcer’s implementation (Bolton, 2010). The significant measures and efforts have gone in to getting hospital to the point of an implementation plan. The best practices aimed at preventing of ulcer pressure are implemented. This is because the changes have made the patients at hospitals develop better outcomes and fewer pressure ulcers are developing. These measures are a principal achievement for the implementation team of the hospital management; thus, every one should be congratulated on the collective effort.
Leadership Management Theories
The legal and ethical issues are extremely essential in considering the best practices on the implantation strategies of pressure ulcers plan. For example, the theory of informed consents on the area of all the nurses, they must be familiar with all the patients’ concern. There should be a legal principle that governs the patients’ ability to accept or reject the medical interventions in the treatment protocol (Bolton, 2010). The informed consent can only be obtained before the procedure commences after the potential risk explained to participants. According to the ethical practices, the evidence based practice, the Institutional Review Boards have to review research projects to assess that the ethical standard have been followed. This board is responsible in protecting the subjects from the risks and losses of the personal rights and dignity. All the nurses in the prevention and implementation of the plan in pressure ulcers must notify the institutional review board of the ethical and legal violations (Taylor et al., 2010).
It is necessary to be up to date on all the appropriate state laws and regulations regarding the pressure ulcers patients being the most vulnerable. This may be based on the consulting the lawyers or the clinicians in the Institutional Review Board (Lo-Biondo-Wood & Haber, 2009). The implementation plan should achieve the professional status based on nursing as a profession which is highly important because it reflects the value in the society’s places and working areas. The personal commitment and identification to the nursing profession should be strong. In accordance to this, the workers should be trained on the ethics, beliefs, and values of the occupation. On the same, they should be monitored, yet the ultimate accountability should rest with employees in their working stations. The commitment is not strong in this case; thus, individual changes are always on board (Lo-Biondo-Wood & Haber, 2009).
Evaluation and Outcomes
The nursing practice protocol on the pressure ulcer prevention should be based on the early recognition in the development of skin changes. The nurse identifies the outcomes which are culturally appropriate and realistic to the patients present and the potential as well as capabilities. In patients, the skin tends to remain intact thus the pressure ulcers will be healed. Nurses in this case will accurately undertake the measures on the pressure ulcers and assess the risk using the standardized tool. On the same, they will implement the procedure followed and the prevention protocols for all the patients being at risk in the pressure ulcers (Taylor et al., 2010). This procedure will assist the early detection of the pressure ulcer among patients. Measures are the principal achievement for the implementation team of the hospital management; thus, every one should be congratulated for collective efforts.
The parameters that can be accepted as the evidence that the problem has been solved are based on the institution, the reduction help in the development of the new pressure ulcers, whereby the number of the increased in risk assessment is performed. The outcome and evaluation of the pressure ulcers will be based on the cost effective of the prevention interventions and the protocols development. On implementing the strategies for pressure ulcers, the evaluation and expected outcomes shows that there will be no skin tears. This will occur at the risk patients and tears that develop will heal (Bolton, 2010). On the same, monitoring and evaluation of the condition should be reassessed for the new skin tears in the aged and adults on further measures. The nursing care strategies and interventions should be practiced to maintain the prevention of skin tears by on implanting prevention protocol for patients who are vulnerable and at risk.
The prevention of pressure ulcers is based on the quality care for patients. The goals of the healing protocol are under weighed on the development of the pressure ulcer on the prevention and infection said to be paramount. The trials based on the randomized control procedure are needed to determine the management and planned strategies on the implementation which depends on the stages of the illness. Nurses are always on the side of protecting and safeguarding the patient from pressure ulcers. The additional nursing research is needed to determine the effective methods in classifying the pressure ulcer with the good reliability. The study has shown that the pressure ulcer prevention can be effective in all the hospital set ups. The optimal solution for preventing pressure ulcer and cleansing should be researched to get the correct frequencies determination of the optimal method for removing devitalized tissues among patients. The quality standard measures should be improved in all nursing departments to take care of patients with the high quality procedure and best practices on the prevention side.