Intoduction to Pressure ulcers

Pressure ulcers also named as decubitus ulcers or bedsores are basically regarded as localized injuries that affect the skin and underlying tissue over a bony prominence due to pressure with a combination of shear and friction. They are mostly found in sacrum, heel, coccyx and hips (Pressure ulcers - what to ask your doctor, 2013). Other than this, they also affect the elbows, ankles, knee or even back of cranium. These ulcers are often found to be treatable if detected at an early stage. However, they can be difficult to treat in critically ill patients along with frail elders that are wheelchair users especially in cases where spine injury is involved (Veredas, Mesa and Morente, 2009). High treatment issues are also found in individuals who are immobile and also have a maximum probability of developing the pressure ulcers. From the statistical data released in recent years, out of 1.5 million nursing home residents, about 1, 59, 000 suffered from the problem of pressure ulcers at any stage. Stage 2 ulcer is considered to be most common that accounts for nearly 50 percent of all pressure ulcers.

Among them only 35 percent received a special wound care service that is in accordance with the practices mentioned in the clinical guidelines. These kinds of ulcers are a very serious practice and a common medical ailment in nursing homes (Verelst, Jacques and et.al., 2012). It is also a critical public health problem as it poses a financial burden on the health care system and also deteriorates the overall quality of physical life of patient as well as the care givers. Hence there is a need to identify the best practices that are involved in prevention and treatment of pressure ulcer. The given essay revolves around the topic of pressure ulcer. It would start with description about pressure ulcer, the underlying issues involved followed by suggestion of prevention and treatment measure for the same (Cork, 2007). The essay would end with a concluding paragraph which is a summary of key points mentioned in the paragraphs along with identification of best practice in prevention and treatment of pressure ulcer.

A pressure ulcer is considered as a damage that occurs on the skin as well as underlying tissue. It is basically caused by three main things i.e. pressure which is the weight of body that presses down on the skin. Second reason is sheer, when the layers of skin are forced to slide over each other especially when transferring individuals to and fro the wheel chair. Thirdly there is a presence of friction which happens when rubbing of skin is involved. Various signs and symptoms are associated with formation of pressure ulcers. First sign happens when the skin of the ulcer area gets discolored. It may get worse progressively that might finally lead to an open wound development (Williams, 2011). Any individual is prone towards the progress of pressure ulcer but some have more chances for development as compared to others. This is inclusive of the people who face problems in moving and changing positions without any help; critically ill patients and those undergoing surgery. It is also prevalent in those individuals that have a past history of ulcers, poor dietary regimes, older people with damaged spinal cord who cannot move or feel their bottom and legs etc (Huang, Chen and Xu, 2013). In this respect, the key to prevention is that the healthcare professional must assess if the individual is at any risk of ulcer development. This would involve for the healthcare professional to ask questions followed by examination of body to check the possible signs of ulcers.

The prevention of pressure ulcers is a must as it is found to develop quickly in some individuals who are unable to move for a short while of time sometimes even within an hour. In absence of sufficient care pressure ulcer can sometimes become a serious problem. The ulcers can not only damage the skin, underlying issue but can also spread to other areas as well thereby making the treatment a difficult task. They also take a long time to heal and sometimes can become life threatening. At times, they also lead to blood poisoning or infections in bone which results in further bodily ailments (Sussman and Jensen, 2007).

In order to prevent the pressure ulcer, many measures are suggested. It can be reduced by relieving the pressure on areas that are vulnerable to ulcers. In this respect, the major step is caring for intact or normal skin in the best possible manner. This involves for washing the skin with warm water and a mild soap so as to reduce any irritation and dryness that is observed in the body  (Pressure ulcers - what to ask your doctor, 2013). A lotion should always be applied on body for avoiding the drying out of skin. Along with this, the clothes and bed sheet must always be kept dry by protecting the skin from sweat and urine. It is essential to check the skin on an everyday basis. In major cases the inspection should be closer at bony areas for checking of redness and any change in temperature (Arao, Shimada, Hagisawa and Ferguson, 2013). Gentle massaging of intact skin is essential as it helps in the process of circulation and provides comfort. However, it must be remembered to avoid massaging of bony areas.

Another suggested step for preventing the pressure ulcers is moving around as well as changing places in the maximum possible manner. This is a key to prevention, but if pressure ulcers are already present in the body then they can further be avoided by lying or sitting on the ulcer position (Spetz, Brown, Aydin and Donaldson, 2013). Moreover, correct sitting and lying positions must also be practiced. Along with this the time interval in which moving, bending to be carried out should also be decided. The legs ought to be supported in a manner so that they provide for a good posture in addition to proper decision about the equipments to aid in the process of moving is also required to be fixed. The position must be changed frequently to aid in the process of treatment and avoid further damage (Moyet, 2009). Above all, whatever method and time interval is chosen for moving and positioning must be fixed on basis of the comfort of patient so as to avoid the development of other ailments in form of body aches etc.

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According to many physicians, one of the primary causes of pressure ulcer is the presence of high pressure areas in the body which are usually present over bony prominences. In this respect the second measure for prevention is via usage of mattresses and cushions. They play a key role to reduce the pressure on bony parts thereby helping in prevention of pressure ulcers. The choice of pressure-relieving supports which is best for a particular type depends on the body type, requirement as well as complexity of condition. There is always a need to take combined decision that involves the patient; his/her care giver and healthcare team (Rueda, 2013).

There should be continuous process of reexamination followed by frequent talks to find out whether there has been a change in needs or is there any need for another support system that would serve better purpose. In order to prevent the eruptions and possible spread of existing spread there should be access to different types of mattress and cushions during days and nights. If an individual has an increased risk of getting grade 1 or 2 pressure ulcer then high specification foam mattress is suggested (Aziz and Flemming, 2012). They have a special mattress mould and contours that help in the process of relieving the pressure and stop the development of ulcers. In case of grade 3 or 4 pressure ulcers, it is suggested to use a foam mattress of a high specification. For example, there can be a usage of more sophisticated mattress with a continuous low or alternating pressure system is advisable (Langer, Knerr, and et.al., 2008).

When an individual is bed ridden due to some bodily ailments then special precaution is required to prevent the formation of pressure ulcers. In this respect, there should be usage of foam mattress that is filled in gel or air. Pads can be placed under bottom to absorb the wetness so as to keep the skin dry. Soft pillow can also be used between parts of body that press against each other (Veredas, Mesa and Morente, 2009). In order to prevent the development of pressure ulcer, the skin must be assessed regularly for checking the signs for pressure ulcer development. The time interval in skin assessment depends on level of risk for pressure ulcer and the general health condition of body. The assessment of skin is a good measure for prevention in suspected individual. It involves for checking for the presence of red patches, bluish/purplish patches, blisters, swelling and patches for cool, hot, hard or damaged skin (Moore and Cowman, 2011).

Along with all the above measures to prevent the formation of pressure ulcers, the need is to undertake means for self care. In this regards, it is important to move and change position by the individual himself or herself. A patient who has ulcers on seating surface should avoid sitting or limited sitting should be practiced. Unfortunately, the alternative solution to sitting happens to be bed rest (McInnes, Jammali-Blasi and et.al., 2011).  In such a situation, it is suggested to manage pressure and friction throughout the daily activities of patient so as to avoid the complications associated with bed rest.

Consulting a heath care professional can also suggest as to how weight can be redistributed in the body. In case of individuals, who are immobile due to presence of physical ailments, the movement can be ensured by taking the help of other individuals. An inspection of one’s own skin can also be carried out on a regular basis so as to check for signs and symptoms related to pressure ulcers. Mirror can be used to check for places like bottom or heels. In case of possible signs for damage, there should be consultation with healthcare team on an immediate basis (Garrow, 2012). In situations of potential presence of ulcer, further preventive measures are required so as to stop its further development. The underlying cause behind progress of ulcer should be understood and written down in notes. A record sheet should also be maintained so as to pinpoint the location, size and overall texture to analyze the possible depth (Spetz, Brown, Aydin and Donaldson, 2013). Photographs or tracing can be utilized to help in further prevention of pressure ulcers. Other features for example, discoloration, swelling and redness, heat and odor, pain can also be analyzed to stop its further development and aid in the process of prevention (Preventing and Caring for Pressure Ulcers, 2012). All the given set of information would aid the healthcare professional in finding out the best practice in prevention and treatment of pressure ulcer.

In order to avoid the development of pressure ulcers at any stage of life, it is essential to eat well and drink water in enough quantities. This is a must in cases where individuals are at a risk of developing pressure ulcers, have a past history or the present condition is likely to get worsen in coming times (Huang, Chen and Xu, 2013). It is also a known fact that proper identification as well as correction of dehydration is a must to undertake the process of optimized healing. Fluids are usually lost from the body via exudation wounds. It may also involve for emesis, large urinary outputs, and topical negative pressure therapy. All this in many cases may decrease the thirst response which may further worsen due to absence of replacement of fluid losses (Arao, Shimada, Hagisawa and Ferguson, 2013). The daily dietary regimes must be discussed with healthcare professional for suggestions of possible improvements (Preventing pressure ulcers, 2013). If a lack of nutrient is observed then, supplement can be taken accordingly. A dietician can also be referred to for receiving a specialist advice. The suggested dietary regime would depend on the missing nutrient in diet, general health status if high risk individuals, preferences and opinions given by experts.

Other than the suggested preventive measures, various means can be suggested to treat the ulcers for aiding in the process of faster healing and avoiding the possible chances for spread. The treatment regime is inclusive of dressings, removal of damaged skin, medications and other measures. The given treatment measures are likely to aid in killing of bacteria and helping the wound towards the process of quicker healing. This would require the assistance of a trained health care professional for deciding the best treatment for pressure ulcer (Pressure ulcers - what to ask your doctor, 2013).

NICE recommends the usage of modern dressings to treat the pressure ulcers and assist in the process of quick healing. Various modes of dressing can be utilized in this regard. Hydrocolloid dressings are adhesive in nature that gels over the wound and sticks to surrounding skin. Hydro gels are simplest form of gel that helps in keeping the skin moist and also cleanse the wounds. The foams are also available in different shapes and sizes, and are designed to absorb and retain the fluid (Skin (pressure) sores, 2011). It will be advantageous to use the modern dressing in place of basic ones inclusive of paraffin gauze, normal gauze and simple dressing pads. Other treatment measures inclusive of electric stimulation (use of electric current to promote healing), negative pressure therapy (usage of suction on wound) can also be utilized (Arao, Shimada, Hagisawa and Ferguson, 2013).

In some cases there may be a requirement to remove the damaged skin which also includes dead tissue from the ulcer so as to encourage the healing process (Taking Care of Pressure Sores, 2013). The given treatment is named as debridement. In this case, there may be a usage of dressing or cutting of dead areas of tissue. The advantage of this method is that it can be easily carried out in homes or via a GP’s surgery (General Practitioner). In situations where ulcer is very deep or has a presence of a lot of dead tissue ought to be operated in a hospital followed by cleaning of wound if needed (McInnes, Jammali-Blasi and et.al., 2011).   The cleaning process would certainly help the wounds to be kept clean and minimize the chances if infection. If the ulcer is in stage one and then it must be gently washed with water and mild soap. However, the open sores must be cleaned with salt water whenever the dressing is changed.

However, there are chances that even with the best treatment measure, the pressure ulcers may not heal. In that scenario, it is advisable to undergo a surgery process for closing the wound. In this respect, the comfort and preferences of patients must also be taken into account. Moreover, communicating the progress of patient is also essential. This involves for helping the nurse keep a log of how the pressure ulcer is healing (Physical Therapist's Guide to Pressure Ulcer (Bed Sore), 2013). The process of healing usually involves for the ulcer getting smaller, development of healthy tissue and less drainage from skin. There can also be usage of a special form like Pressure Ulcer Scale for Healing or PUSH tool so as to keep track of changes related to progress or deterioration of ulcer. The copies of similar tool must also be provided for use in home treatment (Langer, Knerr, and et.al., 2008). Other interventions in form of topical or oral antibiotics are also suggested. For the purpose of pain management and relief from muscle spasm, non steroidal anti-inflammatory drugs inclusive of ibuprofen, naproxen, lidocaine, prilocaine, diazepam, baclofen, dantrolene etc. are suggested.

From the above essay, it can be concluded that pressure sores are damaged areas in skin or underlying tissues that happens as a result of constant pressure and friction. It can develop in anyone but older people who are mostly confined to bed have an increased chance of pressure ulcer development leading to serious complications.  Prevention and treatment of pressure ulcers is not a difficult issue but requires the individuals as well as the care givers to be aware about the condition at an early stage so as to cause an effective cure without any further advancement in the disease (Pressure ulcers - what to ask your doctor, 2013). In this regard, the best practice requires the combination of efforts from the patient, care givers as well as the health care professionals.

Above all, whatever method has been selected for treatment must take care the physical condition and the need of patient. In this respect, the best practice for prevention is self care. This should be inclusive of self inspection of skin in case of increased risk. It involves for checking the presence of patches, blisters, swelling etc. There is also a requirement to follow a healthy diet regime which is supplemented with fluid intake. The diet must be full of calories, fluid, proteins etc. Prevention is also possible when there is a usage of risk assessment scale which is inclusive of factors like diet, mobility, continence level, consciousness, presence of underlying illness etc (Spetz, Brown, Aydin and Donaldson, 2013). It is also required that the Health care professionals use their clinical judgment so as to consult the patient when recommending the possible practices for treatment and prevention. This is based on an underlying aim for bringing a reduction personal, social, physical as well as financial impact that happens due to development of pressure ulcers. Moreover, the decision making process with respect to prevention and treatment of pressure ulcers must be based in consulting the patient and their care givers (McInnes, Jammali-Blasi and et.al., 2011). Above all there is also a requirement to ensure commitment from all the persons that are involved in prevention and treatment of pressure ulcers to help on cure (Preventing and Caring for Pressure Ulcers, 2012).

REFERENCES

  • Arao, H., Shimada, T., Hagisawa, S., and Ferguson, P. M., 2013. Morphological characteristics of the human skin over posterior aspect of heel in the context of pressure ulcer development. J Tissue Viability.
  • Aziz, Z., and Flemming, K., 2012. Electromagnetic therapy for treating pressure ulcers. Cochrane Database of Systematic Reviews. 12.
  • Baranoski, S., and Ayello, E. A., 2008. Wound Care Essentials. Lippincott Williams & Wilkins.
  • Cork, R., 2007. XSENSOR technology: a pressure imaging overview. Sensor Review. 27(1). pp.24 – 28
  • Cox, J., 2013. Pressure ulcer development and vasopressor agents in adult critical care patients: a literature review. Ostomy Wound Management.  
  • Garrow, V., 2012. Mobilizing for rapid change. Strategic HR Review. 11(5).
  • Huang, H.Y., Chen, H.L., and Xu, X.J., 2013. Pressure-redistribution Surfaces for Prevention of Surgery-related Pressure Ulcers: A Meta-Analysis. 59(4).
  • McInnes, E., Jammali-Blasi, A., and et.al., 2011. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. 4.
  • Moore, Z. E. H., and Cowman, S., 2011. Wound cleansing for pressure ulcers. Cochrane Database of Systematic Reviews. 3.
  •  Moyet, L. C., 2009. Nursing care plans & documentation. Lippincott Williams & Wilkins.
  • Sussman, C., and Jensen, B. M., 2007. Wound care: a collaborative practice manual. Lippincott Williams & Wilkins.
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