Running head:PRESSURE ULCERS

Nursing 240 Preventing Pressure Ulcers Jessica L. Schultz Ferris State University

PRESSURE ULCERS 2 Nursing 240 Preventing Pressure Ulcers Throughout history pressure ulcers have been documented and researched. They are preventable and yet still exist in the current world of advanced medicine. It is the responsibility of the Nurse and Nursing staff to provide quality care and safety to the patient to maintain skin integrity. History Pressure Ulcers are believed to be one of the number one causes of skin and tissue breakdown, as well as one of the most expensive conditions to treat according to Lynn P. B. (2011). Pressure ulcers have been described as one of the most costly and physically debilitating complications in the 20th century. Pressure ulcers are the third most expensive disorder after cancer and cardiovascular diseases (Agrawal & Chauhan, 2012). The condition has been documented as being found in 5,000 year old mummies. Hippocrates also documented his research on ulcers found on paraplegic patients in 460-370 B.C. (Agrawal & Chauhan, 2012). For a condition to have been present and well known throughout history, it is strange to me the current prevalence of pressure ulcers today. What is a Pressure Ulcer? There are many definitions for the term, pressure ulcer, in existence. Many of them include the same definition in a slightly different format. For example, Agrawal & Chauhan, 2012, define a pressure ulcer as an area of localized soft tissue ischemic necrosis caused by prolonged pressure higher than the capillary pressure with or without shear, related to posture which usually occurs over a bony prominence. Pamela Lynn

PRESSURE ULCERS 3 has a shorter version describing the same state of the pressure ulcer on page 359 of, Taylor's Clinical Nursing Skills: A Nursing Process Approach, as a wound caused by unrelieved pressure that results in damage to underlying tissue. Both definitions mention the cause as pressure that initiates tissue breakdown. Since these pressure ulcers form from pressure it is the responsibility of the nurse and medical faculty to relieve areas of high pressure by rotating/turning the position of the patient frequently to provide safety and maintain skin integrity. Prevention and Care Safety and quality begins at admission to prevent a hospital acquired pressure ulcer as well as to develop a plan of care for an existing ulcer. As a nurse you should be able to asses your high risk patients. These include quadriplegics, paraplegics, bedridden or weak patients, the elderly, those confined to a chair, patients with diabetes, as well as many others. Many things can help cause an ulcer other than pressure alone. Sheering and friction of the skin (from patient moving in bed), excessive moisture (as with incontinent patients, those who sweat excessively, patients with drainage or discharge, or those receiving bed baths), position of the body in comparison to boney prominences, immobility, neurological factors (such as neuropathy), metabolic and nutritional factors, and edema (Agrawal & Chauhan, 2012). The nurse must practice safety by being cautious of the risk factors and level of risk at which their patient might be at. A thorough skin assessment should be done daily

PRESSURE ULCERS 4 on all patients, especially those of high risk. Patients skin should be assessed on each position change. The skin must always remain clean and dry. High risk patients should be turned or position adjusted at least every 2 hours; unless otherwise directed by their primary care provider. If an ulcer is present on the skin the nurse must provide safe quality care by focusing on asepsis and sterile technique during treatment (Lynn, 2011). If the nurse does not maintain a sterile environment when using evidence based practice to perform wound care on the ulcer he/she can do more harm than good. Nursing Theory The central theme of nursing theorist Florence Nightingale, is meeting the personal needs of the patient within the environment (Taylor, 2011). You must meet every need of the patient including the need to change positions and remain dry. As a mobile nurse you may not easily identify this need until you experience the care of a patient with a pressure ulcer. A nurse may be so used to moving freely and naturally they may not identify the importance and need of a patient less mobile to be turned or adjusted in a bed or chair. Meeting general needs of feeling safe, food, proper hydration, hygiene, and good relationships are more easily identifiable as everyone can relate to them. If you have never been immobile it may be hard to understand the needs that are to be met for all around safety and care. Conclusion

PRESSURE ULCERS 5 The importance of becoming familiar with the risks, prevention, and care of a pressure ulcer need to be identified and practiced by each nurse and health care provider. Simple steps from the providers can help prevent devastation, pain, and unnecessary health care costs to the patient. Practicing patient safety and quality care pertaining to each patient encounter can make a world of difference for patients and their families.

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References Agrawal, K., Chauhan, N. (2012 May). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery, 45(2), 244-254. doi: 10.4103/09700358.101287. Lynn, P. B. (2011). Taylor's Clinical Nursing Skills: A Nursing Process Approach. (3rd Ed.) (pp. 359-365). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2011. Print. Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. B., (2011) Fundamentals of Nursing: The Art and Science of Nursing Care. (7th Ed.) (pp. 74-75). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011. Print