This often occurs when the patient or person stays in one position for a long time, such as after surgery or injury. The persistent pressure on that area of the skin reduces the blood supply and the affected tissue can die. First, it turns up as a reddened skin, then a blister, an open sore and, finally, a crater.
Preventing pressure ulcers has been a nursing concern for many years. Although the prevention of pressure ulcers is a multidisciplinary responsibility, nurses play a major role.
Inthe U. Although the AHRQ document was published 15 years ago, it still serves as the foundation for providing preventive pressure ulcer care and a model for other pressure ulcer guidelines developed afterward.
Nurses are encouraged to review these comprehensive guidelines. The document identifies specific processes e. Research also suggests that when the health care providers are functioning as a team, the incidence rates of pressure ulcers can decrease. Incidence, Mortality, and Costs The incidence rates of pressure ulcers vary greatly with the health care settings.
For patients in the hospital, they can occur within the first 2 weeks. Several studies noted mortality rates as high as 60 percent for older persons with pressure ulcers within 1 year of hospital discharge.
Thus, the development of pressure ulcers can be a predictor of mortality. Studies further suggested that the development of skin breakdown postsurgery can lead elders Pressure ulcer paper have major functional impairment post surgical procedure.
It has been estimated that the cost of treating pressure ulcers is 2. Pressure ulcer paper Pressure ulcers develop when capillaries supplying the skin and subcutaneous tissues are compressed enough to impede perfusion, leading ultimately to tissue necrosis.
Sincewe have understood that normal blood pressure within capillaries ranges from 20 to 40mm Hg; 32mm Hg is considered the average. However, capillary blood pressure may be less than 32 mm Hg in critically ill patients due to hemodynamic instability and comorbid conditions; thus, even lower applied pressures may be sufficient to induce ulceration in this group of patients.
Pressure ulcers can develop within 2 to 6 hours. Risk Factors More than risk factors of pressure ulcers have been identified in the literature. Some physiological intrinsic and nonphysiological extrinsic risk factors that may place adults at risk for pressure ulcer development include diabetes mellitus, peripheral vascular disease, cerebral vascular accident, sepsis, and hypotension.
Microcirculation is controlled in part by sympathetic vasoconstrictor impulses from the brain and secretions from localized endothelial cells. Since neural and endothelial control of blood flow is impaired during an illness state, the patient may be more susceptible to ischemic organ damage e.
The few studies that have included sufficient numbers of black people for analysis purposes have found that blacks suffer more severe pressure ulcers than nonblacks. Due to the number of risk factors identified in the literature, nurses have found the use of risk assessment tools helpful adjuncts to aid in the identification of patients who may be at high risk.
Most health care institutions that use pressure ulcer risk assessment tools use either the Braden Scale or Norton Scale, with the Braden scale being the most widely used in the United States.
The Braden Scale is designed for use with adults and consists of 6 subscales: The scores on this scale range from 6 high risk to 23 low riskwith 18 being the cut score for onset of pressure ulcer risk.
Research has shown that hospital nurses could accurately determine pressure ulcer risk The Braden Scale and Norton Scale have been shown to have good sensitivity 83 percent to percent, and 73 percent to 92 percent, respectively and specificity 64 percent to 77 percent, and 61 percent to 94 percent, respectivelybut have poor positive predictive value around 40 percent and 20 percent, respectively.
The net effect of poor positive predictive value means that many patients who will not develop pressure ulcers may receive expensive and unnecessary treatment. Moreover, optimal cutoff scores have not been developed for each care setting e.
Thus, nurses still need to use their clinical judgment in employing preventive pressure ulcer care. Centers for Medicare and Medicaid Services CMS recommends that nurses consider all risk factors independent of the scores obtained on any validated pressure ulcer prediction scales because all factors are not found on any one tool.
Several key characteristics of facilities that were high users emerged: The appropriate interval for routine reassessment remains unclear. Studies by Bergstrom and Braden 4243 found that in a skilled nursing facility, 80 percent of pressure ulcers develop within 2 weeks of admission and 96 percent develop within 3 weeks of admission.
The Institute for Healthcare Improvement has recently recommended that in hospitalized patients, pressure ulcer risk assessment be done every 24 hours 44 rather than the previous suggestion of every 48 hours.
The challenge is more difficult when there is nursing staff turnover and shortages. Studies have suggested that pressure ulcer development can be directly affected by the number of registered nurses and time spent at the bedside.
Given that the cost of treatment has been estimated as 2. A growing level of evidence suggests that pressure ulcer prevention can be effective in all health care settings. One study examined the efficacy of an intensive pressure ulcer prevention protocol to decrease the incidence of ulcers in a bed long-term care facility.
The sample included residents 69 prior to prevention intervention and 63 after prevention intervention. The 6-month incidence rate of pressure ulcers prior to the intensive prevention intervention was 23 percent.Presence of a pressure ulcer: All patients with an existing pressure ulcer should be considered at-risk for an additional ulcer.
Prior Stage III or IV pressure ulcers: When Stage III or IV ulcers close through a process of scar tissue formation and eventual epithelialization, the resulting skin is not normal as it lacks its former tensile strength .
Pressure Ulcer Prevention Evidence Based Practice Tasha Braggs Chamberlain College of Nursing NR Transitions to professional nursing Summer Professional paper. Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific.
Pressure ulcer is commonly termed as bed-sore, decubitus ulcer or pressure sore and sometimes as pressure necrosis or ischemic ulcer.
It was a landmark paper in which Shea classified these ulcers into five categories defined by the anatomic depth of the soft tissue damage. After Shea, the literature has been flooded with classifications.
The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment . Download "Pressure Ulcers" Term Paper ( Words)!
☘ ulcer is a part of the skin, which breaks down from body weight Berman , Ferguson ) This often occurs when the patient or person. Pressure ulcers per federal guidelines comes with a F-Tag according to federal regulations for pressure ulcers entails that residents who become residents and enter a long -term care facility must not develop a pressure ulcer unless it is unavoidable.