Prevention of Pressure Ulcer - Essay Example

Running Head: Nursing – Prevention of Pressure Ulcer Nursing – Prevention of Pressure Ulcer of the Nursing – Prevention of Pressure Ulcer Introduction As far as the profession of nursing is concerned, there are various aspects and considerations related to its responsibilities. There are various subjects in relation to the duties of a nurse as per the different fields of nursing. Some nurses have to attend mental patients while others have to attend patients in the maternity ward or the general ward. So, there are various topics related to the work and placement of a nurse varying from department to department. However, there are some topics that have wider implications and serious challenges related to them. Prevention of pressure ulcer can be considered as such a topic which is concerned with multiple specialties. Reason behind the choice of topic: A pressure ulcer is a skin area that that would break down as the patient stays in a constant position for too long. Since there is no shift of body weight in certain cases of maladies, irregularity in blood supply may take place in the area of the body under pressure leading to pressure ulcer (Bluestein & Javaheri, 2008). Pressure ulcer (also called bedsore or decubitus ulcer) can be seen in a variety of patients. From patients who have diabetes to those who have Alzheimer’s disease, pressure ulcers may be diagnosed. Therefore, while discussing pressure ulcers, there is a scope to discuss its occurrence in relation with a variety of diseases. Moreover, today in the urban society, hospitals are coming across increased number of accident cases (particularly, the road accidents). Pressure ulcers are often found in patients who have serious problems in mobility, especially due to various accidents. The problem is thus becoming comparatively common and deserves attention in the field of nursing. How the topic relates to the workplace: As a nurse in a nursing home or hospital, adequate knowledge of pressure ulcers may prove to be a basic requirement in the case of caring older adults and accident victims in particular. “Part of a nurse’s work is to assist patients with their physical, spiritual, and social needs if patients are unable to satisfy these needs on their own. Hygiene and skin condition, including nutritional balance, are significant factors in preventing pressure ulcers” (Romanelli et al, 2006). In today’s urban society, increased number of older adults with impaired mobility is leading to larger number of patients with pressure ulcers. Moreover, accident victims too may face the problem of these ulcers in the course of long treatment. Preventing pressure ulcers thus becomes one of the most important responsibilities of any nurse (Miller, 2008). In the workplace like a nursing home, pressure ulcer becomes a topic of major consideration in the contemporary health environment. Search Strategy Looking through the medical science and health related publications from the reputed publishing houses like Elsevier Health Sciences, Lippincott Williams & Wilkins, Francis and Taylor and Springer can be helpful. Resources like Mediline Plus, PubMed and SpringerLink can be used to obtain reliable references. Moreover, the libraries and resources from the local medical college can be helpful. Discussion among the colleagues and practical experience in a nursing home or hospital are reliable means to gather information. Discussion on Pressure Ulcer A pressure ulcer is a lesion caused by unrelieved pressure with damage to the underlying tissue (Mauk, 2009). A pressure ulcer may start as reddened skin but it would become progressively worse. It would form a blister, then a sore and then a crater. The most frequent places for pressure ulcers are over the bony prominences like heels, elbows, hips, shoulders, ankles, back of the head and back. The patient may develop these ulcers if she/he is bedridden or in a wheelchair. Having some kind of chronic condition like vascular disease or diabetes (that would prevent an area of body from receiving normal blood supply) may increase the risk of these ulcers. Inability to move certain parts of the patient’s body without assistance can also increase the risk. Patients after brain or spinal injuries may develop such inabilities. Patients having neuromuscular diseases (e.g. multiple sclerosis) can have limitations on movement, thus they may develop pressure ulcers. Also, in conditions of mental disability like Alzheimer’s disease, the patient may be unable to properly treat or prevent pressure ulcers. Moreover, fragile skin, older age and urinary or bowel incontinence too may increase the risk of development of pressure ulcer among the patients (Fonder et al, 2008). Development of pressure sores can be classified by severity. This classification starts at Stage I and culminate at Stage IV. Stage I: Development of a nonblanchable, reddened skin area. Stage II: The affected area would blister to form an open, irritating sore. The area surrounding the sore is likely to be irritated and red. Stage III: The skin would further breakdown and look similar to a crater. The damage is now at the tissue level below the skin. Stage IV: Pressure ulcer becomes deep and now it can damage the bone and the muscle. It can also affect the joints and tendons. (Fonder et al, 2008) “On a hospital ward the separation of domestic duties and nursing duties is not merely a matter of principle; it is a problem of actual management.” (Davies, 1980) Therefore in treating the pressure ulcer, the nurse concerned must be aware of and satisfied with the various activities in relation to the patient. Maintaining hygiene, proper nourishment and nutritional balance is important. Changing the physical position of the patient from time to time is also important. Cleaning the affected areas may prove to be critical and beyond the ability of the patient or her/his relatives and family members. Thus, at this level, “Both historians of nursing have treated the principles of the selective recruitment and training of nurses as having been introduced into hospitals, and as the principles upon which the progress of nursing is based.” (Davies, 1980) Prevention and treatment of pressure ulcer are also no exception to this accepted system. Nurses trained the practical hospital environment will efficiently handle the case of pressure ulcer. The nurse can be helped by real time exposure to the problem in a nursing home or hospital to acquire more knowledge. Hence, the nurse should come forward to relieve the patient, and in the case of relieving pressure ulcers, the job may involve activities like moving the patient for physical exercise, cleaning the affected area, giving proper medicine in time, monitoring and providing proper diet, etc. (Nicol et al, 2008) The recommended treatment program focuses on an assessment of the patient and the pressure ulcer: tissue load management; ulcer care; management of bacterial colonization and infection, and operative repair in selected patients with Stage III and Stage IV pressure ulcers are crucial parts of the treatment program (Bergstrom et al, 2004) Also, educating the patients and the families may prove to be instrumental in the prevention of pressure ulcer. In addition to nursing, consistent care is necessary which can be provided by the family members only. Also, proper education of the families in regards of pressure ulcer would prevent the occurrence of these ulcers particularly in the case of older adults with impaired movement. (Maklebust & Sieggreen, 2001) The complete perspective on this disease is multifaceted and diverse. Regular checking of the patients with high risk of pressure ulcers is mandatory. The high risk patient might be immobile or bedridden due to mental disabilities, incontinence, circulation problems or diabetes. The nurse must examine the whole body of the patient in a regular and careful manner. In the course of treatment, relieving the pressure on the affected area is important. Use of cushions, sheepskin or pillows is suggestible in reducing the pressure. The sore should be treated depending on the stage of the ulcer. Specific care and treatment instructions are required as per the underlying factors of the ulcer under supervision. Further friction or trauma should be avoided. Sheets on the bed should be properly powdered. The underlying problems with respect to the pressure ulcer must be treated. For example in the case of spinal injury, proper exercise should be done and suitable medication should be taken under a specialist doctor. Susceptibility of spinal cord-injured individuals to pressure ulcers is high, and a neurologist should be consulted. Utilisation of micro-electrodes and biocompatible sensors for the skin pO2 measurements can help in treating these ulcers effectively. (Bander et al, 2005) Summary In the context of nursing and prevention of pressure ulcer, the following points are important: 1. The position of the patient should be changed at least in every two hours to relieve continuous pressure. 2. Items like powders, foam padding, sheepskin and pillows should be placed around the person of the patient properly to relieve pressure. 3. The patient must be given well-balanced and healthy meals that would contain enough amounts of calories to keep the patient healthy. 4. Care of diet should be taken particularly in the case of diabetic patients. Blood sugar levels must be checked in regular intervals. 5. The patient must drink plenty of water and must also exercise regularly, including range-of-motion activities particularly in the immobile cases. 6. Special neuro-psychological care should be taken of the patients who have got spinal or brain injuries. 7. The skin should be kept dry and clean. The area of the ulcer should not be massaged. 8. After the patient urinates or has a movement of bowel, the area should be dried and cleaned. 9. Foul odour from the pressure ulcer, tenderness and redness around it and swollen and warm skin close to it can indicate occurrence of infection. 10. Confusion, weakness and fever are the signs that the infection might have spread to blood or other areas of the body of the patient. Conclusion Nursing is a noble profession. It involves consistent training and development. Practical exposure to the various health problems is necessary. The nurse has to have openness towards new challenges and handle the patient with utmost care and compassion (Nicol, 2008). The problem of pressure ulcers presents a testing situation before the nurse. It involves physical strain since the patient needs timely movement and exercise in regular intervals. It also involves complete alertness since the patient’s body is to be thoroughly examined for the ulcers consistently. Above all, the nurse has to be compassionate towards the patient, particularly those who are the elderly ones. Caring for the ulceration at the levels of Stage I and Stage II is very important, because this is from here that the development of Stage III and Stage IV ulcers may commence. The nurse has a greater role to play since mere timely administration of the prescribed medicines is not enough for the treatment of these ulcers. Regular exercise, assistance in physical movements and cleaning of the sores are indispensable. References Bader, D., Bouten, C., Colin, D. & Oomens, C. (2005). Pressure Ulcer Research: Current and Future Perspectives. New York: Springer Bergstrom, N., Allman, R.M. & Bennett, M.A. (2004). Treatment of Pressure Ulcers: Clinical Practice Guideline. Darby: DIANE Publishing Bluestein, D. & Javaheri, A. (2008). Pressure Ulcers: Prevention, Evaluation, and Management. American Family Physician, 78, 1186-1194 Davies, C. (1980). Recruiting Nursing History. London: Taylor and Francis Fonder, M.A., Lazarus, G.S., Cowan, D.A., Aronsen-Cook B., Kohli, A.R. & Mamelak, A.J. (2008). Treating the Chronic Wound: A Practical Approach to the Care of Non Healing Wounds and Wound Care Dressings. Journal of American Academic Dermatology, 58, 185-206 Maklebust, J. & Sieggreen, M. (2001). Pressure Ulcers: Guidelines for Prevention and Management. Philadelphia: Lippincott Williams and Wilkins Maul, K.L. (2009). Gerontological Nursing: Competencies for Care. Sudbury: Jones & Bartlett Learning Miller, C.A. (2008). Nursing for Wellness in Older Adults. Philadelphia: Lippincott Williams and Wilkins Nicol, M., Bavin, C. & Cronin, P. (2008). Essential Nursing Skills. Philadelphia: Elsevier Health Sciences Romanelli, M., Clark, M. & Cherry, G. (2006). Science and Practice of Pressure Ulcer Management. New York: Springer Read More