Pressure Ulcers: Treatment and Prevention Strategies - Essay Example

? PRESSURE ULCERS: TREATMENT AND PREVENTION STRATEGIES and As suggested by Mendez (2004), pressure ulcers result from uninterrupted pressure leading to localized areas of ischemia, tissue inflammation and tissue anoxia. It is a major problem among patients especially those aged over 70 years. As Mendez (2004) observes, the condition occurs usually over bony prominence and areas around the buttocks, and hips. It could occur in lower extremities and corners of the mouth. While the condition happens due to uninterrupted pressure on the skin areas it can also be caused by shear forces and incontinence of urine and stool. The available literature identifies its risk factors as: physiological alterations, diabetes, low tissue oxygen tension, nutritional deficiency, contractures, and paralysis. This annotated bibliography examines the effectiveness of different treatment and prevention strategies used in hospital settings. The available statistics suggest that the condition mainly affects male adults, and 3-10% of the hospitalized population. The risk of pressure ulcer is also high among neurologically impaired patients, and persons disabled by the spinal cord injuries. According to Mendez (2004) prevention is a key component of managing pressure ulcers, and the presentation of this condition occurs in 4 stages starting with erythema and ending with the infection of the underlying bone or muscle. Stage 1 is characterized by the reddening of the skin while in stage 2, the skin blisters form open sores. In the third stage, a crater is formed while in the final stage, the damages extend to the tendons, joints, muscles and bones. Some of the treatment method used include: de-pressurizing of the affected areas, surgical reconstruction, administration of and antibiotics. While treatment of the affected patients should be administered as soon as possible, prevention should be the first priority for the population as risk of this condition. In this regard, patients on bed rest should be checked frequently for pressure sores. Symptoms to watch out for include: red skin, open sores, blisters, foul smells from the ulcers, and swollen skin. For early detection, the caregiver should consider giving the patient a head to toe examination, and should pay close attention to the following areas: buttocks, elbows, hips, heels, ankles, shoulders, and back. For prevention of this condition, persons at risk should change positions once in every 2hours and use appropriate tool to cushion the affected areas. Most importantly, they should eat well balanced meals, drink lots of water, exercise regularly, use creams to protect the skin and keep the skin dry and clean at all times. Reddy, M., Sedeep, S., & Rochon, P. (2006). Preventing pressure ulcers: A systematic review. Journal of the American Medical Association, 296(8), 974-984 This article which is written by competent authors seeks to examine the adverse health outcomes and treatment costs associated with pressusre ulcers. The objective of the article is to review the evidence examining interventions to prevent pressure ulcers. The systematic review utilizes sources from the MEDLINE, EMBASE and CINAHL. All the databases are well known for publishing credible article dealing with different medical condition. The search strategy identified 763 citations, of which 59 randomized control trial were selected. As suggested by Moore and Cowman (2007), systematic review should have elaborate schemes to prevent bias, and maximize precision of the data obtained. At the same time, it should have a detailed exclusion and inclusion criteria, use clear research questions and adequately address the challenge of assessing the methodology quality of the selected studies. If possible, the systematic review should depend on current and credible secondary sources. In this case, of the citations identified, 650 were excluded since they were not randomized clinical trials, while 53 did not have adequate information about the outcome measures. The other articles that were excluded did not have original data, did not use human participants and focused on treatment rather than on prevention. In the end, 59 randomized control trials were used: 51 focused on impaired mobility, 5 targeted impaired nutrition while 3 targeted impaired skin health. While 51 RCTs were used in this study, they failed to provide qualit4y information, and so the results of the entire study become questioned. To illustrate further, the RCTS dealing with impaired mobility, only 14 gave details on how the sample population was selected. In addition, the participants in some of the studies were not blinded, while the sample population in some of the RCTs was very small. Similarly, the RCTS targeting impaired nutrition has significant methodological problems. This is because the participants in the studies were not adequately blinded and beside the population was not randomly selected. Likewise, the 3RCTs dealing with the impaired health skin has weak methodologies as the sample population was not randomly selected. The systematic review established that support overlays are more expensive are less preferred than dynamic support surface mattress. However, the standard hospital mattresses are less effective than specializes in decreasing incidences of pressure ulcers. However, the systematic review did not establish the most appropriate diet in the prevention of pressure ulcers. In regard to the impaired skin health, the study established that using could significantly reduce incidences of skin ulcers. However, the systemic review did not establish which was more cost-effective; specific topical agents or sample moisturizers. The findings of this systematic review could help hospitals and health-care institutions in choosing cost-effective prevention interventions. However, the hospitals would be skeptical of provision patients with specialized foam mattresses as doing so would significantly increase the operating costs. On the downside, the systematic review fails to suggest costs-effective nutritional supplements and oils that could be used by health-care institutions to reduce incidences of pressure ulcers. In view of this, additional research need to be conducted, and future systematic reviews on this issue should incorporate RCTS with stronger methodologies. Smith, M., Totten, A., Hickam, D., Wasson,N., Rahman, B., Motuapuaka, M., & Saha, S. (2008). Pressure ulcer treatment strategies: a systematic comparative effectiveness review. Annals of International Medicine, 159(1), 39-50 This article establishes that nearly three million Americans are affected by pressure ulcers. The systematic review sought to compare the effectiveness of the available treatment methods. The secondary sources used in this systematic review were retrieved from the MEDLINE, EMBASE, CINANHL and other reputable databases. Randomized trials and comparative observational studies were used to compare the available treatment interventions. The methodology used was relatively strong as the sample size in the RCTs was fairly high. The data obtained from the RCTs was evaluated for accuracy and quality of the studies was also examined. In total, 174 studies were included and the systematic review established that air-fluidized beds, protein-containing nutritional supplements radiant heat dressings and electrical stimulation, were effective in the treatment of pressure ulcers. However, the review failed to establish the effectiveness of the alternating-pressure surfaces, and light therapy. While the study, exalts the effective of nutritional diet, the available literature does not conclusively prove its effectiveness the prevention of pressure ulcers. However, the available empirical evidence suggests that use of mineral and vitamin supplements, in the absence of the deficiency could be helpful. Although, this article shows that nutritional supplements could be helpful to pressure ulcer patients, maintaining optimal nutrition continues to be part of the best practice. While the article examines a wide array of different interventions that can be used in a hospital setting, it fails to conclusively determine their effectiveness. As a result, the findings of this study may of little help to the hospital administrators and medical practitioners. The results of the study also create confusion as it does not improve the decision-making process as far as the treatment of persons with pressure ulcers is concerned. The applicability of these results may also be limited to the poor quality of the RCTs used in the study and the inadequate duration to assess the would-healing process. Future research should address these weaknesses, in order to establish strong rather than moderate evidence in the use of air-fluidized beds, protein supplements, radiant-heat dressing and electrical stimulation. Niixon, J., Cranny, G., Iglesias, C., Nelson, A., Hwakins, K., Phillips, A., Tprgeson, D., & Cullum, N. (2006). Randomized controlled trial of alternating pressure mattresses compared with alternating pressure overlays. BMJ, 332: 1413 The authors are credible as they are affiliated with medical-relate institutions, and the objective of the study was to compare the effectiveness of the alternating pressure overlays and alternating pressures. In total 1972 participants were included in the study, and in the end Nixon et al., found no difference between the effectiveness of alternating mattresses and alternating pressure overlays. While the methodology used in this quantitative study is well examined, it failed to conduct blinded outcome assessment. Nixton et al. established that alternating mattresses are more cost-effective than alternating pressure overlays and this outcome should be helpful to the hospital administrators. The researchers further observed that alternating pressure mattresses were associated with a delay in ulcerations than alternating pressure overlays, hence leading to positive outcomes such as shorter hospitalization periods. This outcome could be useful to hospitals dealing with patients with high of developing pressure ulcers. The study further established that the patients are more dissatisfied with overlays that with pressure mattresses, a clear indication that overlays should never be used in hospital setting. To improve future studies, the researchers should minimize potential for biasness and probably the sample size. Reference List Mendez, E. S., 2004. Determining the appropriateness of negative pressure wound therapy for pressure ulcers. Ostomy Wound Manage, 50, 13–6 Moore, Z.E., and Cowman, S., 2007. Wound cleansing for pressure ulcers (Review). The Cochrane Collaboration, 1, 1–16. Niixon, J., Cranny, G., Iglesias, C., Nelson, A., Hwakins, K., Phillips, A., Tprgeson, D., and Cullum, N.,2006. Randomized controlled trial of alternating pressure mattresses compared with alternating pressure overlays. BMJ, 332: 1413 Reddy, M., Sedeep, S., and Rochon, P., 2006. Preventing pressure ulcers: A systematic review. Journal of the American Medical Association, 296(8), 974-984 Smith, M., Totten, A., Hickam, D., Wasson,N., Rahman, B., Motuapuaka, M., and Saha, S.,2008. Pressure ulcer treatment strategies: a systematic comparative effectiveness review. Annals of International Medicine, 159(1), 39-50 Read More