Dressing Pressure Ulcers and Adequate Nutrition for Hospitalized Patients - Literature review Example

DRESSING PRESSURE ULCERS AND ADEQUATE NUTRITION FOR HOSPITALIZED PATIENTS] Submitted By: Name Course Lecturer Date Introduction Pressure ulcers and associated nosocomial infections are on the rise in spite of using the guidelines recommended by the Australian Wound Management Association for forecasting and handling pressure ulcers. Moreover, there are several complaints about patients not getting adequate nutrition. A number of patients do not get proper meals and nurses are not adequately preparing them for self-feeding or assisting them to eat. This report will provide findings about current suggestions for dressing pressure ulcers and guidelines that need to be implemented to ensure proper management of the condition. In addition, the report will include an exploration of what is needed in ensuring that hospitalized patients get adequate nutrition as well as factors helping or hindering sufficient nutrition in those patients. It will also include an overview on the impact of socio-economic status and education level of patients and families on wound healing and nutritional status in surgical or medical settings. Search Strategy In looking for the articles relating to both dressing of pressure ulcers and nutritional management issues in hospitalized patients, I searched different databases including EBSCO, ProQuest, PubMed, ScienceDirect, and Serials Solutions. However, different key words were used for each task. The key words used in searching for pressure ulcers’ articles include pressure ulcers, types of dressing, and management of pressure ulcers. Nutrition management’s articles were searched using key words such as nutrition, hospitalized patients, nutrition management, and causes of poor nutrition. Other key words used include wound healing, nutritional status, socio-economic status and education level of patients and families. Findings: Pressure Area Management Pressure ulcers are a major source of morbidity. These wounds stem from persistent pressure on the skin, which cause an inflammatory reaction resulting in systemic disease or bacterial contamination. Although there is a range of treatment methods available for the condition, there has not been a widely established algorithm for treating pressure ulcers. There are several recommendations that have been currently made for pressure ulcers’ dressing. To start with, wound cleansers are considered to play an important role in healing of pressure ulcers. Through the removal of foreign bodies and dead tissue, wound cleansers get the wound ready for dressing. The use of saline spray with silver chloride, decyl glucoside and aloe has also proved to be effective in enhancing ulcer healing (Levine et al. 2013, p.603). Levine et al. (2013, p.604) note that, there is a debate in surgical literature regarding the best form of debridement as a form of dressing. Debridement options include autolytic, biologic, chemical, enzymatic, and mechanical debridement. Autolytic debridement involves the use of natural enzymes to dissolve sloughed wound tissue. Biologic debridement applies sterile maggots or larvae on the wound to eliminate devitalized tissue. Chemical debridement utilizes compounds like sodium hypochlorite to improve wound debridement. Enzymatic debridement involves the use of preparations like collagenase, urea or papain over damaged wound tissue. Lastly, mechanical debridement comprises of several techniques such as dry and wet dressings, whirlpool debridement, and wound cleansing. Moreover, honey has also been used in wound dressing for centuries. The wound healing mechanisms for honey include immunologic modulation, physiologic mediation, and antimicrobial activity. Study has shown honey-soaked wound dressings to be more effective in wound healing than saline-soaked ones (Levine et al. 2013, p.606). According to Lohi, Sipponen, & Jokinen (2010, p.123), there are several treatment modalities for pressure ulcers, and method used is dependent on the ulcer’s nature and grade and comorbidities. Sequential wound dressing using hydrocolloid and calcium alginate has shown to be more effective compared to hydrocolloid treatment only. Moreover, using traditional spruce resin ointment dressing is highly effective in regard to total ulcer healing as well as elimination of bacteria in the wound than treatment using carboxymethylcellulose hydrocolloid polymer. Although honey may form an effective treatment in chosen cases, no randomized controlled trials published on its effectiveness. In addition, biological agents are currently receiving an increasing interest as adjuvant treatments for chronic wounds. Altering nerve, fibroblast and beta-3 growth factors have seemed more effective compared to placebo in the local management of pressure ulcers. They have also been effective in wound closure, accelerating angiogenesis, granulation formation of tissue and collagen deposition (Lohi, Sipponen, & Jokinen 2010, p.125). Rapp, Slomka, & Cron (2010, p.E5) claim that, after the identification of pressure ulcers, most medical facilities use interventions that aim at managing pressure, moisture, nutrition, and relief, such as frequent repositioning, toileting plans, and indwelling catheters. The only type of pressure ulcer dressing recommended by the authors is the application of ointment on the wound bed. Drawing from Simon et al. (2009, p.165), while the early Greeks and Egyptians used honey in wound care, natural unrefined honeys from varied sources are being used across the globe to treat wide range of wounds. Medihoney is among the first clinically certified types of honeys approved as a medicinal product for specialized treatment of wounds in Australia and Europe. Medihoney is effective in the sense that, it is hygroscopic implying it removes moisture from the setting, thus dehydrating bacteria. Moreover, leptospermum spp. honeys exhibit antibacterial activity as verified by proper in vitro analysis methods. Such activity fastens wound healing due to the honey’s anti-inflammatory effects. In addition, honey dressings can be easily changed without pain or harming the regenerating tissue. Alginate dressings are naturally gotten from seaweed, principally brown algae, which contain calcium and sodium salts of alginate acids. After coming into contact with the ulcer, the dressing creates an elastic gel-fibrous coating maintaining a perfect environment for wound healing. The wound exudates are soaked up around the alginate fibres. The patient does not experience any pain during changing of the dressing. During exudates soaking, sodium ions in the exudates are substituted with the dressing’s calcium ions, which facilitate blood coagulation and prevent any likely bleeding. Despite their usefulness’ in wound healing, alginate dressings cannot be used alone; they need to be covered with other types of dressing (Sopata et al. 2012, p.42). Findings: Nutritional Management Nutritional support constitutes an integral component of care of patients in the intensive care units. Nevertheless, feeding continues to receive low priority than other treatments in the ICU. Malnutrition is common among hospitalised patients and nutrition varies widely in ICUs and may be inadequate. Nurses for critical care play an important role in managing enteral feeding. Insufficient knowledge among nurses in relation to enteral feeding has been identified as a significant barrier in ensuring adequate nutrition among patients in the ICUs. Critically sick patients have thorough metabolic responses typified by protein catabolism and hyper metabolism. In this case, adequate nutrition can be realised through the initiation of early, safe, and sufficient enteral feeding by nurses and other health care staff. Moreover, through a comprehensive understanding of practices for nutrition support for critically sick and hospitalised patients, nurses can ensure the delivery of enough nutrition resulting in improved health outcomes (Ros, McNeill, & Bennett 2009, p.2407). According to Bloomfield & Pegram (2012, p.53), dehydration and nutritional deficiencies are linked with increased duration of hospitalization, high mortality risk, and delayed recovery. Thus, it is important for hospitalised patients to receive adequate hydration and nutrition. The role of the nurse is varied in ensuring that hospitalised patients get adequate nutrition, and might include nutritional assessment and screening and referring patients to dietician. Nurses can also ensure adequate nutrition among patients in the hospital by providing correct nutritional advice, helping them in selecting healthy choices of food and delegating or undertaking necessary actions where patients cannot meet their dietary requirements. This may include assisting patients to increase their food intake or feeding totally dependent patients along with making sure they take enough fluids. Maintaining adequate hydration and nutrition levels in hospitalized patients may be hindered by a range of factors. Such factors may include patient-specific aspects such as physiological impacts of illness, as well treatment-related aspects such as medications’ side effects. Physical hindrances from equipment like oxygen masks and intravenous treatment tubing may as well hinder the ability of a patient to drink and eat, thus leading to inadequate nutrition. Moreover, medical setting issues relating to fewer staff, actual or perceived time constraints, and availability of drinks and food that match the liking of the patient may negatively affect the fluid and food consumption of a hospitalized patient (Bloomfield & Pegram 2012, p.53). The formulation of strategies to reduce the prevalence of malnutrition in most care settings has been encouraged. One crucial mealtime care’s aspect for ensuring adequate nutrition in hospitalized patients is adequate assistance during mealtimes to enable ingestion of drink and food. Mealtime assistance helps a patient to finish the eating procedure after a snack or meal is served within care settings. Such assistance may range from physical guiding and nonverbal and verbal prompts to feeding the patient. Various plans have been devised in ensuring patients receive mealtime help if needed. These include using supervised dining areas, and protected meals. Personalised occupational therapy programs have been found to boost dietary intake, reduce improper meal behaviour, and ensure adequate nutrition among patients in medical settings (Green et al. 2011, p.1810). Prins (2010, p.11) maintains that, assessment of nutrition status among hospitalised patients is crucial in ensuring adequate nutrition since it helps establish nutritional risks and also act as a basis for checking the adequacy of nutritional support. Moreover, the assessment helps prevent malnutrition among patients by identifying those requiring closer monitoring and aggressive intervention. Some of the factors that hinder adequate nutrition among patients in medical settings include failure to establish patients facing malnutrition risks, malnourished patients, at risk obese and elderly patients, and patients facing refeeding syndrome risks for early and necessary intervention. Drawing from Schueren et al. (2012, p.278), deficient food and drink intake among hospitalised is caused by a number of reasons. First, patients with deteriorating health status usually have a decreased appetite and thus inadequate nutrition among such patients is common. In addition, rates of malnutrition increase with the duration of hospital stays. This implies that, long stays in hospitals hinder adequate nutrition among hospitalised patients. Moreover, most patients lack information about meal services as well as availability of additional food in between meals in their medical settings. Thus, are unable to order for food when they have increased appetite or make food choices according to their liking. Recommendations for practice: Pressure area management From the literature on pressure ulcer dressing, three recommendations are made for implementation in the medical setting. First, wound cleansers should be adopted as a form of dressing. The reason why cleansers should be used is because; they act as the preliminary step in dressing by removing dead tissue and foreign bodies. After such bodies and tissue are removed, further infection is prevented and thus other types of dressing may be used. Second, the medical setting should use honey dressing. Several studies have shown honey to be effective in wound healing than other products such as saline. Moreover, given the fact that honey is a natural product, it is cheap, readily available. Thus, the setting can easily access and afford it. It is also patient-friendly since no pain is experienced in changing the dressing. Lastly, the medical setting should use debridement as a form of dressing. Given the wide range of debridement dressings, the setting has a wide variety of dressing to choose from, depending on the availability of the dressing products, nature of wound, and its staff’s expertise in the use of different types of debridement. Debridement is also a good recommendation since the setting will be in a position to compare the effectiveness of different types of debridement and settle for the most effective one. Recommendations for practice: Nutritional Management The first recommendation for ensuring effective nutritional management for hospitalised patients in the medical setting is ensuring that nurses have adequate knowledge about nutritional support and intervention for different types of patients. This might be facilitated through additional training of the nurses. Such knowledge is crucial because it will help nurses in effective nutrition assessment, and giving informed and appropriate advice about nutrition to patients. In addition, the setting should ensure that patients receive adequate assistance from nurses during meal times. This can be made effective by ensuring that the proportion of nurses matches that of the patients. This is important for the setting because it will help ensure that patients receive the necessary care and attention and take adequate drink and food. Furthermore, the setting should publish and distribute booklets relating to meal services offered in the setting especially to new patients. This is essential in the setting since it will create awareness among patients in relation to the kinds of foods available and when to order for food. This will in turn reduce chances of missing meals and also enable patients to request for food when they have appetite. Impact of level of education and socio economic status The socio economic status and level of education of a patient and his or her family members may influence the patient’s wound healing process and nutritional status in different ways. To start with, socio economic status will determine the kind of medical setting a patient will be admitted. Different medical settings offer different prevention and treatment interventions for pressure ulcers (Saunders et al. 2010, p.387). For instance, a private hospital is more likely to provide high quality wound care and thus faster wound healing compared to a government hospital. A patient with a low economic status will definitely go for a cheap government medical setting. Moreover, expensive private hospitals are likely to provide patients with specialised and a variety of meals to choose from, as well as employ carers to assist patients with their nutrition. In such as a case, patients will definitely have adequate nutrition support (Odufuwa & Fadupin 2011, p.115). Drawing from Shoeps et al. (2011, p.47), families with high socio economic status are able to afford a balanced diet unlike poor families, which might boost the nutrition status of or avoid malnutrition in a patient. In terms of education, patients and families with high education level are more likely to observe hygiene and have better knowledge about wound care than those with low education level (Saleh, Anthony, & Parboteeah 2009, p.1925). Thus, the former may fasten the wound healing process, while the latter might slow the process. According to Mohannad, Rizvi, & Irfan (2012, p.104), high education level is likely to be associated with great knowledge about nutrition and balanced diet, which might boost the nutrition status of a patient unlike a case where the patient and family members are less educated. Conclusion There are several types of dressing for pressure ulcers, whose use may depend on the nature and type of wound. Such dressings include wound cleansers, debridement, honey dressing, hydrocolloid, and alginate dressing. The kind of dressings recommended for use in the medical setting are wound cleansers, honey and debridement. Adequate nutrition among hospitalised patients can be ensured through practices such as early, safe, and sufficient initiation of enteral feeding in critically sick patients, better understanding of nutrition support’s practices, and provision of correct nutritional advice. Some of the factors that hinder sufficient nutrition include longer hospital stays, patients’ health status, availability of information on meal services, and staffing levels. The recommendations for nutrition management include adequate knowledge about nutritional support and intervention, assistance of patients during mealtimes, and provision of information to patients about meal services in the setting. The socio economic status and education level of patients and their families may impact the patients’ nutrition status and wound healing through hygiene and wound care practices, the kind of care available and affordable, and nutrition information. Reference List Bloomfield, J & Pegram, A 2012, Improving nutrition and hydration in hospital: the nurse’s responsibility, Nursing Standard, 26 (34), 52-56. Green, SM, Martin, HJ, Roberts, HC & Sayer, AA 2011, A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings, Journal of Clinical Nursing, 20 (2), 1810–1823. Levine, SM, Sinno, S, Levine, JP & Saadeh, PB 2013, Current Thoughts for the Prevention and Treatment of Pressure Ulcers, Annals of Surgery, 257 (4), 603–608. Lohi, J, Sipponen, A & Jokinen, J 2010, Local dressings for pressure ulcers: what is the best tool to apply in primary and second care? Journal of Wound Care, 19 (3), 123-127. Mohannad, A, Rizvi, F & Irfan, G 2012, Impact of Maternal Education, and Socioeconomic Status on Maternal Nutritional Knowledge and Practices Regarding Iron Rich Foods and Iron Supplements, Annals of Pakistan Institute of Medical Sciences, 8 (2), 101-105. Odufuwa, B & Fadupin, G 2011, Nutritional Status of Haemodialysis Patients in a Developing Economy: A Case Study of Nigeria, Journal of Human Ecology, 36 (2), 111-116. Prins, A 2010, Nutritional assessment of the critically ill patient, Journal of Clinical Nutrition, 23 (1), 11-18. Rapp, MP, Slomka, J & Cron, SG 2010, Practices and Outcomes: Pressure Ulcer Management in Nursing Facilities, Nursing Administration Quarterly, 34 (2), E1–E11. Ros, C, McNeill, L & Bennett, P 2009, Review: nurses can improve patient nutrition in intensive care, Journal of Clinical Nursing, 18 (1), 2406–2415. Schueren, MA, Roosemalen, MM, Weijs, PJ & Langius, JA 2012, High Waste Contributes to Low Food Intake in Hospitalized Patients, Nutrition in Clinical Practice, 27 (2), 274-280. Saleh, M, Anthony, D & Parboteeah, S 2009, The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients, Journal of Clinical Nursing, 18 (13), 1923-9. Saunders, LL, Krause, JS, Peters, BA & Reed, KS 2010, The Relationship of Pressure Ulcers, Race, and Socioeconomic Conditions After Spinal Cord Injury, Journal of Spinal Cord Medicine, 33 (4), 387–395. Shoeps, DO, Abreu, LC, Valenti, VE, Nascimento, VG & Oliveira, AG 2011, Nutritional status of pre-school children from low income families, Nutrition Journal, 10 (1), 43-52. Simon, A, Traynor, K, Santos, K, Blaser, G, Bode, U & Molan, P 2009, Medical Honey for Wound Care—Still the ‘Latest Resort’? Evidence-Based Complementary and Alternative Medicine, 6 (2), 165–173. Sopata, M, Tomaszewska, E, Machyńska-Bućko, Z & Kotlińska-Lemieszek, A 2012, Modern methods of conservative treatment of pressure ulcers, Advances in Dermatology and Allergology, 29 (1), 40–46. Read More