Tuesday, March 17, 2020

Policies and Procedures in Preventing Pressure Ulcers Essay Example

Policies and Procedures in Preventing Pressure Ulcers Essay Example Policies and Procedures in Preventing Pressure Ulcers Essay Policies and Procedures in Preventing Pressure Ulcers Essay Procedures and Policies in Preventing Pressure Ulcers 1 Running head: Procedures and Policies in Preventing Pressure Ulcers Procedures and Policies in Preventing Pressure Ulcers Procedures and Policies in Preventing Pressure Ulcers 2 One of the most serious obstacles that long- term care facilities face with their residents is the development of pressure ulcers. Pressure ulcers, or bed sores, occur when pressure is applied to areas of the body causing skin breakdown. Most pressure ulcers develop over bony prominences, where friction and shearing force combine with pressure to breakdown skin and underlying tissues (Lippincott, Williams, Wilkins, 2010, p. 1). † Pressure ulcers may occur when great force for a short period or less force over a long period impairs circulation to an area of skin. This process obstructs capillary blood flow which deprives the tissues of oxygen and nutrients. The results are ischemic lesions and tissue necrosis which can lead to serious infection. Common areas that pressure ulcers occur are on the coccyx, sacrum, greater trochanters, vertebrae, scapulae, elbows, knees, and heels. Patients who are bedridden or have impaired mobility are at great risk for pressure ulcer development (Lippincott, Williams, Wilkins, 2010). Lippincott, Williams, Wilkins (2010) state that the prevention of pressure ulcers includes relieving pressure, improving circulation, and providing adequate nutrition. Prevention also includes managing diseases such as vascular disorders and diabetes. Vascular disorders can impair circulation and uncontrolled diabetes can promote infection. The prevention of pressure ulcers begins with an accurate assessment. The National Pressure Ulcer Advisory Panel (2007) categorizes pressure ulcers into six stages that include: suspected deep tissue injury, stage I, stage II, stage III, stage IV, and unstageable pressure ulcers. Suspected deep tissue injury occurs when underlying soft tissue is damaged by pressure or shearing. The appearance is described as a localized area that is urple, Procedures and Policies in Preventing Pressure Ulcers 3 maroon, or presents a blood filled blister on intact skin. A stage I pressure ulcer occurs over localized, intact skin that is red and nonblanchable. Stage II ulcers are characterized by partial-thickness loss of the dermis that is broken with a shallow, open ulcer that has a reddish-pink wound bed. These ulcers can be intact or open serum-filled blisters. Stage III ulcers have similar characteristics as stage II ulcers. However, subcutaneous fat may be seen in the wound bed. This represents full-thickness tissue loss. Undermining or tunneling may be present at this stage. Stage IV pressure ulcers progress through subcutaneous fat exposing muscle, tendons, or bone. Slough or eschar may be present in the wound bed. Undermining and tunneling are common in this stage. An unstageable ulcer occurs when the base of the ulcer is covered by slough, eschar, or both. Unless the slough and eschar are removed, the depth of the ulcer is unknown. For this reason, the ulcer is unstageable. Prevention is the key to avoiding extensive treatment and complications. At McCauley Sanctuary, a long- term care facility in Muskegon, preventative tools such as the Braden scale are used during an assessment. The Braden scale is a reliable instrument used to measure a patient’s risk of developing pressure ulcers. There are six areas that are assessed: sensory perception, skin moisture, physical activity, mobility, nutrition, and friction and shear. Each area produces 1-4 points, depending on the description that fits the patient. After the six area assessment, the points are tallied. The lower the points, the greater the risk is for the patient to develop pressure ulcers. The Braden Scale is useful in developing the patient’s plan of care. When a patient is at risk for pressure ulcers, a plan of care may include frequent repositioning to decrease pressure. It may also include the use of special equipment to reduce Procedures and Policies in Preventing Pressure Ulcers 4 pressure intensity (Lippincott, Williams, Wilkins, 2010). At McCauley Sanctuary, every patient has a 4† thick mattress overlay to reduce pressure intensity. They are also anti-microbial, which discourages infection. I noticed that every wheelchair had a thick foam cushion as well. Bolster pillows and regular pillows are used to reposition patients and relieve pressure from bony prominences. I had the duty of showering a patient on my first day of clinical. After her shower, I was instructed to apply a moisturizing cream to her sacrum, coccyx, and any other areas that showed signs of skin breakdown. The use of special equipment that reduce pressure and cream that is used on patients are examples of how McCauley Sanctuary complies with preventative measures. The patient I worked with did not require repositioning since her mobility was only slightly limited. Upon request I was given a handout of the clinic guidelines entitled Pressure Ulcer Prevention. The policy stated to turn and reposition a patient with impaired mobility every 1-2 hours. It also advised lifting the patient, with assistance, instead of sliding them. This is because sliding increases friction and shear which can contribute to the development of pressure ulcers. This handout was supported by EBP articles from the Journal of Advanced Nursing and the Journal of Wound, Ostomy, and Continence Nursing. It also included EBP provided by the National Pressure Ulcer Advisory Panel. I have read and studied information regarding pressure ulcers, but being at McCauley allowed me to apply assessment skills and prevention of pressure ulcer development. I am a hands-on learner and being able to actually see prevention and care plan implementation has made learning and retaining this information easier. I am very grateful that I had this Procedures and Policies in Preventing Pressure Ulcers 5 opportunity provided to me by Grand Rapids Community College, Pilgrim Manor, and the patients I provided care to. Procedures and Policies in Preventing Pressure Ulcers 6 References Lippincott, Williams, Wilkins. (2010). Pressure ulcer prevention. Retrieved on July 15, 2010 from nursingprocedures. net/lnp/form/printPage. jsp National Pressure Ulcer Advisory Panel. (2007). Pressure ulcer stages revised by NPUAP. Retrieved on February 19, 2011from npuap. org/pr2. htm

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