Top PDF Adult pressure area care: preventing pressure ulcers

Adult pressure area care: preventing pressure ulcers

Adult pressure area care: preventing pressure ulcers

cause damage below the skin surface (Hanson et al, 2010). A common example is when a patient is moved up the bed. The bones move while the skin remains in contact with the bed surface. Friction is a mechanical force defined as the resistance to motion in a parallel direction of two surfaces (NPUAP, 2007). Friction causes abrasion to the skin of the epidermis and dermis increasing vulnerability to pressure damage and can be most hazardous for patients requiring repositioning. For example, the skin layers slide over each other when the patient is moved up the bed (Hanson et al, 2010). Both factors either combined or separately can have negative consequences. These must be considered when assessing the skin and actions should be taken to mitigate any risk factors when possible.
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Medical device-related pressure ulcers

Medical device-related pressure ulcers

MDR PrUs and SKIN bundle were tracked. Results show an absolute reduction of MDR PrUs from 0.06% incidence of stage 3 + MDR HAPUs per 1,000 patient days to zero in pediatrics (benchmark 0.0%–0.04%). Among adults and elders, the cumulative incidence was reduced from 0.28% to zero with benchmark 0.05%–0.09%). The hospital has sustained a “zero zone” incidence among adults and pedi- atric patients for PrUs overall, receiving a top performing, “Clinical Excellence Award” from CALNOC (the Cali- fornia Collaborative Alliance for Nursing Outcomes), for the past 3 years. Coyer reported that systematic and ongo- ing assessment of the patient’s skin and risk for pressure injuries as well as implementation of tailored prevention measures are central to preventing pressure injuries in the critically ill. 26 Visscher et al found similar results through
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Effect of high voltage stimulation on pressure ulcers healing: (systematic review)

Effect of high voltage stimulation on pressure ulcers healing: (systematic review)

Bedsores also called pressure sores or pressure ulcers are injuries to skin and Pressure ulcers are often undertreated. A pressure ulcer is a break in the integument usually caused by continuous pressure to skin and muscle. Although these ulcers can occur anywhere on the body, they are often located in the trochanteric, ischial, heel, and sacral areas. Patients may not immediately be aware of these developing wounds. Because they often occur in bed-bound, paralyzed, and elderly patients undergoing treatment for other diseases. The prevalence of pressure ulcers in the United States is estimated to be 1.3 million to 3 million. The incidence of pressure ulcers is estimated to be 5% to 10% among hospitalized patients (Barrois, 1995). Nearly 700,000 people are affected by pressure ulcers each year, across all care settings, including patients in their own homes, with the most vulnerable of patients aged over 75. Around 186,617 patients develop a pressure ulcer in the hospital each year, and each pressure ulcer adds over £4,000 in additional costs to care (Michelle, 2014). Pressure ulcers develop as a result of a combination of physiologic events and external conditions. The classic thinking of tissue ischemia induced by prolonged external pressure on the tissue being the sole causative factor of pressure ulcer formation has been examined more systematically. Along with localized ischemia and reperfusion injury to tissues, impaired lymphatic drainage has been shown to contribute to injury as well. Compression prevents lymph Article History:
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A Review on Perioperative Pressure Ulcers

A Review on Perioperative Pressure Ulcers

To achieve the best functional result with the most efficient use of resources, a comprehensive treatment plan is needed, that include preoperative workup, physical therapy, nutritional considerations, wound care, treatment of spasticity and reflex spasm, pre and postoperative bowel management, pulmonary consideration, anesthetic consideration, antimicrobial regimen. Surgical patients are prone to developing HAPU. In the United States, patients with HAPU had a longer length of stay, higher total hospitalization costs, and greater odds of readmissions compared with patients with no HAPU. Preventing HAPU involves accurate and ongoing risk assessments so that preventive measures can be implemented as early as possible and carried out throughout the period of immobility. The prevalence of HAPU among surgical patients is about 8.5% or higher depending on the type and the duration of the surgery. Patients with proximal femur fractures or patients after major lower limb amputation, the incidence of pressure ulcers was high (10.4% and 8.8%, respectively). Patients undergoing bowel surgery and peripheral vascular reconstructions are also prone to developing pressure ulcers. Several plausible mechanisms might be accounting for increasing risk of infections in relation to prior pressure sore exposures [4-6]. To start with, pressure sores were perceived to induce impairment of skin protection function by destroying integrity of erythematous skin and prompting reproduction and growth of pathogenic bacteria.
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Reducing pressure ulcers across multiple care settings using a collaborative approach

Reducing pressure ulcers across multiple care settings using a collaborative approach

The Collaborative did attempt to measure pressure ulcers in the simplest possible way to make the process easy and convenient for staff working within busy ward/ area environments, with the view to increasing the partic- ipation of the teams involved. However, not including the grade of pressure ulcers was a limitation in understanding the precise impact this study has had on patient care as well as costs, as there may have been a reduction in the more severe grades of pressure ulcers (grades 3 and 4) but this information was not captured.
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Volume 9 | Issue 3 - 2019

Volume 9 | Issue 3 - 2019

stage, 35 nurses of internal intensive care units, 35 nurses of trauma intensive care units, and in total 70 nurses were recruited. In the second stage, 35 nurses of internal intensive care units through a random allocation were divided into 2 groups of intervention (17 cases) and control (18 cases); and 35 nurses of trauma intensive care units through a random allocation were divided into 2 groups of intervention (17 cases) and control (18 cases). Inclusion criteria were as follows: Nurses with a bachelor's and higher degrees that worked full- time at intensive care units were in charge of patients with immobility in intensive care units. They had at least one-year experience of working at the ICU and they had not participated in the pressure ulcer training course in the past six months or were not taking the course. The exclusion criteria were the nurses who were not in charge of any patient with pressure ulcers, and also nurses’ displacement was carried out from the intensive care units during the time the research. The researcher received the code of ethics with number IR.SBMU.PHNM.1395.583 and obtained research license from Shahid Beheshti University of Medical Sciences and submitted it to Alborz University of Medical Sciences and then attended to the affiliated medical centers, introduced herself, stated the purpose and process of the research, and in order to collect information, she was present in the research locations during the weekdays and selected the cases in accordance with study inclusion criteria after providing them with necessary information about the research, keeping the information secret, the right of voluntarily participation and after obtaining the informed consent. The researcher did experimental observations within two weeks to familiarize with the study design, nurses acquaintance with the researcher and to make nurses get accustomed to the presence of an observer. Data collected at the experimental stage was not included in the main study. The data collection tool included 2 parts. The first part of the checklist was the demographic information of the nurses. The second part of the checklist was "the review of nurse's performance on prevention of pressure ulcer", which had 48 items that covered 4 areas including patients' skin care (20 items); back massage care (6 terms); nutritional care (12 terms) and providing care for body position state, supportive levels and mobility (10 items). The checklist was based on study tools designed in this regard. [6, 12] Face validity and content validity
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The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients.

The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients.

However, the Gorecki et al., (2011) review was limited because they were unable to evaluate PU descriptors for Category 1 PUs (the most prevalent PU Category) [6]. A problem with research in this field is that there is a pau- city of research about pain associated with Category 1 PUs. Only one patient from the combined review sample had a Category 1 PU, the majority of patients had mul- tiple PUs of mixed categories. Furthermore, the system- atic review of patients’ experiences of pain and pressure ulceration highlighted that pain at skin sites was experi- enced by patients prior to PU development but was often not recognised as important by their health care professionals [3,6]. Patients felt that they were respon- sible for communicating pain and that their care pro- vider was responsible for attending to it, but patients’ views and concerns did not always prompt action and many healthcare professionals dismissed patients’ re- ports of pain at pressure areas [6,12].
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Negative pressure wound therapy for treating pressure ulcers

Negative pressure wound therapy for treating pressure ulcers

Rigorous RCTs in wound care are feasible - they must follow good practice conduct and reporting guidelines, for example CON- SORT (Schulz 2010). Key areas of good practice are the robust generation of a randomisation sequence, for example, a computer- generated one; robust allocation concealment, for example the use of a telephone randomisation service; and use of blinded outcome assessment where possible. All this information should be stated clearly in the study report, as trial authors should anticipate the inclusion of their trials in systematic reviews. Additionally, studies should report clearly how they planned to collect adverse event data and how this process was standardised for both treatment arms. In terms of analysis, where possible, data from all partic- ipants should be included - that is an intention-to-treat analy- sis should be conducted - and measures of variation such as the standard deviation or standard error should be presented around measures where appropriate. Steps should be taken while a trial is being conducted to prevent the occurrence of missing data as far as is possible.
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The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients

The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients

Reviews of the literature carried out by Girouard et al., 2008, and Pieper et al. 2009 described how PU pain had been measured in a number of studies [9,10]. They also synthesised research on the prevalence of PU pain. The two reviews identify 8 studies reporting the prevalence of pain associated with pressure ulcers in samples ran- ging from 20 to 186 participants in diverse populations including hospital, community and palliative care. In the two largest studies (>100 participants), pressure ulcer pain prevalence estimates were 37% and 66%. Data qual- ity is an issue as only 5 studies, however, used validated and reliable measures to assess pain. Furthermore, the methods of pain assessment differed, for example, some studies described nurse reported pain where nurses are asked to judge how much pain a patient is experiencing as opposed to direct patient reported outcomes. The former has been shown to result in under-reporting of patients’ pain in other situations [11].
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Prevalence and Features of Pressure Ulcers among Patients in ICU Department of Governmental Hospital in Palestine: Cross Sectional

Prevalence and Features of Pressure Ulcers among Patients in ICU Department of Governmental Hospital in Palestine: Cross Sectional

The occurrence rate of PUs greatly depends on population, health care condition, and resources of country. The prevalence of PUs was 33% most of them was in stage I, when excluded the stage I prevalence was 7.34 %. The author observed that the prevalence of PU was significantly higher at vertebrae, sacrum and heel of ICU patients consequently, therefore, nursing protocols and skills that aimed at preventing the development of PU may benefit from increased attention on these regions .In this study change position was not effective related to dishonesty among nurses when ask them, not able follow up periodically and the most not use air matrix. The need for comprehensive skin assessment as PUs may develop in usual and unusual locations of patient’s body.
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Neonatal pressure ulcers: prevention and treatment

Neonatal pressure ulcers: prevention and treatment

The treatment approach to PUs should be carried out in an interdisciplinary way, in which the nursing professionals should have a leading role, since PU prevention and applica- tion of treatment in the hospital setting is their responsibility. PU prevention in neonates focuses on skin care (hygiene and hydration, moisture control and management), pressure management (local pressure relief devices, postural changes and SSPMs) as well as adequate nutrition. However, a funda- mental part is the assessment of PU risk by valuation scales. The scales validated for PU risk detection in neonates are scarce, and are adapted from adult scales. This impairs the adequate assessment in neonates, and highlights the need to develop scales applicable in neonates of all GAs.
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Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial

Pressure ulcers are considered to be an economic, social and health problem that does not just decrease the quality of life of the patients and their social and familiar environ- ment but also involves the worsening of the patients’ prognosis, as well as decreasing the patients’ life expect- ancy, owing to the high number of related physical com- plications. Pressure ulcers may be defined as injuries to the skin caused by the ischaemic process that may affect and necrotize those areas in the epidermis, dermis, sub- cutaneous tissues, and muscles where the pressure ulcers appear, and may also affect bones and joints in the most severe cases. Pressure ulcers tend to appear when the soft tissues are compressed between two layers, namely, the bony prominences of the patient and an external surface [1]. Additionally contributing to their appearance are the vascular occlusion produced by the external pressure and the endothelial damage to arterioles and microcirculation, mainly due to tangential shear and frictional forces. Pres- sure ulcers involve the alteration of a basic need for pa- tients, which is to preserve skin integrity. Pressure ulcers may appear in any part of the body, with the bony promi- nences (sacrum, hips, heels) being most common, and mainly affect older people, immobilized patients with severe acute disease and patients with neurological deficiencies.
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Pressure ulcers: a review

Pressure ulcers: a review

Patients at risk of developing ulcers should be identified and have their skin inspected for any changes and damage at least twice daily. The skin should be kept clean and dry. Special mattresses should be used to eliminate pressure. Currently these special mattresses are classified based on their static or dynamic nature. Static surfaces (such as foam filled mattresses, air-filled mattresses, fluid-filled mattresses) do not require electrical power, while dynamic surfaces (such as alternating air pressure mattresses or pneumatic ripple beds) require electrical power for shifting and redistributing the pressure within the surface. Other integrated electronic beds like air fluidised beds (Clinitron or Kin Air bed) (Hargest and Artz, 1969) and electronic moving air mattresses require high technology and heavy machinery to let air and ceramic sphere particles support the object on a stream mechanically; are often costly, noisy and not easily available. Due to lack of substantial evidences and researches, it is difficult to firmly conclude about relative effects of support surfaces. Those who are wheelchair bound can be provided with custom designed gel and pneumatic wheelchair cushions which are easily available, and they help to distribute the load more evenly and help in preventing ulcer formation. In addition, patients and their caretakers are advised to conduct pressure release movements or weight shifts on regular intervals to prevent pressure concentration and tissue damage. It is important that the patient understands that there is always a need to do pressure relief and give several options on how to perform pressure reliefs in a variety of settings. Pressure relief in sitting needs to be done every 15–30 min (McDonald, 2001).
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Factors Affecting Nurses’ Compliance in Preventing Pressure Ulcer Among Hospitalized Patients at King Abdulaziz University Hospital

Factors Affecting Nurses’ Compliance in Preventing Pressure Ulcer Among Hospitalized Patients at King Abdulaziz University Hospital

This correlation research sought to have a positive impact on the preventive care provided by nurses to patients at risk for pressure ulcers by exploring evidence-based research concerning the effects of the factors affecting nursing compliance with the protocols for preventing pressure ulcers. Pressure ulcer prevention is an interdisciplinary problem. Thus, it needs multidisciplinary efforts and team work to contribute to successful care. Inadequate facilities and equipments, dissatisfaction with staff shortage were found to be barriers facing nurses in following evidence based practice of pressure ulcer prevention. If staff shortages continue, with the stress caused during the busy and overloaded clinical shifts, it will be no surprise if pressure prevention becomes less of a priority. In-service training, upgrading courses and ensuring availability of the necessary facilities and equipments are some of the important steps to improve nurses ’ knowledge and practice regarding to prevention of pressure ulcer.
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Negative pressure wound therapy versus healing by secondary intention in pressure ulcers

Negative pressure wound therapy versus healing by secondary intention in pressure ulcers

Abstract—: Pressure ulcers are a highly prevalent source of morbidity with an equally high incidence of up to 38.0% amongst different categories of healthcare institutions. There- fore, the management and therapeutic approach toward these often hospital- or facility-acquired problems remain critical aspects of long-term care. Negative pressure wound therapy (NPWT) has proven effective in addressing the barriers to pres- sure ulcer healing including increasing blood flow to previously ischemic wound areas by generating subatmospheric pressure which vacuums in circulation. The objective of this study was to compare negative pressure wound therapy (NPWT) versus surgical wounds healing by secondary intention (SWHSI). A systematic literature search was conducted using the PubMed and Scopus search engine up until the 20 Th January 2017 including the terms: “negative pressure wound therapy” and “pressure ulcers”. In this systematic review, six randomized controlled trials were included. NPWT is deemed appropriate and effective method and widely used by clinicians to promote the healing of wounds and ulcers of different etiology. The heterogeneity found in individual trials regarding the inclusion criteria, therapeutic procedures, the criteria and methods of outcome evaluation, however, did not allow for a data evaluation with statistically valid conclusions. It is reasonable to assume that a subset of patients with pressure ulcers can be effectively treated with NPWT, with optimal results and good cost-benefit ratio, also with respect to the quality of life.
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Pressure-relieving devices for preventing heel pressure ulcers

Pressure-relieving devices for preventing heel pressure ulcers

Heel-specific devices also tend to fall into one of three categories - CLP devices, off-loading devices or low friction devices. CLP heel devices (e.g. a gel or foam heel cup or bootie) are designed either to reduce the magnitude of the applied pressure by spreading it over a larger area, or reduce the effects of the forces of friction or shear, or both. Off-loading devices are designed to remove the pressure of the ’at-risk’ body site completely. This could be through using a pillow or wedge under the calf to leave the foot suspended above the mattress, or through supporting the foot or calf in a splint or trough, thereby leaving no pressure on the heel. Low friction devices consist of dressings or booties that do not reduce the magnitude of pressure at the heel, but are used to reduce risk of pressure ulcer development through reducing the forces of friction and shear. There are no heel-specific AP devices, although the heel section of some mattresses may alternate and work in this manner.
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Nurses’ perceptions of the root causes of community‐acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare

Nurses’ perceptions of the root causes of community‐acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare

A pressure ulcer is a localised injury to the skin or underlying tissue, which is caused by pressure, or pressure in combination with strain between the skeleton and a support surface. Pressure ulcers are classified according to the International Pressure Ulcer Classification System (National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA), 2014). This system defines four levels of injury from stage 1 (non-blanchable redness of intact skin) to 4 (full thickness tissue loss with exposed bone, tendon or muscle). It also identifies unstageable injury (full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar) and deep tissue injury (intact or non-intact skin with localised area of
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Prevention of Tracheostomy-related Pressure Ulcers in Children

Prevention of Tracheostomy-related Pressure Ulcers in Children

cycles are designed to establish rela- tionships between process changes and outcomes by trialing and adapting small-scale interventions over time. This process was used both to de- termine the interventions most bene- fi cial to prevent TRPU and to effectively implement a TRPU-prevention bundle. PDSA cycles were planned and exe- cuted by a multidisciplinary team in- cluding the medical director of the unit, bedside nurse and respiratory therapist, nurse educator, and the unit ’ s skin care champion. Based on knowledge gained from the literature, as well as results previously obtained from our institu- tion ’ s pressure ulcer collaborative (preliminary work to reduce pressure ulcers of all types), key drivers thought to prevent TRPU development were identi fi ed to guide our interventions. These included (1) pressure ulcer risk and skin assessment, (2) moisture-free device interface, and (3) pressure-free device interface. PDSA cycles testing interventions in each of these drivers
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Negative pressure wound therapy with instillation: effects on healing of category 4 pressure ulcers

Negative pressure wound therapy with instillation: effects on healing of category 4 pressure ulcers

octenilin® wound irrigation solution instillation. During the instillation of the rinsing solution the negative pressure is not maintained and the system is prone to leakage, so this phase should be as short as possible. Conventional NPWT or the use of antiseptic soaked dressings are typically the treatments of choice for preparing the wound bed prior to grafting or flap coverage. In the novel approach described in this paper, both methods were combined successfully. A short treatment period was required using this approach, meaning that less than a week was needed for the combined NPWT/instillation phase. After only 6 days, there were no signs of wound infection and granulation was taking place in the studied patients.
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Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

(13 patients, 4.0%) because of severe chronic heart failure. Two hundred and six patients (62.6%) did not develop pres- sure ulcers during their stay in the ward (group A), 84 patients (25.5%) were admitted to the ward with pressure ulcers (group B), and 39 patients (11.9%,) developed pressure ulcers while in the ward (group C). Group C and group A (as a control) were included in further analysis (Figure 1). Compared to patients who did not develop pressure ulcers during hospitalization (group A), patients who developed pressure ulcers (group C) presented more frequently with colorectal cancer, higher body mass reduction within 6 months, a longer period of physical deterioration, longer pre-admission nursing home residency, lower systolic and diastolic blood pressure, lower hemoglobin level, and higher Table 1 Pressure ulcer prevention strategies applied in the Palliative Care Unit at Independent Public healthcare railway hospital in Wilkowice–Bystra, Poland
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