Abstract
The presence of pressure ulcers is a marker of poor prognosis and is a known cause of premature mortality. It poses a economic burden both on the state and the client, but it can be prevented in many cases and a targeted preventive approach may prove to be less costly that focused on treatment of established ulcer. Repositioning the patient can prove to be an essential nursing care tool, and this study examines this proposition to be implemented in a structured care plan.
Introduction
Pressure ulcer is defined as localized areas of breakdown of skin and underlying tissues caused by pressure, shear, friction, or a combination of these. They can occur in all situations where subjects are subjected to sustained mechanical loads, but are particularly common in those who infirm and bedridden, wheelchair bound, or wearing a prosthesis or orthosis. These usually result from local breakdown of skin and soft tissue as a result of compression or shear between a bony prominence and external surface (Lyder CH., 2003). They usually develop on the lower half of the body, two-thirds around the pelvis and a third on the lower limbs with particularly predilection for appendages in the lower extremities such as heels and toes (National Pressure Ulcer Advisory Panel, 1989). As is evident, elderly persons are particularly prone to develop these ulcers, especially the age group above 70. However, bed bound patients or confined to wheelchair related to their primary diseases, the incidence rises to almost 8%. The picture in the long term health care facilities are poorer, because up to 25% of these patients may develop pressure ulcers. As can be conceived, these ulcers are painful, difficult to treat, and represent a burden to the community in terms of healthcare and finances (Iglesias C et al., 2006).
Literature Review Support
In the study by Pokorny, Koldjeski, and Swanson in 2003, the authors acknowledge the prevalence of pressure ulcers in the hospital settings to be a major problem, particularly in older persons, debilitated persons, and persons with immobility. The authors recognized prolonged pressure and compression of tissues as major contributing factors to the development of pressure ulcers. Pathologically, they cause occlusion of blood vessels due to external pressure and endothelial damage in the microcirculation to such an extent that the damaged tissue area cannot remove toxic cellular materials and excess fluids. Therefore, small relative changes in pressure may distort the tissue and occlude microcirculation leading to necrosis instantaneously. This study design accommodated repeated interventions in the form of therapeutic nursing interventions (Whitfield MD et al., 2000). The authors concluded that development of pressure ulcers are events that can be altered by nursing care. This indicates that there is dearth of literature specifically on this topic, and therefore, it would be worthwhile to undertake an intervention research with the hypothesis that adequate preventative strategy in high-risk patients. The intervention would involve nursing care that consists of a standard of evidence-based practice that includes awareness and application of two-hourly repositioning of the patients those are admitted to the hospitals with diagnoses that pose high risk of development of pressure ulcers.
Problem
Pressure ulcers represent a common but potentially preventable condition seen most often in high-risk populations such as elderly patients and those with physical impairments. A variety of treatment and preventive measures have been proposed, and it seems to be a lack of consensus about which would be the basic standards.
Solution
In this case, another research to enhance pressure ulceration healing is through the use of therapeutic air mattresses. According to the research of Sinclair and the group (2004), the utilization of air mattresses can further enhance the conditions of wound healing among pressure ulceration incidents. The proposed argument of the research involves the effectiveness of traditional turning and positioning protocols, which is evidently predominant in the nursing setting, and the therapeutic air mattresses.
Conclusion
Pressure ulcerations have been a major health care problem as well as the indicators of adequate and proper delivery management of care. In such case, it is therefore necessary to maintain strict, adequate, and the best appropriate intervention against the occurrence of pressure ulcerations. In the light or research developments progressing in the medical field, various wound enhancing treatments have been proposed to enhance the means of curing pressure ulcers. Turning patients every two hours is still a strong key to prevent pressure ulcers.
References
Iglesias C et al., (2006). Cost effectiveness analysis. Web.
Lyder C.H. (2003). Pressure ulcer prevention and management. JAMA;289:223-226.
National Pressure Ulcer Advisory Panel. Pressure Ulcers: Incidence, Economics, Risk Assessment—Consensus Development Conference Statement. West Dundee, Ill: SN Publications; 1989.
Pokorny, M.E., Koldjeski, D., and Swanson, M., (2003). Skin Care Intervention for Patients Having Cardiac Surgery. Am. J. Crit. Care.; 12: 535 – 544.
Whitfield M.D. et al. (2000). How effective are prevention strategies in reducing the prevalence of pressure ulcers? J Wound Care. 9:261-266.