Description Of The Intervention
The aim of pressure ulcer prevention strategies is to reduce either the magnitude, or duration, of pressure between a patient and his support surface , or both. This may be achieved by regular manual repositioning , or by using pressurerelieving support surfaces such as cushions, mattress overlays, replacement mattresses or whole bed replacements, which are widely used in both institutional and noninstitutional settings. Often a combination of repositioning and support surface enhancement may be used. Support surfaces are used with the aim of redistributing pressure, reducing shearing forces and controlling the local microclimate. The cost of these interventions varies widely from over GBP 30,000 for some bed replacements, to less than GBP 100 for some foam overlays. Information on the relative costeffectiveness of this equipment is needed to inform use.
Ways To Prevent Pressure Ulcers
1. Risk Assessment: risk assessment tools, such as the Braden scale, help caretakers recognize a patients risk of developing pressure ulcers. Clearly documented risk assessment is vital in preventing and treating pressure ulcers.
2. Skin Inspections: a patients skin should be examined regularly for signs of pressure damage. The first sign of tissue damage is often non-blanching erythema. Other signs of skin damage include heat, induration and swelling.
3. Skin care: keeping a patients skin clean, dry, and hydrated can help prevent damage. Skin should be dried carefully and any rubbing or friction should be avoided.
4. Moisture: excessive perspiration, oedema and incontinence can cause skin damage from excess moisture. Incontinence can be particularly harmful to a patients skin and appropriate measures should be taken to prevent any associated damage.
5. Incontinence: incontinence and pressure ulcers often co-exist. The use of incontinence pads with the appropriate application of a barrier cream can be helpful, while the use of indwelling urethral catheters should only be considered as a last resort due to the risk of infection.
6. Nutrition: good nutrition is essential for pressure ulcer prevention and healing. A Patients diet should be assessed regularly and any nutritional needs should be addressed. Keeping patients hydrated is also a vital part of preventing pressure ulcers.
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Less Fragile And More Resistant
Linovera® is indicated for prevention and treatment of stage I pressure ulcers. It lubricates the skin, thus reducing shear and friction and maintaining the moisture barrier function of the skin.
The active ingredients of Linovera® are linoleic acid, the most important essential fatty acid for the skin, Aloe Vera, which acts as an emollient and a humectant and Centella Asiatica, a soothing skin tonic agent.
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Causes And Prevention Of Pressure Sores
Pressure sores are wounds that develop when constant pressure or friction on one area of the body damages the skin. Constant pressure on an area of skin stops blood flowing normally, so the cells die and the skin breaks down.
Other names for pressure sores are bedsores, pressure ulcers and decubitus ulcers.
Try To Maintain Nutrition
There is a strong correlation between nutrition deficits and pressure ulcer risk. If your loved one has an appetite, try to maintain adequate nutrition with nutrient-rich foods . If his appetite is waning, offer supplements such as Ensure or Boost to help bolster nutrition.
Nutrition is often a problem in palliative care patients and its important to note here that you should never try to force your loved one to eat.
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Pressure Ulcers: Treatment And Prevention
Despite greater-than-ever awareness of the issue, pressure ulcers remain a significant problem in hospitals, facilities and home care situations. They are one of the leading Hospital Acquired Conditions , with up to 23% of hospital patients affected with these painful, potentially life-altering injuries.
Pressure ulcers can be notoriously difficult to treat in certain circumstances and can lead to permanent damage to skin and underlying tissue. Fortunately, leading wound care manufacturers have developed cutting-edge technology, leading to product solutions that have seen more success in treating pressure ulcers than ever before.
Even better, many of those products are designed to perform a dual role both aiding in the treatment, but also prevention of pressure ulcers. Read on to learn more about prevention, along with causes and treatments for this unfortunately common condition.
Keep Skin Clean And Dry
- Bathe daily with mild soap and warm water and rinse and dry thoroughly. Pay particular attention to keeping the genital area and skin folds clean and dry.
- Immediately wash and dry skin and change clothing after any leakage of stool or urine.
- Avoid harsh soaps, skin agents with alcohol, and antibacterial or antimicrobial soaps. Do not use powders. Use a moisturizer that has been approved by your health care provider.
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Stage 2 Pressure Sores
When you get into stage 2 of a pressure sore it is when there is top tissue damage. or underlying tissue damage the dermis layer. This is when a small or wound that can be open might start to form. It may also look like a blister. This is when medical assistance should be sought because there are chances if its not dealt with properly it can form into a higher risk pressure sore.
What Increases The Risk Of Developing Pressure Ulcers
People who are confined to a bed or chair for example due to stroke, spinal injury or dementia are at greater risk of developing extensive pressure ulcers. Other risk factors include:
- immobility being confined to bed after an illness or surgery, or due to paralysis
- diabetes and other health conditions that can affect blood supply
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Preventing Pressure Sores By Self
It is important to understand how and why pressure sores form. Once you do you can help to prevent pressure sores from forming by trying the following methods.
- Use moisturizing creams daily
- When bathing only use a soft sponge. Do not scrub hard
- Be sure to clean areas and dry properly in areas that could stay moist
- Do not shower or bathe daily as this can be counterintuitive and dry out your skin
- Stay clear of strong soaps
- Stay clear of talc powders
What you wear matters. Keep the following in mind when dressing.
- Do not wear clothes that are really tight
- Try and not to wear clothes that have buttons or seams that are thick. This can rub against the skin or cause unnecessary pressure points
Why It Is Important To Do This Review
Research indicates that pressure ulcers represent a major burden of sickness and reduced quality of life for patients, their carers , and their families . Often patients who develop pressure ulcers require prolonged and frequent contact with the healthcare system and suffer much pain , discomfort and inconvenience .
The presence of a pressure ulcer creates a number of significant difficulties psychologically, physically and clinically to patients, carers and their families. Clinicians, working in a variety of clinical and nonclinical settings, including primary care and acute trusts, also face challenges when providing holistic, personcentred services for the assessment and treatment of pressure ulcers. These challenges include clinical decisions regarding methods of assessment, and which treatments to use on individuals with an existing pressure ulcer.
Healthcare professionals attempt to reduce the incidence of severe pressure ulcers by the identification of people at high risk, and the use of preventative strategies, such as the deployment of pressurerelieving equipment. It is essential that initiatives are based on the best available clinical and costeffectiveness evidence, and we have, therefore, undertaken a systematic review of the evidence for the effectiveness of pressurerelieving support surfaces such as beds, mattresses, cushions, and repositioning interventions.
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What Are The Best Practices In Pressure Ulcer Prevention That We Want To Use
Once you have determined that you are ready for change, the Implementation Team and Unit-Based Teams should demonstrate a clear understanding of where they are headed in terms of implementing best practices. People involved in the quality improvement effort need to agree on what it is that they are trying to do. Consensus should be reached on the following questions:
In addressing these questions, this section provides a concise review of the practice, emphasizes why it is important, discusses challenges in implementation, and provides helpful hints for improving practice. Further information regarding the organization of care needed to implement these best practices is provided in Chapter 4 and additional clinical details are in Tools and Resources.
In describing best practices for pressure ulcer prevention, it is necessary to recognize at the outset that implementing these best practices at the bedside is an extremely complex task. Some of the factors that make pressure ulcer prevention so difficult include:
How Are Pressure Sores Diagnosed
Your doctor will do a physical exam to look at the sores. They will examine the size and depth of the sore and look to see if blood or fluid is oozing from the sore. Your doctor will check to see if your sore has a bad smell. They also will check for additional sores.
Testing may help to diagnose pressure sores or their complications. These tests might include a blood test. Another test would be to take a sample of the tissue from the sore. This is done by scraping or cutting it from the sore. That sample is sent to the lab for examination.
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How To Prevent Pressure Ulcers
Pressure ulcers are preventable if an experienced caregiver or nurse properly inspects skin for areas of redness. If someone you love is at risk for bed sores, consider the following:
- Change position and turn every two hours
- Place soft padding in a wheelchair or bed to reduce pressure.
- Keep skin clean and dry.
- Get enough fluids, protein, minerals, and vitamins.
Consider the following tips for skin care:
- When washing the skin, use a mild cleanser and then dry the skin thoroughly. Try to do this cleansing routine regularly.
- Use a good moisturizer to protect your skin from urine and feces.
- Change bedding and clothes frequently. Beware of buttons and folds of bedding as they can irritate the skin.
- Examine your skin daily for warning signs of pressure ulcers.
Can Pressure Sores Be Prevented Or Avoided
The best way to prevent pressure sores is to avoid spending long periods of time in a chair, wheelchair, or bed. If youre unable to move on your own, make arrangements for somebodysuch as a family member, friend, or caregiverto help you move.
If you must spend a lot of time in a chair, wheelchair, or bed, check your entire body daily. Look for spots, color changes, or other signs of sores. Pay attention to the pressure points where sores are most likely to occur. Again, if youre unable to look on your own, ask someone to help you.
Another way to avoid pressure sores is to keep your skin healthy. This includes keeping it clean and dry. Wash it with mild soap and warm water. Dont use hot water. Apply lotion often.
Even small amounts of exercise can help prevent pressure sores. Thats because exercise improves blood flow, strengthens your muscles, and improves your overall health. Talk to your doctor if physical activity is difficult. They can suggest certain exercises. Your doctor also may refer you to a physical therapist. They can show you how to do exercises that fit with your current health condition.
Lastly, if you smoke, quit. Smoking increases your risk of pressure sores.
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Description Of The Condition
Pressure ulcers are areas of localised damage to the skin and underlying tissue, believed to be caused by pressure, shear or friction . Pressure ulcers are more likely to occur in those who are seriously ill neurologically compromised ) have impaired mobility or who are immobile . Other risk factors include impaired nutrition obesity poor posture, which puts extra pressure on bony prominences or using equipment that does not provide appropriate pressure relief, such as seating or beds. Pressure ulcers particularly affect older people but have also been reported in pregnant women . Pressure ulcers have also been associated with an increased incidence of infection, including osteomyelitis .
The financial cost of treating ulcers in the UK varies from GBP 1,064 for a grade 1 ulcer to GBP 10,551 for a grade 4 ulcer, with total costs in the UK estimated as being GBP 1.4 to 2.1 billion annually, which is equivalent to 4% of the total National Health Service expenditure . National prevalence and incidence data from the US, based on a 24 hour data collection period at each participating institution, indicate that the annual cost to the American health system of treating all hospitalacquired pressure ulcers is between USD 2.2 and 3.6 billion . An Australian study of public hospitals in 20012002 predicted a median of 95,695 cases of pressure ulcers with a median of 398,432 bed days lost, incurring median opportunity costs of AU$285 Million .
Causes Of Pressure Ulcers
Pressure ulcers are caused by sustained pressure being placed on a particular part of the body.
This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue is damaged and will eventually die.
The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria.
People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body.
For example, you may think that you are lying still when asleep, but you may shift position up to 20 times a night.
Pressure ulcers can be caused by:
- pressure from a hard surface such as a bed or wheelchair
- pressure that is placed on the skin through involuntary muscle movements such as muscle spasms
- moisture which can break down the outer layer of the skin
The time it takes for a pressure ulcer to form will depend on:
- the amount of pressure
- how vulnerable a person’s skin is to damage
Grade 3 or 4 pressure ulcers can develop quickly. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just 1 or 2 hours. However, in some cases, the damage will only become apparent a few days after the injury has occurred.
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Get A Proper Seating Evaluation At Least Every Two Years Or Sooner If Your Health Or Skin Condition Changes
- Make sure you have the proper cushion for your wheelchair and your seating tolerance.
- Make sure you have the appropriate wheelchair, one that has been measured specifically for you and is compatible with your level of mobility, activities, work and associated equipment.
- The therapist doing the seating evaluation should place a pressure map above your cushion and under your buttocks to see where your pressure-sensitive areas are. If at-risk areas on the pressure map are found, then the therapist may try a different cushion alter the wheelchair seat, back or foot rest or show you how to relieve pressure on the vulnerable areas by repositioning your body.
- Pressure mapping is an excellent way to visually demonstrate the effectiveness of weight shifts.
- If pressure mapping is unavailable, work with a seating professional and try several different cushions to see what works best for you.
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How To Prevent Pressure Ulcers Or Bed Sores
Pressure ulcers are a common problem in palliative care patients. Decreased mobility, increased time spent in bed, and altered nutrition make these patients prime targets for skin breakdown. Pressure ulcers are painful. As a caregiver, one of the most important things you can do to keep your patient comfortable is to prevent one from developing.
Special Devices That Can Help You
In addition to turning and repositioning frequently, using a special surface to reduce or relieve pressure can help a great deal. The simplest of these is an egg crate mattress. Many hospice and home health agencies provide these free of charge but they are relatively inexpensive at your local department store.
If your loved one is spending a lot of time up in a chair, egg crate chair pads are also available. An egg crate surface helps distribute pressure more evenly, helping minimize the amount of pressure on one area.
A step up from the egg crate mattress is an air mattress overlay. This type of surface is placed on top of a mattress and typically alternates air pressure in various columns. When using an egg crate mattress or an air mattress overlay, its still important to maintain the turning schedule. These devices dont replace frequent repositioning.
The big guns of pressure-relieving devices are the fluidized air mattresses. These special mattresses contain silicone-coated glass beads that become fluid when the air is pumped through them. These mattresses do a wonderful job of relieving pressure but they have their downside.
The frame of the mattress makes transferring to and from bed difficult. And if the person wants to sit up in bed, a foam wedge would probably need to be used to help support their back. This mattress is really best suited for palliative care patients who are fully bed-bound, have severe pressure ulcers, and are in a lot of pain.
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