Introduction
A pressure ulcer is an area of skin with unrelieved pressure resulting in ischemia, cell death, and necrotic tissue. The constant external pressure or rubbing that exceeds the arterial capillary pressure (32mmHg) and impairs local normal blood flow to tissue for an extended period of time, results in pressure ulcer (Smeltzer et. Al., 2013). According to National Pressure Ulcer Advisory Panel, 2014, pressure ulcers are a major burden to the society, as it approaches $11billion annually, with a cost range from $500 to $70,000 per individual pressure ulcer. It is a significant healthcare problem despite considerable investment in education, training, and prevention equipment. This paper includes two different studies to link cause-effect
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With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
Risk assessment scales have been in situ for over 50 years within the adult sector. These scales consist of several categories, which are thought to be associated with the potential occurrence of a pressure ulcer. Factors such as mobility and incontinence etc. are considered. Each category of the assessment is added up to give a total. The score then suggests whether a patient is at low, medium or high risk of developing a pressure ulcer. Higher-risk patients are therefore more susceptible to develop pressure ulcers and interventions are implemented such as, Air mattresses or nutritional support which is hoped to reduce the occurrence of pressure
Vicki is a 42-year-old African American woman who was diagnosed with Hypertension a month ago. She has been married to her high school sweetheart for the past 20 years. She is self-employed and runs a successful insurance agency. Her work requires frequent travel and Vicki often has to eat at fast food restaurants for most of her meals. A poor diet that is high in salt and fat and low in nutrients for the body and stress from her job are contributing factors of Vicki’s diagnosis of hypertension. This paper will discuss the diagnostic testing, Complementary and Alternative Medicine treatments, the prognosis for hypertension, appropriate treatment for Vicki, patient education, and potential barriers to therapy that Vicki may experience.
How does this history of high blood pressure demonstrate the problem description and etiology components of the P.E.R.I.E. process? What different types of studies were used to establish etiology or contributory cause?
...ssure ulcers can be preventable if there is a systemic and multi-professional approach to their prevention and continuing assessment of skin integrity. Mary was determined and worked well with the physiotherapist; she was up and on her feet within a week of returning. Staff had to prompt her to move around the ward, which at times was hard for her due to her anxiety. Mary was deemed high risk for falls, so was put on a prevention of falls chart in conjunction with the pressure area chart and repositioning chart.
The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture.
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
Current Status of the Use of Modalities in Wound Care: Electrical Stimulation and Ultrasound Therapy: William J. Ennis, D.O.,M.B.A.,Claudia Lee, M.P.T.,Malgorzata Plummer, M.D.,Patricio Meneses, Ph.D.
Due to the fact that I have not read any of the Harry Potter books, or even watched any of the movies, I chose to go a different route. I decided to use the familiar character, Winston Smith, the protagonist from George Orwell‘s 1984. Winston is considered of having bad health, he smokes, drinks and has a hard time getting up in the morning. One of the most notable deformities that Winston is his varicose ulcer above his right ankle . This is Winston’s Mark that sets him apart as the protagonist for the story, Because it symbolizes his hatred and dislike for the party. In the second time the ulcer is brought up in the book, it itches due to the fact that Winston can’t remember why he started his diary. Subconsciously he is holding back his
The skin is part of the integumentary system; it is the largest organ of the body. The skin helps regulate body temperature, permits the sensations of touch, and protects the body from external infection. (Lewis, Dirksen, Heitkemper, & Bucher, 2014). Overtime mostly with bed bound patients the skin develops injuries due to prolonged pressure on the bony surface of the body and this is called pressure ulcer. A Pressure ulcer is a “localized injury to the skin and/or underlying tissue (usually over a bony prominence) as a result of pressure or pressure in combination with shear and/ or friction.” (Lewis, et al., 2014, p. 184).
The awareness of the risk assessment tools and methods to prevent pressure sores are essential in my nursing career to help save lives and improve the patients quality of life. This experience also showed me the importance of turning patients to reduce pressure on weight bearing areas or areas with pressure sores, and the use of pressure relieving mattresses In the prevention of pressure sores. In treating pressure sores, I now understand the role of the healthcare staff and the importance of coordination between them to formulate a patient centred care plan. It is also essential to follow the aseptic non-touch technique procedure in changing wound dressings to prevent the risk of developing infection and to promote healing. In the future, I will be more observant and will use critical analysis and reflection in every situation to be able to have better understanding of what is happening around
Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
This new era of year it is necessary for most nurses to undertake a literature review at one point in their study time. It is a complex process of skills, such as learning how to find the research topics and gaining skills of literature searching and developing ability to study and blending the data. The first step in literature search is to find a review topic. I found my topic, as I was interested in studying pain management of patient with pressure ulcers. I refined my search in to more specific so that the final information will be manageable. Selecting key terms is critical for achieving successful results when searching for evidence. A good place to begin identifying key terms is the PICOT question (smidt-114). In electronic data base
15, 18). The authors illustrated the SSM conceptual map in a clear and comprehensible manner that is easy to understand by identifying how the potential contributing factors to skin injury, along with the exacerbating elements, can lead to potential skin injuries such as pressure ulcer, skin tear, moisture-associated skin damage, and etc. (Campbell et al., 2016, p. 18). Lastly in the conceptual map, the authors enumerated the potential outcomes of skin injury in order of disease progression, as well as death (Campbell et al., 2016, p. 18). In addition to its conceptual map, the framework links and supports the research purpose stated by the authors. Campbell et al. (2016) stated that their research purpose is, “to develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults.” (p.