The Skin: The Integumentary System

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).

Pressure ulcer is mostly developed in the coccyx, buttocks, ankles, hips and heels. Pressure ulcers staging is a wound

classification best carried out by the wound care team. The staging of pressure ulcer ranges from suspected deep tissue injury; where the skin is purple or maroon caused by damage to the underlying soft tissue due to pressure, but the skin is intact or blood filled blister, to the unstageable ulcer; this is when there is a full thickness tissue loss and the base of the wound is covered by purulent or slough. (Lewis, et al., 2014). However, the treatment of pressure ulcer is relatively dependent on the staging of the ulcer.
Totally dependent patients are patients that depend totally on others for activities of daily living. These groups of patients are at great risk of developing pressure ulcer, and they develop pressure ulcer from various stages and has contributed to their long hospital stay. Immobility is not just the only characteristics that put this group at risk of developing pressure ulcer, but also their body is deprived of nutrients, adequate blood circulation, and effective immunology.
A Pressure ulcer is a major skin care concern for healthcare providers, especially for the totally dependent patients. However, not only the healthcare providers are unease about the epidemic engulfment of pressure ulcer, but also caregivers, community, Medicare and Medicaid management center. As the caregiver, they want to be alleviate of the worry that their love ones will not develop pressure ulcer after their hospital stay. The community health systems are providing education to patients, families, and caregivers as regards measures to prevent development of pressure ulcer. However, because “of the relativity short time community nurses spend with patients, pressure ulcers can develop between visits, so it is essential to get patients and their families and/or carers involved in pressure-area management.” (Payne, 2016) More so, pressure relieving equipments are also provided to reduce community acquired pressure ulcer. With the Medicare/ Medicaid program, there are eleven preventive adverse outcomes under the CMS reimbursement policy and of these 11 patient outcomes, “four (severe pressure ulcers, falls and trauma, catheter-associated urinary tract infections, and vascular catheter-associated infections) are considered nursing-sensitive quality outcomes that can be decreased with greater and better nursing care.” (Sung-Heui, 2016). All hospitals are working endlessly to ensure that these outcomes are reduced or possibly zero in their organization.