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Pressure ulcers refer to the damage of an area or part of the skin due to lying or sitting in one condition for quite long. The skin damage occurs over a long duration as the blockage cuts off blood supply to that particular body part. Other terms for pressure ulcers include bed sores, pressure injuries, pressure damage or pressure sores (Pressure ulcers, 2015).
Friction causes localized underlying skin tissue abrasions especially in areas having lots of bones such as knee, elbow or ankle joints. The frictional damage is due to either pressure or a combination of both stress and damage or deformation of the affected skin tissue. The clinical manifestation of pressure ulcers occur in four stages depending on the degree of damage as follows:
The skin reddens and feels warm to touch. The affected part develops itchiness. The skin's abnormal redness or erythematic occurs as a result of the dilation of blood vessels within the skin resulting from blockage of the free flow of blood. The reddened skin area may remain close to an hour even after the release of pressure.
The second stage occurs when the reddening skin part develops into a painful blister or sore that is open with a discolored skin forms around the sore. Both the epidermal and dermis skin loses thickness partially presenting its symptoms and signs as a swollen crater, blister or abrasion.
When a patient does not receive treatment, the damaged skin develops an appearance that resembles a crater which indicates that the pressure has damaged the tissue below the surface of the skin.
The fourth stage indicates the severity level of the pressure ulcer that has damaged both the skin and body tissues with high possibility of infections. Tendons, bones, and muscles may become visible as the wound around the damaged area worsens. The severity level is critical, and a patient requires immediate medical care.
Pressure ulcers have adverse health effects on patients hence the importance and relevance of the study to health practitioners particularly for nurses and caregivers involved in treating and managing the pressure ulcers. The research, however, focuses on priority for nursing diagnosis, implementation of particular nursing interventions, the kinds of complications that may occur when poorly managed or inadequate interventions.
The significance of the study of pressure ulcers to both the healthcare service providers and the overall health of patients are numerous. Firstly, pressure ulcers are among the major causes of mortality and morbidity, presenting healthcare challenges globally even though many such impacts are preventable. The topic is thus important as it aims at providing some of the nursing interventions and prevention measures to reduce the prevalence of pressure ulcers (Avşar & Karadağ, 2017).
On the part of healthcare, treatment and management of pressure ulcers are costly, yet it is easy to prevent. The study seeks to highlight the need to avoid the occurrence of pressure ulcers instead of focusing on the treatment which tends to be counterproductive especially among patients who have diabetes. Pressure ulcers adversely affect the overall health of patients who are the clients of healthcare service providers hence the need for adequate, effective and timely treatment (Wentworth, 2013).
The treatment ought to be during the initial stages before the condition worsens as it causes extreme pain, infections, slow recovery from morbid conditions and a patient may die especially if the situation reaches its final stage and causes infections to the wound. Richardson and Barrow (2015) noted that the determination and treatment of pressure ulcers depend on its severity level. The moment a patient reports to a health facility or home-based care health facilities suffering from pressure ulcers, a nurse's priority according to the nursing diagnosis handbook is a thorough skin assessment.
The skin assessment helps a nurse to determine if the patient may develop pressure ulcers or if they have symptoms of pressure ulcers. The evaluation tool during diagnosis is the Braden Scale which rates all the assessed factors on a scale of One to Four. The outcome of the assessment helps in staging the severity of the ulcer into different stages for effective treatment (Richardson & Barrow, 2015).
The 1993 American Nurses Association endorses clinical practice guidelines for treatment of pressure ulcers as per the nursing diagnoses handbook which guides nurses on how to diagnose pressure ulcers. If the diagnosis indicates that a patient suffers from pressure ulcers, some intervention measures are necessary to prevent the ulcer from worsening. The three essential nursing intervention based on the stage of infection includes reducing pressure on the affected area, caring for the wound and preventing infections (Smith, 2014). Reducing stress is during the first stage when the ulcer has not aggravated.
The reduction of pressure is through repositioning the patient or using support surfaces such as different cushions to help the patient lie or sit to protect the vulnerable skin. Caring for the wound through cleaning using a cleanser and a waterproof pad on an unbroken skin or dressing using a bandage to hasten to heal since bandage providers moisture on the surface and prevents microorganisms hence preventing infections (Wentworth, 2013).
During the implementation of the nursing intervention, a large number of possible complications may occur. Of unlimited possibility is the infection when a nurse poorly handles the ulcer sores which may worsen the condition and cause the death of the patient or recurrence of the pressure ulcers.
In conclusion, there is a need to strictly adhere to the preventive measures to treat and reduce the health effects of pressure ulcers. Inadequate cleaning of the wound may lead to infections that may worsen the patient's health and wellbeing. The topic thus highlights the causes of the pressure ulcers such as friction and tear, financial and health burden of the disease and intervention measures such as wound cleaning to prevent infection and ensure good health among elders and people prone to pressure ulcers.
Avşar, P., & Karadağ, A. (2017). Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis. Worldviews on Evidence-Based Nursing, 15(1), 54-61.
Pressure ulcers. (2015). Nursing Standard, 29(44), pp.17-17.
Richardson, A., & Barrow, I. (2015). Part 1: Pressure ulcer assessment - the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE). Nursing In Critical Care, 20(6), 308-314.
Smith, A. (2014). Pressure ulcer prevention. Nursing Standard, 28(31), pp.61-61.
Wentworth, K. (2013). Diagnosis, Management, and Prevention of Pressure Ulcers. Hospital Medicine Clinics, 2(2), e274-e291.
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