/
Pressure Ulcers Pressure Ulcers

Pressure Ulcers - PowerPoint Presentation

stefany-barnette
stefany-barnette . @stefany-barnette
Follow
574 views
Uploaded On 2016-06-16

Pressure Ulcers - PPT Presentation

Evidenced Based Presentation Michelle Scarlett Purpose and Objective of presentation Educate about Pressure Ulcers and its presentation Introduce a case scenario Preventable Measures ID: 364421

ulcers pressure stage skin pressure ulcers skin stage patients ulcer intervention nursing tissue nutrition amp loss wound study risk

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Pressure Ulcers" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Pressure UlcersEvidenced Based Presentation Michelle ScarlettSlide2

Purpose and Objective of presentation

Educate

about

Pressure Ulcers and it’s presentation

Introduce a case scenario

Preventable

Measures

Current

treatment/intervention

Gaps in reducing frequency

Encouraging the use of current methodsSlide3

Video

on Pressure

Ulcers

http

://

www.youtube.com/watch?v=Eyuguc7KKC4Slide4

Statistics“Pressure ulcers are the 3rd most costly complications following cancer and cardiovascular disease”

Incidence rate 0.4-38 % and prevalence has been reported to be 3.5 -69%

The acceptable incident rate is less than 2%

2/3 of pressure sores occur in the elderly above 70 years of age

In spinal cord injury patients, pressure ulcers occur in 30-85 % of patients in the first month of injury.

Paraplegics and quadriplegics are likely to have multiple ulcers.

The National Pressure Ulcer Advisory Panel reported in 2005 a 68.8% mortality rate in the elderly with stage 3-4 pressure ulcers, because of secondary systemic complications.Slide5

Case scenarioHPI: Patient was a 64 year old white female diagnosed with Alzheimer's. She presented to the hospital on October 4, 2012 from her nursing home, following an obstructed bowel for which she had to have surgery. At the time of her assessment

it was noted that the patient had a stage 3 pressure ulcer of her left buttocks that was progressively turning into a stage 4 ulcer. The patient was about 250

lbs

with impaired mobility of her lower extremities. She was listed to be repositioned every two hours and have her wound flushed with saline solution to assist with healing. However, instead of the ulcer getting better the ulcer got worst. According to the doctor's notes it appears that client wasn’t being repositioned in the nursing home as often as she should have and the conditioned may have continued to get worst if someone didn’t take note to the fact that she hadn’t had a bowel movement in almost a week.Slide6

Pathophysiology

A

pressure ulcer is an irregularly shaped, depressed area that results from necrosis of the epidermis and/or dermis layers of the skin. Prolonged pressure causes inadequate circulation, ischemic ulceration, and tissue breakdown. Muscle tissue seems particularly susceptible to ischemia. Pressure ulcers may occur in any area of the body but occur mostly over bony prominences that can include the occiput, thoracic and lumbar vertebrae, scapula, coccyx, sacrum, greater trochanter, ischial tuberosity, lateral knee, medial and lateral malleolus, metatarsals, and calcaneus.

Some 96% of pressure ulcers develop in the lower part of the body, with the hip and buttock region accounting for almost 70% of all pressure sores.Slide7

Other NamesBed soresDecubitus ulcers

Decubiti

Pressure

soresSlide8
Slide9

StagesStage I- Nonblanchable erythema; involves changes in the underlying vessels of the skin; bright red color that does not resolve after 30 min of pressure relief; can be painful and

tender

Stage II-

Partial thickness skin loss of epidermis and dermis; cracks or blisters on skin with erythema and/or

indurations

Stage III-

Full-thickness skin loss of epidermis and dermis; extends down to subcutaneous tissue; appears as a crater or covered by black eschar, wound base usually not painful; indistinct borders; may have sinus tracts or undermining

present.

Stage IV-

Full-thickness

skin loss with extensive destruction of tissue, muscle, bone, and/or supporting structures; appears as a deep crater or is covered by thick eschar; wound base not painful; may have sinus tracts and undermining presentSlide10

Stages 1-4Slide11

Other StagesSuspected deep tissue injury-Area

of localized, discolored intact skin that is purple or maroon-red in color. It may also appear as a blood-filled blister resulting from damage to underlying soft tissue. Preceding skin changes may include skin that is painful, firm, boggy, or that has a different temperature compared to the surrounding

skin Slide12

Other

Stages

Unstageable

-

Full-tissue

thickness loss in which the base of the ulcer is covered by slough or an eschar and, therefore, the true depth of the damage cannot be estimated until these are removed

.Slide13

At Risk PatientsBedridden- limited mobilityIncontinent-moisture

causes maturation of skin

Obese-

more weight bearing on bony prominences

Poor nutrition-

balance of vitamins-C, Zinc and other trace minerals

Mobility is

impaired

-failure to make postural changes

Cognitively

impaired

to state need for change and repositioning

I

As a nurse you have to do skin inspections!”Slide14

Nursing DiagnosesIneffective peripheral tissue perfusion related to reduced interrupted blood flow as evidenced by presence of inflamed, necrotic lesions.Slide15

Pressure Ulcers affect and can causeIncreased hospital stayPatients more prone to infections

Loss of self-esteem

Loss of earnings

Amputation

DeathSlide16

Medical and Nursing Interventions and Care Guidelines from current research literature

supporting

international best practice of

Repositioning !!!

Study:

Randomized study on 213 Irish and white patients from 12 long-term hospital settings at risk of developing pressure ulcers. 77% were women, 65 % over 80 years old. 70 % low risk of malnutrition. 77% limited activity. 79 % bed ridden.

Data:

Braden scale-risk assessment, MUST- nutrition, EPAUP-classification

Results:

3 (3%) patients in the experimental group and 13 (11%) in the controlled group developed a pressure ulcer.

Conclusion:

Repositioning older adults at risk of pressure ulcers every three hours at night, using the 30 degree tilt, reduces the incidence of ulcers. The study supports the intervention that repositioning patients is a vital preventive method in avoiding pressure ulcers.

Study based on: http

://www.pressureulcerguidelines.org/therapy/Slide17

30 degree tilt versus 90 degree tiltSlide18

Medical and Nursing Interventions and Care Guidelines from current research literature supportingThe objective of this study was to evaluate the effects of nutrition intervention on nutritional states and healing of pressure ulcers

by standardizing or unified factors including nursing, care and treatment in a multicenter open randomized trial.

Tube-fed

patients with Stage III-IV

pressure

ulcers

were selected. The control group (30 patients) received the same nutrition management as before participating in this trial, whereas the

intervention

group (30 patients) was given calories in the range of Basal Energy Expenditure (BEE) × 1.1 × 1.3 to 1.5. The

intervention

period was 12 weeks. The efficacy and safety were evaluated based on the nutritional states and the sizes of

ulcers

(length × width), and on the incidence of adverse events related to the study, respectively. The calories administered to the control and

intervention

groups were 29.1±4.9 and 37.9±6.5 kcal/kg/day, respectively. Significant interactions between the presence or absence of the

intervention

and the

intervention

period were noted for nutritional states ( p<0.001 for body weight, p<0.05 for

prealbumin

). Similarly, the size of

ulcers

differed significantly between subjects in the

intervention

group and in the control group ( p<0.001). The results suggest that nutrition

intervention

could directly enhance the healing process in

pressure

ulcer

patients

.Slide19

Medical and Nursing Interventions and care guidelines as applied to specific patient

Pressure Ulcer

Classification

- Stage 3

Debridement

- Removing dead

tissues

Assessment, Monitoring & Cleansing

- to prevent urine and feces from entering the wound

Nutrition

for

Healing

- increase protein, vitamin and calorie intake

Pain Assessment &

Management

-medication-

diazepam, baclofen, or

dantrolene

sodium

Support Surfaces for

Treatment

-pillows to relieve pressure on the opposite side and between bony prominences and air birds

Dressings

-Hydrocolloid

dressings

(

DuoDerm

)

Biophysical Agents

Negative Pressure Wound Therapy

Growth Factors & Biological Dressings

Slide20

GapsMore research needs to be completed regarding the right intervals to reposition patients to reduce their risk of pressure ulcers.Studies needs to be focus on the situation of the patient and how to reduce prevalence in their case, as current intervention may not be as effective for all bedridden individuals.Slide21

Pertinent NCLEX style Questions You are caring for a patient and noticed a superficial ulcer on the patient’s buttock that appears as a shallow crater involving the epidermis and the dermis. Which of the following stages would you say best describes this break in skin integrity?Stage I

Stage II

Stage III

Stage IVSlide22

Pertinent NCLEX style Questions

Which

of the following interventions is most appropriate for preventing pressure ulcers in a bedridden elderly client

?

1

.

Slide

instead of lift the client when turning.

2. Turn and reposition the client at least every 8 hours.

3. Apply lotion after bathing the client, and vigorously massage her skin.

4. Post a turning schedule at the client's bedside, and adapt position changes to her situation.Slide23

Don’t forget!!- people who can’t turn themselves need your help!!Slide24

ReferencesAgrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal Of Plastic Surgery,

45

(2), 244-254.

Moore

, Z., Cowman, S., & Conroy, R. (2011). A

randomised

controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers.

Journal Of Clinical Nursing

,

20

(17/18), 2633-2644.

doi:10.1111/j.1365-2702.2011.03736.x

Ohura, T.,

Nakajo

, T., Okada, S.,

Omura

, K., & Adachi, K. (2011). Evaluation of effects of nutrition intervention on healing of pressure ulcers and nutritional states (randomized controlled trial).

Wound Repair & Regeneration

,

19

(3), 330-336.

doi:10.1111/j.1524-475X.2011.00691.x

Unbound

Medicine-Disease and Disorders-http://

nursing.unboundmedicine.com/

nursingcentral

/

ub

/view/Diseases-and-Disorders/73697/all/

Pressure_UlcerSlide25

Questions?????