As a result of Lily’s extensive hospitalisation period, a grade 3 pressure ulcers developed on her buttocks. A pressure ulcer is a localised injury to the skin which is usually located over a bony area as a result of pressure or pressure combined with friction (Willock et al., 2007). According to Sibbald et al., (2003) excreted bodily fluids are often common factors which contribute to the breakdown of skin, especially as a consequence of urinary or faecal incontinence. There were many factors which contributed to the breaking down of Lily’s skin, such as infrequent nappy changes and lack of mobilisation. Ensuring the maintenance of skin integrator within the critical care setting has its challenges. Often, patients are attached to multiple …show more content…
Stage 1- Non blanchable erythema of skin. The epidermis is still intact. Stage 2- partial loss of skin to the epidermis or the dermis. A superficial ulcer may be present. Stage 3- tissue loss, damaged or necrosis of tissue. Appears as a deep crater. Stage 4, full tissue loss with great destruction, Tissue necrosis or damaged muscle/bone (EPUAP, 2005). It has been argued that the identification of pressure ulcers is complex and patient specific. Often, nurses lack the expertise and education to identify the appropriate treatment of specific pressure ulcer stages and prevention. Nurses often show uncertainty in differentiating between grade two or grade three lesions. Diagnostic inaccuracies can have negative results in treatment and prevention interventions. Also, risk assessment tools should be considered (Suddaby et al., …show more content…
A study of both the Glamorgan scale and Branden Q scale found that there was a lack of variability regarding the Glamorgan scale. The study notes it was acceptable to use either the Branden Q or the Glamorgan scale within an ICU setting, however, the Branden Q scale proved to be far more superior to a general paediatric unit. However, the author noted that during the study there were few ulcers and therefore it’s premature to a draw a conclusion from this data (Willock et al., 2016).
McGough (1999) undertook a study to systematically review the effectiveness of risk assessment tools. Findings from this study suggested that risk assessment tools may be useful as a memory aid for nursing staff, however, should not be used to replace clinical
The Braden risk assessment tool was deemed to be appropriate due to the patient’s comorbidity’s of peripheral vascular disease and lymphoedema with the addition of an arterio-venous leg ulcer of the right leg. This scale is universally accepted as a tool to help identify those most at risk with a goal of allowing health care providers to use their experience and judgement to consistently reduce the risk or to ensure preventive care is appropriately prescribed (Guy, 2012). Pressure ulcers are a risk factor for those who suffer from
...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.
A similar study to predict risk of ulcers in pediatric patients was conducted to test the validity of using the Braden Q scale. A modified version of the Braden Scale, only containing three subscales, was used to utilize a shorter comparable tool. The Braden Q Scale is a revision of the Braden scale that is applicable in pediatrics. The two tools that were used were: the Braden Q Scale and skin assessments. The sample study consisted of 322 patients who were on bed rest for at least 24 hours. The patients were observed three times per week, for two weeks, and then weekly until discharge, which totaled 887 individual assessments. It was determined that both the Braden Q, as well as the modified Braden Scale was adequate tools to measure skin breakdown.
These risk assessments include, pressure injury assessment, nutritional status, fluid balance charts, falls risks assessment, and double checking of the right medication. These are all a set of examinations that are done throughout every day of the patients stay and depending on the individual it may be assessed every 20-30 minutes or every other hour. For Mr Azikiwe, each of these assessments must be made throughout the day as his flu-like symptoms are worsening, he lacks energy and does not feel like eating. With his lack of energy and weakening body it may lead Mr Azikiwe to be dehydrated, malnourished and have pressure injury sores from lack of movement. Through the help of these risk assessments, it can be determined exactly where Mr Azikiwe is with his health and come up with possible ways to improve it. A pressure injury assessment would be crucial because at this age his skin is more prone to pressure sores, and due to his lack of energy, he will need to be checked on and turned at least every 2 hours. Other things that may reduce his chances of getting pressures injuries are by keeping the skin clean and dry, protecting the skin by applying talcum powder or cushioning at friction points. Due to the fact that Mr Azikiwe does not feel like eating much, his nutritional status and fluid balance will need to be assessed daily. By keeping track on these, it will help in achieving a healthy nutritional status and fluid balance chart so that he may regain his energy. In addition, because of Mr Azikiwe’s condition, a set of falls risks assessment must be made each time before leaving the room to ensure there is no chance of him accidentally falling in the absence of a nurse. Along with this, it is crucial that he receives
Each inflatable mattress has its own main cause punkteringen.Beach mattresses suffer mainly from sharp-edged shells, stones, twigs or pieces of glass, but sleeping mattresses, bed inflatable ie they can be victims of domestic animals that have decided to innocent clawing, while the owner is not ser.Men this is a fact - a product suddenly blown away, and we urgently need to look for information on how to seal the mattress, and preferably ponadezhnee.
This assignment will discuss the nurse’s role with an individual elderly male patient they have been involved with, in their treatment for a diabetic foot ulcer within a community setting. An overview of the patient’s care will be explained including an explanation of type two diabetes and blood glucose control for this class. The development of the ulcer will be explored and the factors that influence it within the community setting for district nurses. This essay will critically analyse the role of the nurse in establishing learning opportunities and issues that relate to the healing of a diabetic ulcer, whilst facilitating the patient’s home environment and correspondingly educating them on their changing health care. The importance and need for risk assessment scales in clinical practice is also discussed using the Waterlow scale. It will also review and discuss relevant literature relating to diabetic foot ulcers, their development and treatment, then reflect on the nurse’s own experiences in clinical practice and evidence based practice.
Respiration is vital for all physiological systems to function and is especially important for patients that are recovering from disease and invasive medical procedures. Respiration is contingent on how much pressure is exerted on the internal organs and how much resistance these organs meet when trying to relieve this pressure. In this regard, posture has a great influence on how well the respiratory system functions. It has been found that standing and lying in an augmented prone position are the best postures for promotion of respiratory function, as these positions allow more room for respiratory muscles to move and decrease resistance. In these positions, patients are able to intake greater amounts of air, which allows for greater perfusion of oxygen to the tissues, in turn allowing the tissues to heal faster. These postures are found to be most beneficial in patients who suffer from respiratory distress or have similar symptoms. The position that best promotes respiratory function is not always one that is used by medical professionals, as many variables influence this decision. Practitioners must consider the complex needs of the patients when deciding how to treat them. This process often leads the professional to place the patient in positions that are less beneficial to respiratory function in order to accommodate other needs of the patient, such as medical equipment or relief of pressure sores. Further barriers to use of the evidence-based practice are the overall practicality of placing a patient in the discussed postures. It may be very difficult to place a patient in an augmented prone position if he or she is in respiratory distress, as this position seems counterintuitive to the patient. Other patients may not b...
The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety issues surrounding PCA use include infusion pump programing errors, basal infusion dosing, and proxy errors when using PCA by proxy (Ladak, Chan, Easty, & Chagpar, 2007). Therefore, the purpose of this report is to examine the benefits and risks of patient-controlled analgesia and how it relates to nursing practice.
In providing quality patient outcomes, current evidence based research has to be an important part of this process. With every new research proposal, a solid foundation has to be the basis for that specific research. The following paper is a literature analysis of current studies that support the use of negative pressure wound therapy (NPWT) in healing diabetic foot ulcers in adults. This paper will also discuss what search methods were used, strengths and weaknesses of each study, and the validity and relevancy of the research on the issue of non-healing diabetic foot ulcers in healthcare today.
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).
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
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.
When a wound is determined as non-healable, as described by Sibbald et al (1), it should not be treated with a moist treatment and should be kept dry in order to reduce the risk of infection that would compromise the limb. It is also important to consider the patient 's preferences and try to control his pain, his discomfort in activities of daily living and the odour that their wound may produce. In this case, special attention must be given to infection prevention and control. Some charcoal dressing would be interesting in the care of our non-healable wounds at St. Mary 's Hospital.
Firstly, nurses are expected to practice evidence-based health care hence a mastery of information about the essential and safe dose of drugs for a patient is very important for a nurse. Consequently, it could be the determinant between the life and the death of the patient. Pharmacology is a discipline which is mandatory for the nurse to excel in to be efficient in discharging his/her duties. Understanding which drug to use, the right dosage, the expected side effects which may occur and the contra-indications of the various drugs are key in the preservation of