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executive summary on pressure ulcers
Case studies of pressure ulcers
nursing, case study, pressure ulcers
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Roles of the Registered Nurse (RN) are ever changing where it is key to continue to educate for the protection and well being of the patient. Pressure ulcers have become a main issue in healthcare in an attempt to lower cost as well as prevent further morbidities and complications for the patient. According to the National Institute of Health (NIH) a pressure ulcer is defined as an area of skin that breaks down when something keeps rubbing or pressing against the skin. An increase in immobile and elderly patients has increased the risk for the development of pressure ulcers. The education and prevention of pressure ulcers should be implemented as a key goal for a nurse during the care of a patient.
Pressure ulcers is tissue damage that occurs when the epidermis and softer underlying tissue is pressed up against a bony prominence for extended periods of time. (Ignatavicius, 2013) The pathophysiology behind the development of a pressure ulcer is the compression on blood vessels, which in turn restrict blood flow to the tissue leading to a decrease in tissue perfusion and oxygenation with an end result of cell death. (Ignatavicius, 2013) Pressure ulcers can occur anywhere on the body however it is most common over the sacrum, hips, and ankles due to the common position of the body residing on those bony prominences. Tubing and cords are another common source of pressure ulcers, such as lying on a Foley catheter tubing or having a nasal cannula that is to tight around the patient. As with most prevention and healing of illness or disease, proper nutrition plays a large role in pressure ulcers. Nurses must be aware of the mechanical forces that can put a patient at risk for or create a pressure ulcer. Friction is when a surface ru...
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...ng assistant and in turn free up time for the nurse to care for other aspects of the patient. Monitoring and assessing high-risk areas for development of pressure ulcers of these patients was a necessity at least once every shift. More frequent turning and positioning was needed due to the complete immobility of these patients. I found that the diligence and expertise of these nurses, combined with the continuance to gain knowledge, helped prevent pressure ulcers from developing or progressing.
Even the most experienced nurse must continue to gain knowledge to ensure proper safety for their patients. The use of evidence based practice to evolve the current prevention strategies will help make sure the best care is given to the patient. The nursing profession will only succeed with the continuation to gain knowledge and implement proper protocols for the client.
Dressing was chosen according to the availability in the hospital. This would include fatty acids, hydrogels, alginate, collagenase, and pa-pain. Depending on the stage of the pressure ulcer, various products were used such as hydrocolloids, calcium alginate, or chemical debridement. A nutritional evaluation was performed due to its extreme importance for wound recovery. Nurses emphasized the importance of changing the dressing daily during the research. The pressure ulcers were treated accordingly to the guidance of the team applying the dressings. However, air mattresses were used at the same time, and if the patients’ condition is allowed, they were taken from bed to chair.
The nursing profession is constantly in a state of change becoming more complex over time. Registered nurses work to prevent disease, promote health and help patients cope. They develop and manage nursing care plans, instruct proper outpatient care, and help improve and maintain health within their community. They are educators of health governed by state laws. Registered nurses can work in many different settings which determine their daily job duties. Depending on their level of training a RN could work with geriatrics, in intensive care units, as an educator, as clinical study observers, a midwife, oncology, or palliative care. Hospital nurses make up the majority of the RN group. They work as staff nurses who carryout medical regimens and provide bedside care. Most registered nurses work in well-lighted comfortable facilities, work nights, weekends, and holidays, and spend a considerable amount of time on their feet. They have to be available at a moment’s notice. Nursing also has its hazards all employees of care facilities are at risk for infectious disease, radiation poisoning, back injuries, shocks from electrical equipment, and hazards posed by compressed gas. Nurses are the link between doctors and patients.
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).
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Many years from now, I will take this experience with me to better myself as a nurse. I know for the future that it is in my patient’s best interest, if I collaborate with other health care professionals. In order to maintain patient safety, I must always remember to work together with my fellow collogues to obtain a positive working environment. In order to be a good nurse, I need to always understand that I am part of a team to help those in need. I want to incorporate providing efficient care to each and every patient the best way I possibly
Thomas, D. R. (2001). Issues and dilemmas in the prevention and treatment of pressure ulcers: A
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
Evidence-based practice (EBP) is a process, a clinical master tool, so to speak, used by the nurse who is focused on positive outcomes in patient care. Registered Nurses (RNs), that assume a leadership role, continuously assess their practice in order to find out what is working and what is lacking or in need of more information (Barry, 2014). The RN who uses EBP strives to prevent healthcare errors, critically thinking through processes and anticipating obstacles, methodically drawing upon clinical research and expertise, including their own knowledge and drawing upon the individual patient experience toward improving safety and quality care (Barry, 2014). This systematic approach sets the RN apart from others, who may otherwise be tempted to remain stuck in old ineffective routines, and allows the RN the unique opportunity to affect change, most importantly, change that is directed toward keeping patients safe and receiving the best quality care (Barry, 2014).
Additionally, the LPN cannot push medications into a peripheral intravenous line if the patient “weighs less than 80 lbs, is prenatal, pediatric, or antepartum”, although given that the situation is on a general med-surg floor it is unlikely these patients would be under Sarah’s care at this time. (Rules and Regulations of Practical Nurses. 2015) Sarah can delegate the postoperative patients who need dressing changes and ambulating them to the LPN, but Sarah should assess the wounds for complications initially and serve as resource to the LPN if she has questions about the wounds. Additionally, she could help the nursing assistant with answering calls and serve as a reference for the nursing assistant to ask questions or help with tasks if Sarah is not available. With regards to supervision, the LPN would need continuous supervision given that the working relationship is new. (Cherry and Jacob, 2014) Sarah should be available and willing to answer any questions or address any concerns the LPN
A registered nurse is a critical piece of the support system for injured and sick patients. Nurses are greatly valued in the health care system because they have many and varied responsibilities within hospitals and clinics, including: patient care, administration of medications; communication with other health care providers, patients and patients’ families; and education of patients, family members, and new nurses in training (Isaac, 2014).
Nurses are an equally important part of each client’s life. Nurses provide stable care to each client, answers their questions, gives medications and treatments, and assists with medical procedures. They also have the responsibility to explain to clients and family members what they should and should not do as they go through treatment and recovery. Nurses must quickly respond to patients needs. Every individual nurse has his or her own unique way of caring. There are so many ways to show caring that the possibilities are never ending. Nurse’s support, comfort, and help allow the patients to recover to the best of their ability. Their experiences in dealing with different patients that have unique situations on a daily basis helps the nurses become better caregivers. Therefore, every nurse is capable of demonstrating care in their respective environments.
The rate of errors and situations are seen as chances for improvement. A great degree of preventable adversative events and medical faults happen. They cause injury to patients and their loved ones. Events are possibly able to occur in all types of settings. Innovations and strategies have been created to identify hazards to progress patient and staff safety. Nurses are dominant to providing an atmosphere and values of safety. As an outcome, nurses are becoming safety leaders in the healthcare environment(Utrich&Kear,
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
My first patient that I started as student nurse on one of the long Rehab Center was a seventy two year old man who had Clostridium difficile (C.diff), Dementia, Hip replacement, and Obesity. Due to the above sickness he had many complications. I can still remember his face suffering from pain. Because of his lack of ambulation and incontinence, he had developed a very serious pressure ulcer under his sacral area. I went through to the room with my instructor and the instructor introduces me for the patient as his student nurse from Towson University and will taking care of him. However the patient was not happy and he becomes a challenging patient in my first experience day. But I may learned more from that challenging patient for my future experience.