Management of pressure ulcers in a high risk patient: a case study

1. IntroductionClinically, twinge ulcers atomic number 18 defined as the lesions that are the result of localized tissue damage or cell demise ( normally necrosis), splited beca subprogram of rack over a bony prominence.More commonly, they are as well as known as public press sores or linesores as they are principally developed by forbearings that are keister-bound (Wake, 2010). Approximately, 3 million adults are touched by draw ulcers and are most(prenominal) common in infirmaryized longanimous roles (Lyder and Ayello, 2008). However, trenchant solicitude and fear throws against impel ulcers are still missing. The role of treat care is a fundamental aspect to tweet ulcer management, including its barroom and treatment (Wake, 2010). In this upshot study report, I visited a diabetic uncomplaining as a district nurse for insulin administration and earmark house by assessing the long-sufferings endangerment of evolution thrust ulcers out-of-pocket to associated pathological and other pretend factors.1.1. Purpose of the studyIn all wellness care settings, coerce ulcers remain unrivaled of the major issues. More so, public press sores or imperativeness ulcers are associated with signifi nookyt cause for morbidity in the medical examination community. The main purpose of this persevering visit was to provide healthcare support for patients who were at adventure of exploitation crush ulcer. The healthcare support included the encounter minimisation by doing peril perspicacity, therapeutic interventions, suggestions for modus vivendi changes including exercise and fastetical habit. All these were targeted with the views of providing fourth dimensionly assessment of pressure ulcers in mellowed risk patients, and suggest therapeutic interventions for timely treatment of the condition.1.2.Patient historyThe patient was 75 years old male, diabetic and paralysed delinquent to recent barb attack. He was completely be d bound and was on wheelchair. fostermore, the patient was deplorable from canistercer of the oesophagus. Since the patient could not mobilize, his family members and carers used to transfer him from the bed to his wheelchair and wheelchair to his bed.1.3. risk assessments of needs, vulnerabilities and strengths of the patientThe patient was inveterateally ill and had several complications associated with his conditions. Stroke attack had caused him palsy and was unable to move. This had put him in significant risk of development pressure ulcers. The patient was also diabetic. Diabetes causes s piteous healing of wounds that whitethorn lead to ulcer (Guo, et.al. 2010). In this patient, the combination of factors including diabetes and immobility had increased his risk of underdeveloped pressure ulcers. Other factors such as old age of the patient, cancer and sustenanceary factors would trigger the development of these pressure sores. Cancer is a chronic complaint that ma y cause severe debilitation and prolonged confinement to bed. Therefore, it is judge that patients with cancer are at significant risk of developing pressure ulcers (Walker, 2001). Diet may have a supporting role in the development of pressure ulcers. Although the role of victual in thwarting the development of pressure ulcers is still debatable, it is obvious that patients who are malnourished are at risk of developing those (Doley, 2010). Thus, edible therapy could be central in minimising the risk of developing pressure ulcers. It was seen that the patient was clearly underweight due to his chronic health conditions. Overall, the following risk factors of the patient were considered maculation making his assessment. Based on these risk factors, care plans and suggestions were made to minimise the risk in the patient. sensory(a) factorThis factor was assessed in order to identify how well the patient can process sensory input from the shinny, as well as how potently he can communicate level of sensation. Since the assessment of clamber is an important way to identify patients risk of developing pressure ulcers, it would ensure the degree of risk of pressure ulcer in this patient and hence, take measures to prevent them before complications arise.MoistureMoisture is other hallmark of pressure ulcers. Excess skin moisture puts patients at great risk of developing pressure ulcers. It is common that patients who are confined to bed produce more sweat. Thus, it is require to assess what degree the skin is capable to moisture.ActivityLack of activity is 1 of major risk factors of developing pressure ulcers in bedbound patients. Continuous friction between the skin and bed mattress may result the development of pressure sores. Measuring the activity is another(prenominal) important parameter to predict the patients risk of pressure, irrespective of their degree of mobility. Patients who are unable to move need to be materially turned by healthcare s taffs or family members at regular intervals alimentationAs mentioned earlier, although aliment may not have direct effects on the patients risk of developing pressure ulcers, it may be workable that lack of required nutrients may increase its complications. It is thus important to evaluate what constitutes the usual pattern and amount of caloric intake in the patients. later evaluating the above risk factors in the patient, it was concluded that the patient was likely to develop pressure ulcers if timely interventions were not introduced. These would have direct effect in patients health. These ulcers influence the risk of bacterial and viral infections, which can become life threatening in chronically ill patients. In addition, there is a high rate of mortality associated with pressure ulcers. deathrate rate is high as 60% is reported in old patients with pressure ulcers within 1 year of hospital discharges (Lyder and Ayello, 2008).The patient in this case study could have weak ened immune system due to his old age and illnesses such as cancer and diabetes. In immune-compromised patients, the risk of infections spreading into their blood and other organs of the body are well high. This may result blood poisoning and septicaemia. Both these conditions are real fatal and categorised as medical emergencies (Redelings, et.al. 2005).However, despite of several associated risk factors, the patient was provided with proper care and support by his carers and family members. He was regularly taken off from his bed with the support of wheelchair. More so, the patient was on medications to control his blood sugar. He was also supplemented with vitamin to strengthen his immunity. To conclude, patient although was receiving hold healthcare service, these were mainly therapeutics which included medications against the chronic illnesses which he had. Patient and family members were lacking suggestions and expert advice in regards to minimising the risk of pressure ul cers. It was also observed that the patient was provided with a normal bed and mattress that would further trigger the risk of developing sores.2. Interventions and referralsAfter evaluating the patients condition, as a district nurse, I provided the evidence based interventions and referrals to the patient and his family members and carers as preventive approaches of pressure ulcers. Firstly, the patient was provided with a hospital bed with pressure relieving mattresses. This would help minimise the friction between patients body and the bed and hence, reduce the risk of pressure ulcers. Moreover, this would provide support surfaces and help in pressure redistribution (Stannard, 2012). some(prenominal) recommendations for skin care including the use of cold water instead of warm water, use of mild cleansing agents to minimise irritation and dryness of the skin and excessive moisture was suggested. The patient was also advised to avoid low humidity as it may promote scaling and d ryness (Lyder and Ayello, 2008). Further suggestion such as avoiding mechanical loading was given. This is considered as one of the most effective preventive measures of pressure ulcers in hospitalized patients (Lyder and Ayello, 2008). Thus, family members were advised to much turn and reposit the patient while in bed. It is essential that patient intake adequate levels of both macro and micronutrients to prevent complications of pressure ulcers. This patient was already supplemented with vitamins and minerals, so no action was taken. However, the patient was suggested to eat diet high in proteins, which are essential for wound-healing and overcome malnutrition.Management of offend is another key aspect in patients with pressure ulcers (Cooper, 2013). Pressure ulcers can be very painful and may require interventions with analgesics (Wake, 2010). However, this patient did not require analgesic treatment as the pain due to pressure ulcers was not very severe. Instead, focus was giv en on the preventative approaches in minimising the complications associated with pressure ulcers. Finally, the focus was given on the patient/carer education in the management of pressure ulcers. Both patient and carers/family members were made aware active the risk factors of pressure ulcers. Also, they were educated and made aware on the most vulnerable sites of the body that are at risk of developing pressure ulcers. General training was also given on how to take care of skins and methods for pressure reduction. They were told about the severity of the condition and requested to seek medical advice if symptoms of pressure ulcers persist.3.Critical evaluation and evidence-based examination of outcomes of interventions and referralsThe interventions and referrals made for the patient in this case study were evidence based. Risk assessment was made considering the shopworn pressure ulcer prediction tool, Braden Scale, by observing the six vital signs of pressure ulcers as explain ed earlier. This tool has allowed for the early prediction of pressure ulcers and thus door of early interventions before the complications are developed (Sving, 2014).Classification of pressure ulcers is one of the best ways to predict its outcome. Pressure ulcers are classified into unlike periods (Lyder and Ayello, 2008). put I is determined by the presence of redness in the skin. In case if the redness in the skin is observed, nurses are required to make thorough skin inspection and advice patients about the preventive measures. Stage II is characterized by the loss of skin with the presence of blisters. In stage III loss of skin is quite thick however, not candid to muscle or bone tissue. In this stage, there is a high risk of infections, so care should be given in personal hygiene (Sving, 2014). Also, patient should be suggested to include vitamins and minerals in the diet to prevent the possible risk of infection. In stage IV there may be an exposure to bone, tendon and muscle. This condition is considered as potentially dangerous, due to associated risk of life threatening bacterial infections. In many cases, this may also require hospital admission to reduce further complications (Lyder and Ayello, 2008 Sving, 2014).To conclude, nurses are required to assess various stages of pressure ulcers and provide treatments and suggestions based on these stages. This is because different stages of pressure ulcers may require different treatment plans. close to could be minor and may be improved through general suggestions such as encouraging patients to move and involve in physical activities and maintaining healthy diet whereas some may require therapeutic interventions including the use of antibiotics to treat bacterial infections, dressing and cleaning of the wound and hospital admissions if complications are severe. (Wake, 2010).Ample evidence is now available on the perceiveing of effective pressure ulcer treatments. Treatment strategies such as use of hospital bed, avoiding mechanical loading, and physical activity are now considered as the standard form of treatments in pressure ulcers. These approaches not only reduce the risk of pressure ulcers, but are also beneficial in grave its complications. Furthermore, the association of pressure ulcers with other chronic diseases such as cancer, diabetes and guessing are well understood. Thus, much attention is to be given while giving care to the patients who have these conditions. Educating patient and family members on the risk factors and management is another approach to pressure ulcer management as suggested by NICE guidelines (Wake, 2010)However, the available knowledge on the evaluation of risk assessment of pressure seems insufficient. The evidence lacks support and requires further epidemiological research to understand risk factors of pressure ulcers in greater depth. Some of the interventions and their effectiveness including re-positioning and nutrition are still questionable. Further studies on the influence of different round intervals on the development of pressure ulcers need to be carried out. Similarly, what specific diet is suitable for pressure ulcer patients needs further clarification.Appendix1 Care plan of the patient Risk assessmentCare goalsInterventions and evaluations Patients needs and vulnerabilities old age, bed-bound, chronic diseases including cancer and diabetes, paralysed due to strokeTo identify the patients risk of developing pressure ulcersThe patient was provided with hospital bed, cushion for his wheelchair and family members were suggested to move the patient time to time Patients strength on proper medications, carers and family members providing the support, supplemented with vitamins and minerals to march on the immune functionTo build on the patients strengths and to meet his needsPatient was provided with ample support from the family members. High protein diet was suggested as this may improve would-hea ling. Signs of complications, such as pain, bacterial and viral infections.To avoid complications associated with infections including blood poisoning and septicaemiaImmune fighter such as vitamins and disinfectant creams to avoid infections.ReferencesCooper, K.L. 2013, Evidence-based prevention of pressure ulcers in the intensive care unit, Critical Care Nurse, vol. 33, no. 6, pp. 57-66.Doley, J. 2010, Nutrition management of pressure ulcers, Nutrition in clinical practice authorized publication of the American Society for Parenteral and Enteral Nutrition, vol. 25, no. 1, pp. 50-60.Guo, S and DiPietro, L.A, 2010. Journal of dental research. Factors Affecting Wound Healing, vol. 89, no. 3, 219-229.Lyder, C.H and Ayello, E.A, 2008. Patient refuge and Quality An Evidence-Based Handbook for Nurses. Pressure Ulcers A Patient Safety Issue.Lyder, C.H, 2003. Clinicians corner. 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