Pressure ulcer prevention and staging in clinical nursing practice

Nursing

Pressure Ulcers

A pressure ulcer is a lesion that is caused by unrelieved pressure, which consequences in damage to underlying issue. Pressure ulcers normally develop on bony prominences, but they can also develop in other areas related to pressure from an ill-fitting device, cast, and cervical collar or other many other things. It is believed that up to 1.7 million pressure ulcers occur every year in the United States. Treatment is costly in both healthcare dollars and patient quality of life, but the good news is that they are preventable.

Pathophysiology / Risk factors

Pressure is the vertical force exerted that causes tissue hypoxia and ischemia. Over time, pressure to an area occludes capillary blood flow and lymphatic circulation. If pressure is relieved in a timely fashion before injury has occurred, they body can compensate and blood will return to the area and the skin will seem to flush. This is called reactive hyperemia. The area of erythema will become white when condensed with a finger. When hyperemia continues there is a greater chance for deeper tissue injury to take place. This is a serious sign that tissue damage is about to happen or has already taken place.

Prevention / Intervention

Screening tools can be a cost effective means of identifying patients who are at risk for developing pressure ulcers. These tools identify specific areas that need to be addressed and watched closely. After areas of risk are identified, targeted interventions can be put into place that can further reduce the risk of pressure ulcer development.

Knowledge of pressure ulcer prevention strategies is vital. Implementation of targeted prevention strategies may be dependent on the areas that have been acknowledged to be at risk. Education is the essential piece of pressure ulcer prevention. This includes education for staff at all levels, as well as patients and caregivers. Staff education should include information on the facilities specific policies and pressure ulcer prevention program. Staff should be educated on the risk assessment tool used, excellent skin assessment skills, how to consult the wound care specialist if need be and the importance of consultation with the multidisciplinary team if necessary.

Future use of Knowledge

The knowledge that was contained in this article was very informative and will be very helpful as I continue my nursing education. As I learn the tools of my trade it will be important for me to know which patients are more likely to be susceptible to pressure ulcers so that I can do the best that I can to try and prevent them. Since prevention and/or early detection are the keys it is important for me to know as much about pressure ulcers as possible. I need to know how to prevent them, how to treat them and what to look for when doing risk assessments. I don't feel that a person can know too much about something, so my goal is learn as much as possible so that I can be the best nurse possible.