The present project aims to identify the epidemiology and clinical presentation of pressure ulcers as one of the most disturbing issues that may develop in patients staying in bed for a long time. The definition of pressure ulcer, as well as its complications and diagnosing procedures, will be presented. The paper will explore the background of the researched problem and will end with a PICOT question.
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A pressure ulcer is defined as a localized “damage to the skin and underlying soft tissue” that commonly occurs over a bony prominence (Edsberg et al., 2016, p. 2). A pressure ulcer can also appear on the skin related to a medical device (Edsberg et al., 2016). This kind of injury develops when there is prolonged or intense pressure. Also, the injury may appear when pressure is combined with shear (Edsberg et al., 2016). Apart from pressure intolerance, the following aspects may cause the damage of soft tissue: perfusion, comorbid conditions, microclimate, nutrition, and soft tissue condition (Edsberg et al., 2016).
A pressure ulcer is the most common in elderly patients. Frequently, pressure sores are believed to be the result of insufficient nursing care. However, it is more relevant to consider pressure ulcers as a preventable complication that may be caused by prolonged immobility of a patient (Coleman et al., 2014). Pressure injury may be of four stages. At stage 1, only the upper layer of the skin is affected (Edsberg et al., 2016). Stage 2 involves the partial-thickness loss of skin with exposed dermis (Edsberg et al., 2016). At stage 3, full-thickness skin loss is observed. At stage 4, the stage 3 damage is complicated by tissue loss (Edsberg et al., 2016).
The clinical manifestation of pressure sores can be misleading to observers with insufficient experience. The degrees of pressure resistance is different in soft tissue, muscle, and skin (Kirman, 2018). As a rule, the muscle has the lowest degree of resistance, and it may become necrotic prior to the process of skin breakdown (Kirman, 2018). What is more, the distribution of pressure is not equal. At the bony prominence, the pressure is the greatest, and then it slows down toward the periphery (Kirman, 2018). A minute skin breakdown may hide a large undermining of skin edges.
Complications of a pressure ulcer may vary between moderate and rather serious or even life-threatening. The most common types of complications are infections (Chou et al., 2013). The infection can damage both joints and bones. If not treated promptly, such complications may limit joint or limb mobility. Also, tissues may be harmed because of infections (Chou et al., 2013). In rare cases, the prolonged pressure ulcer without appropriate care and treatment can lead to sepsis or cancer.
To diagnose pressure ulcers, it is necessary to perform a close analysis of the patient’s skin. It is crucial to define the stage of the sore correctly in order to ensure the most suitable treatment (Edsberg et al., 2016). One of the major aspects of the diagnostic procedure is the confirmation of “the presence of pressure and/or shear as a causative factor” (Edsberg et al., 2016, p. 2). Inquiring about the degree of the patient’s pain may help the doctor to establish the seriousness of the sore.
Conclusion with PICOT Question
A pressure ulcer is a rather serious health issue that may occur when the patient stays in bed for a long time. In order to minimize the risk of pressure sores’ development, the intervention is suggested that is reflected in the following PICOT question: in patients that are identified at high risk for developing a pressure ulcer (P), does the implementation of a pressure ulcer protocol initiated in the emergency department (I) as compared to patients who receive usual care (C), reduce the incidence of hospital-acquired pressure ulcers (O) on day 3 of hospitalization (T)?
as little as 3 hours
Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A. J., Reitel, K., & Buckley, D. I. (2013). Pressure ulcer risk assessment and prevention: A systematic comparative effectiveness review. Annals of Internal Medicine, 159(1), 28-39.
Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., … Nelson, E. A. (2014). A new pressure ulcer conceptual framework. Journal of Advanced Nursing, 70(10), 2222-2234.
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. Journal of Wound Ostomy & Continence Nursing, 43(6), 1-13.
Kirman, C. N. (2018). Pressure injuries (pressure ulcers) and wound care clinical presentation. Medscape. Web.