One of the most topical issues of pressure ulcers is to increase the efficiency and methods of their prevention. Pressure ulcers are areas of the skin of degenerative or necrotizing nature resulting from prolonged compression of the shear or displacement between the human and bed surface. Usually, pressure ulcers occur in sacrum, buttocks, heels, legs at the position of the patient on the back.
Literature Review
The prevention measures related to pressure ulcers are inseparably connected with the whole complex of care. Adequate prevention of the emergence and development of pressure ulcers requires an appropriate organization of nursing activities (Nuru, Zewdu, Amsalu, & Mehretie, 2015). It is important to identify risks and start preventive measures immediately using proper and timely sanitary and preventive procedures.
First of all, a patient’s body should be carefully examined every day paying special attention to all areas of risk and places of bone protrusions (Qaseem, Mir, Starkey, & Denberg, 2015). The patient’s clothes should be comfortable and seamless as possible excluding buttons and buckles. The use of synthetic clothes is unacceptable.
The leading factor in the successful preventive treatment of pressure ulcers is the elimination of a long continuous pressure. Turning a patient in bed every two hours could completely prevent the formation of pressure ulcers, but it is rather difficult to implement because of the workload of the medical staff. In this regard, plastic tires, special beds, mattresses, cushions, and pads that are filled with foam, water, gel, air, or a combination of these materials to reduce the pressure force and to ensure its continuity become widespread. However, according to Qaseem, Mir, Starkey, and Denberg (2015), “the use of advanced static mattresses or overlays was associated with a lower risk of pressure ulcers compared with standard hospital mattresses” (p. 365). Patients prone to pressure ulcers need a fairly soft mattress so that the patient would be partially immersed in it, and most of the skin surface would be assumed the weight of the body. The cover of the mattress should be easy to stretch. The mattress should be soft, but not bend like a hammock.
Nutrition of the patient at risk should be balanced and moderate. Because human activity at bed rest is minimized, it requires fewer calories but more vitamins and minerals. The presence of vitamin C, zinc, and iron in a diet is particularly important. Estimated daily calorie intake should count “30 to 35 kcal/kg of body weight per day” (Qaseem, Mir, Starkey, & Denberg, 2015, p. 362). The patient’s diet should include cereals, meat, fish, dairy products, fruits, vegetables, and nuts. It is better to limit the consumption of animal fats, bakery products, sweets, and fizzy drinks as the patient’s weight should be normal.
Moreover, it is recommended to massage tissues in the area of the possible formation of pressure ulcers by mild rotary movements. Areas of skin maceration should be washed with soap and cold water and wiped thoroughly and carefully drying out.
In the case, if the patient is not completely paralyzed and retains some minimal activity, a caregiver should encourage him or her to move, even if movements are reduced to the perturbation of fingers and bending arms at the elbow. Sometimes, bedridden patients fall into a depression losing hope. The principal role of the caregiver is to avoid it (Nuru, Zewdu, Amsalu, & Mehretie, 2015). He should personally communicate with the patient talking to him and carefully listening to his requirements and complaints.
Implementation of the Suggested Intervention
Policies of my clinical facility in Miami correspond to these above. According to Cano et al. (2015), the analysis of the University of Miami Hospital shows that nurses evaluate patients at risk monthly and provide the corresponding treatment. The latter includes skincare policies, re-education of staff to initiate an early intervention, and “wound, ostomy, and continence (WOC) nurse addition to staff to lead and coordinate the skin maintenance and management programs and to provide continuous education and training for the patient care staff” (p. 580). Therefore, one might state that preventive policies are strictly followed in that organization. However, the study indicates no results of patients’ diet.
Modern healthcare organizations provide the institutionalized elderly with plenty of prophylactic measures aimed at the prevention of pressure ulcers. However, the same issue concerning the community-dwelling elderly should be addressed as well. It might be rather difficult for such patients to live alone or with a temporary nurse. Consequently, they need professional caregivers who should be able to assist them almost all the time. It is significant to implement discussed measures in their life as well. For example, patients should purchase a special mattress and other necessary equipment. If the hands of the patient are active, a mandatory attribute of the patient’s bed space should be a therapeutic arc or belt-tightening, and a massager for hands. It is also important to carefully monitor the cleanliness of bed linen and the patient’s body.
Conclusion
In conclusion, preventive measures concerning pressure ulcers are of great importance as they allow avoiding the worst consequences such as sepsis.
References
Cano, A., Anglade, D., Stamp, H., Joaquin, F., Lopez, J., Lupe, L.,… Young, D. (2015). Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics. Healthcare, 3(3), 574-585.
Nuru, N., Zewdu, F., Amsalu, S., & Mehretie, Y. (2015). Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC Nursing, 14(34), 1-8.
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-370.