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Risk Assessment and Management Strategies for Pressure Ulcers

  • 09 Pages
  • Published On: 12-12-2023

Introduction

The chosen risk assessment to be focused in the essay is the risk of development of Pressure Ulcer. Pressure ulcer (PU) is referred to localised damage on the skin and the underlying tissues which usually develops on the bony prominence due to long-term pressure on a specific area or long-term friction on the same area (NHS, 2019). The importance of risk assessment of pressure ulcer is to be explained. The Waterlow Tool is to be used to mention the risk factors to be considered in risk assessment for pressure ulcer. Thereafter, key intervention effective to manage pressure ulcer is to be discussed.

Importance of risk assessment of Pressure Ulcer

The impact of the pressure ulcer on patients is that it hinders their quality of life and increases their mortality rate. This is because the pressure ulcer leads to support development of complicated infection on the body with the potential to cause sepsis which later worsens to contribute the individual to face death (Ünver et al., 2017). Thus, the risk assessment for pressure ulcer is significant to be determined so that the negative impact of it on the health of the patients can be prevented by avoiding or managing its development. The risk assessment for pressure ulcer is also important because its initiation creates complication on the skin of the elderly which led to cause them intense pain and suffering. In certain condition, amputation of the parts where pressure ulcer have occurred is required to prevent the infection from being further spread to the other parts of the body (Jaul et al., 2018).

Risk Factor of Pressure Ulcer

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In determining the risk factor for pressure ulcer, the Waterlow Tool is to be used. This is because the tool mentioned the key seven risk factors that influence pressure ulcer development in patients (Charalambous et al., 2018). One of the risk factors mentioned by the Waterlow Tool for pressure ulcer is the body mass index (BMI) of the patient (Charalambous et al., 2018). The increased BMI of patient indicates the individual has increased amount of body weight and fat mass due to which they are overweight or obese. The patient with increased BMI rate shows decreased mobility out of being burden with increased body mass and fat. The lack of relaxed mobility makes individual remain in same position leading to development of pressure on certain point in the body where ulcer developed out of the continuous pressure (Børsting et al., 2018). In the study by Hyun et al. (2014), it is mentioned that patients with increased BMI rate who are overweight and extremely obese are 2 times more likely to develop pressure ulcer compared to normal individuals.

The Waterflow tool mentions that risk factor for pressure ulcer which supports its development is level of mobility of the individual (Charalambous et al., 2018). This is because among who are confined to bed shows inability to move on their own. The inability to move leads the sick individual to remain in the same position and develop pressure on specific area which makes them be at risk of developing the health condition (Jocelyn Chew et al., 2018). The sex and age are another risk factor for pressure ulcer as mentioned by the Waterlow Tool. The elderly who are above the age of 70 years are found to be at increased risk of developing pressure ulcer. This is because the elderly people are found to have mobility problem and prone to develop increased damage to their skin as a result of dehydration and associated aging factors (Serrano et al., 2017). The exact reason of relation with gender and pressure ulcer development is unknown. However, the study by Xie et al. (2017) has mentioned that male show lesser risk of development of pressure ulcer compared to females. The fact is also supported by the study of Hyun et al. (2019), but it mentioned that sex cannot be independent risk factor for development of pressure ulcer.

The Waterlow tool mentions that level of continence and skin condition are risk factors for development of pressure ulcer (Charalambous et al., 2018). As mentioned by Kayser et al. (2019), the faecal or urinary continence affects the individuals to have excessive moist skin. The increased moisture on the skin makes the skin to be weakened and support increased shear and tear with minimum friction with any objects leading the individual to develop pressure ulcer. As argued by Lechner et al. (2017), dry skin condition in individuals makes them susceptible to develop pressure ulcer. This is because increased dry skin causes the skin to erode easily with friction which subjects the skin tissues to develop ulceration out of shear stress. The Waterlow tool mentions nutrition level of the patient or patient’s appetite and certain trauma, surgery, medication and others influences risk of development of pressure ulcer (Charalambous et al., 2018). The poor nutrition along with reduced fluid intake leads to risk of pressure ulcer because it led to lower tensile strength of the muscles, negatively alter immune function and impair synthesis of collagen which are needed for maintaining healthy skin or effective healing of wounds (Taylor, 2017). The hindered healing of wounds from surgery which on facing continuous pressure due to hindered mobility of the patients may support the risk of pressure ulcer development in people (Jaul et al., 2018).

Intervention for managing Pressure Ulcer

In managing pressure ulcer, one of the key interventions is extensive and enhanced patient monitoring who are at risk for the condition or are already suffering from pressure ulcer. This is because continuous monitoring of patients helps the nurses to remain aware of the presence and progress of ulcer development on the skin of the individual. It makes them implement specific preventive measures at the earliest such as repositioning of patient, use of pressure-reducing surface and others for enhanced health of the patients (Vera-Salmerón et al., 2019). Another intervention that is continuous reposition of patients who are confined to bed is one of the actions to prevent and manage pressure ulcer. This is because repositioning of patients led to distributes the pressure on the body in an even manner among the immobilised individuals and those confined in bed that leads to avoid the formation of pressure sores (NHS, 2019).

The presence of support surfaces that evenly distributes the pressure on the body among immobilised patients are effective action in resolving pressure ulcer (NHS, 2019). This indicates that the patients at risk of pressure ulcer are to be placed in high-density foam-based mattresses where the bare minimum pressure is created on the body leading the patient to minimise risk of pressure ulcer (de Oliveira et al., 2017). The support surfaced which lower pressure on the body are to be used in all condition for patients with less mobilisation ability and at risk of pressure ulcer such as during resting, sitting, travelling on wheelchairs and others (Boyle et al., 2020). As argued by Zwaenepoel et al. (2020), reactive support surface is effective intervention in managing pressure ulcer. This is because such surfaces help in changing the load distribution in relation to the different position of the patients helping to increase area of contact of the body with the surface and developing redistribution of pressure to avoid the condition.

The use of different pressure ulcer preventing tools are to be used in managing its occurrence among individuals. For example, the pressure visualisation system is to be used in managing pressure ulcer among elderly. This is because it uses technology to allow visual monitoring of the patients at risk of pressure ulcer. It also allows effective tracking the different body position and pressure affects it to develop detailed report and identify support surface or services to be provided to the patients to avoid pressure ulcer in them (Onose et al., 2020). The different turning and repositioning sensors are to be used as intervention for managing pressure ulcer as it helps the nurses to remember and easily reposition patients who at risk of the condition (Raizman et al., 2018). The sensor socks can be used in early detection and condition of risk pf pressure ulcer. This is because the socks help to track foot temperature and mention any unusual increase in the food temperature during mobility to the patients and nurses to develop better inspection regarding it (Najafi et al., 2020). The patient with pressure ulcer is to be provided protectors on surface of wounds to avoid further injury to them and neglect any shear force which may worsen them (Najafi et al., 2020).

The actions required is managing pressure ulcer is putting bandage on the wound to create barrier from infectious agents. Moreover, the bandage helps the pressure wounds to be kept moist and ensures faster healing (NHS, 2019). Therefore, enhanced wound management in pressure ulcer patients is important to help them heal from the condition. The other action required for pressure ulcer risk management is removal of damaged tissues from the affected area and flush the wound with anti-infection medication. This is because such a technique helps to avoid worsening of the pressure wounds and ensures effective healing (NHS, 2019). As argued by Saghaleini et al. (2018), intake of enhanced nutrients and fluids are to be ensured to manage pressure ulcer. This is because adequate food intake with proper nutrients helps the patient at risk of pressure ulcer to strengthen muscle tenacity, immune system and others to avoid the risk and faster wound healing. A scheduled repositioning of patients who are at risk of pressure ulcer is to be established. For this purpose, clock charts are to be used as intervention by the nurses. This is because it would indicate which patient are to be repositioned and when to ensure effective care delivery to avoid pressure ulcer (Woodhouse et al., 2019).

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The nonsteroidal anti-inflammatory drugs can be used as pharmacological actions to support faster healing and management of pressure wounds (NHS, 2019). The presence of efficiently trained multi-disciplinary team is required to be present for managing pressure ulcer. The nurses are key members of the multi-disciplinary care team for pressure ulcer where they have the role to perform key actions of monitoring and examining the patient and repositioning them along with provide them different support to reduce risk of pressure ulcer (Clarkson et al., 2016). The other members in the multi-disciplinary team for pressure ulcer acts to provide active support and advice to the nurses to deliver care to the patients. The other professionals to include in the team is dietician. The dietician is needed in pressure ulcer to ensure the patients at risk of the condition are taking healthy meals and adequate fluid to retain effective inner body strength and efficiency to avoid pressure ulcer development (Cestaro et al., 2020). The study by Clarkson et al. (2016) mentioned that occupational therapist, physiotherapist and podiatry are required to be present in the multi-disciplinary care team for pressure ulcer. This is because the therapist uses different mechanism to avoid pressure development of key parts of the body and area which is essential for pressure ulcer prevention.

Conclusion

The above discussion mentions that pressure ulcer is a major health issue faced by elderly. The importance of discussion of risk management of pressure ulcer is that it would avoid supporting development of sepsis in individuals, hindered wound healing and others. The Waterlow Tool mentions that the key risk factors related to pressure ulcer development is age, nutrition ability, appetite of patients, BMI rate, level of mobility and others. The intervention to be made for managing development of pressure ulcer includes enhanced patient monitoring, use of pressure ulcer prevention tool, support devices and others. The multi-disciplinary team required to include occupational therapist, physiotherapist and podiatry, dietician and others apart from nurses to deliver care regarding the health issue. Moreover, pharmacological approach can be used to managing risk of pressure ulcer among individuals.

References

Børsting, T.E., Tvedt, C.R., Skogestad, I.J., Granheim, T.I., Gay, C.L. and Lerdal, A., 2018. Prevalence of pressure ulcer and associated risk factors in middle‐and older‐aged medical inpatients in Norway. Journal of clinical nursing, 27(3-4), pp.e535-e543.

Boyle, C.J., Carpanen, D., Pandelani, T., Higgins, C.A., Masen, M.A. and Masouros, S.D., 2020. Lateral pressure equalisation as a principle for designing support surfaces to prevent deep tissue pressure ulcers. PloS one, 15(1), p.e0227064.

Cestaro, G., Cavallo, F., Zese, M., Prando, D. and Agresta, F., 2020. Severe Soft Tissue Infection in Pressure Ulcers: A Multidisciplinary Approach. Op Acc J Bio Sci & Res, 4(4).

Charalambous, C., Koulori, A., Vasilopoulos, A. and Roupa, Z., 2018. Evaluation of the validity and reliability of the Waterlow pressure ulcer risk assessment scale. Medical Archives, 72(2), p.141.

Clarkson, P., Worsley, P., Schoonhoven, L. and Bader, D., 2016. A multidisciplinary approach to pressure ulcer prevention: Exploring healthcare professionals’ knowledge and attitudes to pressure ulcer prevention in the community setting. Nursing, 84, p.71.

de Oliveira, K.F., Nascimento, K.G., Nicolussi, A.C., Chavaglia, S.R.R., de Araujo, C.A. and Barbosa, M.H., 2017. Support surfaces in the prevention of pressure ulcers in surgical patients: An integrative review. International journal of nursing practice, 23(4), p.e12553

england.nhs.uk 2018, Pressure ulcers, Available at: https://www.england.nhs.uk/documents/2932/NSTPP_summary__recommendations_2.pdf [Accessed on: 19 April, 2021]

Hyun, S., Li, X., Vermillion, B., Newton, C., Fall, M., Kaewprag, P., Moffatt-Bruce, S. and Lenz, E.R., 2014. Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients. American Journal of Critical Care, 23(6), pp.494-501

Hyun, S., Moffatt-Bruce, S., Cooper, C., Hixon, B. and Kaewprag, P., 2019. Prediction model for hospital-acquired pressure ulcer development: retrospective cohort study. JMIR medical informatics, 7(3), p.e13785

Jaul, E., Barron, J., Rosenzweig, J.P. and Menczel, J., 2018. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics, 18(1), pp.1-11

Jaul, E., Barron, J., Rosenzweig, J.P. and Menczel, J., 2018. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics, 18(1), pp.1-11.

Jocelyn Chew, H.S., Thiara, E., Lopez, V. and Shorey, S., 2018. Turning frequency in adult bedridden patients to prevent hospital‐acquired pressure ulcer: A scoping review. International wound journal, 15(2), pp.225-236.

Kayser, S.A., Phipps, L., VanGilder, C.A. and Lachenbruch, C., 2019. Examining prevalence and risk factors of incontinence-associated dermatitis using the International Pressure Ulcer Prevalence Survey. Journal of Wound, Ostomy, and Continence Nursing, 46(4), p.285.

Lechner, A., Lahmann, N., Neumann, K., Blume-Peytavi, U. and Kottner, J., 2017. Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes. International Journal of Nursing Studies, 73, pp.63-69.

Najafi, B., Reeves, N.D. and Armstrong, D.G., 2020. Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission. Diabetes/metabolism research and reviews, 36, p.e3239.

Onose, R., Enokibori, Y., Harasawa, Y. and Mase, K., 2020. Educational Support System for Pressure Ulcer Prevention using Textile Pressure Sensor. 情報処理学会論文誌ジャーナル (Web), 61(3), pp.746-755.

Raizman, R., MacNeil, M. and Rappl, L., 2018. Utility of a sensor‐based technology to assist in the prevention of pressure ulcers: a clinical comparison. International wound journal, 15(6), pp.1033-1044.

Saghaleini, S.H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A. and Ostadi, Z., 2018. Pressure ulcer and nutrition. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(4), p.283.

Serrano, M.L., Mendez, M.G., Cebollero, F.C. and Rodriguez, J.L., 2017. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. Medicina Intensiva (English Edition), 41(6), pp.339-346.

Taylor, C., 2017. Importance of nutrition in preventing and treating pressure ulcers. Nursing older people, 29(6).pp.56-89.

Ünver, S., Fındık, Ü.Y., Özkan, Z.K. and Sürücü, Ç., 2017. Attitudes of surgical nurses towards pressure ulcer prevention. Journal of tissue viability, 26(4), pp.277-281.

Vera-Salmerón, E., Rutherford, C., Dominguez-Nogueira, C., Tudela-Vázquez, M.P., Costela-Ruiz, V.J. and Gómez-Pozo, B., 2019. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR research protocols, 8(8), p.e13701.

Woodhouse, M., Worsley, P.R., Voegeli, D., Schoonhoven, L. and Bader, D.L., 2019. How consistent and effective are current repositioning strategies for pressure ulcer prevention?. Applied Nursing Research, 48, pp.58-62.

Xie, Z., Page, L. and Hardy, B., 2017. Investigating gender differences under time pressure in financial risk taking. Frontiers in behavioral neuroscience, 11, p.246.

Zwaenepoel, E., Van Hecke, A., Manderlier, B., Verhaeghe, S. and Beeckman, D., 2020. Pressure ulcer Cat. II‐IV incidence on the CuroCell SAM PRO powered reactive air support surface in a high‐risk population: A multicentre cohort study in 12 Belgian nursing homes. International wound journal, 17(1), pp.124-131.

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