How to prevent pressure ulcer.
PRESSURE ULCER (BED SORE)
Terminally ill patients are at risk of developing pressure. This article is a guide for care givers to have some knowledge of the factors that causes pressure ulcer and take measures to prevent the development of pressure ulcer.
HOW DOES PRESSURE ULCER DEVELOP?
When the skin and body tissues are compressed for a very long period against bony areas and hard surfaces, such as the mattress, it causes localized damage to the tissues. The extent of damage can be very superficial such as redness or can be deep where the damage involves muscle tissues, and tendons and bones may be exposed.
AREAS THAT ARE PRONE TO DEVELOP PRESSURE ULCERS
WHAT FACTORS CONTRIBUTE TO THE DEVELOPMENT OF PRESSURE ULCERS?
1. The primary cause of pressure ulcer is prolonged pressure that is applied on soft tissues over bony prominences and hard surfaces such as the mattress.
2. Contributing factors are
b. Decreased activity
c. Decreased sensory perception
e. Friction and shearing
f. Poor nutrition
g. Advanced age
FACTORS THAT CONTRIBUTE TO PRESSURE ULCERS IN PATIENTS WHO ARE TERMINALLY ILL
1. Fragile skin condition
2. Older age
3. Decreasing fluid and food intake
4. Altered sensation
5. Poor general physical condition
6. Lean body constitution
7. New pain site or unrelieved pain
8. Shortness of breath and inability to lie flat related to shortness of breath (patients normally are in sitting position to relieve shortness of breath. This causes continuous pressure on the buttocks or sacrum)
10. Decreased mobility
WHY IS IT IMPORTANT TO PREVENT THE DEVELOPMENT OF PRESSURE ULCERS?
Pressure ulcers have negative effect on patient, family and caregivers. It can lead to social isolation and a feeling of burden to others.
Patient’s quality of life is affected as there is a change in body image, pain, odour and drainage, and it also affects the patient financially.
HOW TO PREVENT THE DEVELOPMENT OF PRESSURE ULCERS?
1. IDENTIFY PERSONS AT RISK AND APPLYING PREVENTIVE MEASURES
· We need to first identify persons who are at risk in developing pressure ulcers. Please refer to the factors that contribute to the development of pressure ulcers (as mentioned above). Having identified the factors, assist us to take preventive measure accordingly.
2. MINIMIZING PRESSURE
3. MINIMIZE OR ELIMINATE FRICTION OR SHEARING
4. MANAGE MOISTURE
If the patient is using adult pampers, you can use a spray bottle to rinse after cleaning the private area with soap. Make sure the soiled pampers is not removed before you rinse with a spray bottle so the dirty water is absorbed by the soiled pampers.
5. MAINTAIN ADEQUATE NUTRITION AND HYDRATION
When a patient has reached end-of-life, they are no longer able to eat or drink to maintain adequate nutrition, therefore, the caregivers will need to take the other measures such as minimize pressure, friction and shearing and managing moisture to prevent the development of pressure ulcers.
THESE ARE GUIDELINES IN PREVENTION OF PRESSURE ULCER. EACH INDIVIDUAL PATIENT IS DIFFERENT AND MAY NEED A DIFFERENT APPROACH. PLEASE CONSULT YOUR ATTENDING NURSE FOR ADVICE IF YOU FACE ANY DIFFICULTIES
1. Anderson, J., Langemo, D.K., Sulkowski, K. & Ayello, E.A. (2007). Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions (1st Ed.). St. Louis, Missouri, USA: Elsevier Mosby. Retrieved from Mosby’s Nursing Consult.
2. Bryant, R.A & Nix, D.P. (2012).Acute & Chronic Wounds: Current Management Concepts. (4th Ed.) . St. Louis, Missouri, USA: Elsevier Mosby. Retrieved from Mosby’s Nursing Consult.
3. Churbock, C. (2011). Pressure Ulcer: Risk Assessment and Prevention. Retrieved from Mosby’s Nursing Skills.
4. Meiner, S.E. (2010). Gerontologic Nursing (4th Ed.). St. Louis, Missouri, USA: Elsevier Mosby. Retrieved from Mosby’s Nursing Consult.
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Nurse Chong Fei Gin is a practicing hospice nurse.