DQ 3 Health outcome
I have been working as an NP for two years with home bound adults and geriatric patients, and it is very common to provide treatment for pressure ulcer/skin breakdown/ bedsore. Many of these patients develop the skin break down after just a short hospital stay, while others develop it in the home environment. Among the common factors that contribute to pressure ulcers are debility, immobility and poor nutritional intake. Pressure ulcers have been a significant health problem, especially among the geriatric population (Jaul, E. (2010).
The presence of a pressure ulcer constitutes a geriatric dilemma, the cause of which is multifactorial. Some of the problems leading up to this condition are immobility, nutritional deficiency
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Operational definition of pressure sores: A skin risk assessment is the first step in determining what treatment is needed to prevent or treat skin breakdown. The Braden scale is one of the tools used to perform this risk assessment. Based on the result of the assessment, measures are implemented to prevent or to treat the problem.
Braden scale: This is a clinically validated tool used to reliably score a patient’s level of risk for developing pressure ulcers (Health, 2013).
It is a summated rating scale comprising of six subscales with scores ranging from 1-4. The lowest level of functioning is represented by 1, while the highest level of functioning is represented by 4. Total scores range from 6-23 each subscale is accorded values of 1-3. A lower Braden Scale Score indicates lower levels of functioning and, therefore, higher risk for pressure ulcer development (Health, 2013).
Pressure injuries are staged to indicate the extent of tissue damage and or the level of improvement.
• Stage 1 pressure injury: Nonblanchable redness of intact
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Pain and temperature change often precede skin color changes. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss (Wolters Kluwer Health, 2017).
Level of measurement for the result is ordinal where stage 0-1 means no skin breakdown.
Reference
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal Of Plastic Surgery, 45(2), 244-254.
Jaul, E. (2010). Assessment and management of pressure ulcers in the elderly: current strategies. Drugs & Aging, (4), 311.
Wolters Kluwer Health, I. (2017). Pressure ulcers get new terminology and staging definitions: Staff repor. Nursing Management, 46-50.
Health, N. I. (2013, April 17). U.S. National Library of Medicine. Retrieved from http://www.bradenscale.com/: https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/
Wolters Kluwer Health, I. (2017). Pressure ulcers get new terminology and staging definitions: Staff repor. Nursing Management,
The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.
Pressure ulcers are the result of a deficient patient care in many health care organizations like
A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).
Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.
“Pressure ulcers are key clinical indicators of the standard and effectiveness of care (Elliott, Fox & McKinley, 2008).” L.M. was at high risk for pressure ulcers for multiple factors such as immobility, poor nutrition, age, and health. Therefore, I used the Braden Scale as a quality indicator in order to assess the risk of pressure ulcers and also to
Pressure ulcers during a hospital admission are preventable. Assessment and early intervention can stop skin breakdown before it begins. Many factors regarding Mr. J’s condition placed him at a high risk regarding nursing indicators. Mild dementia, recent fall and a fractured hip all require a high level of nursing care and indicates preventative practice. Upon assessment, precautions should be in place to deter further complications. The elderly are more
While University Hospital is already on the brink of completely preventing pressure ulcers I would still recommend implementing all of the current practices but also add new additions to the team. Currently, we have a wound care team that diligently treats at risk and affected patients. Adding a nutritionist into the team to guarantee treatment from within along with prescribed medications. This will make the team and the strategies multidisciplinary. In addition to that, each treatment should be customized for each patient in regards to cost options and best treatment for their health. The project would also have to be performed repetitively without error to ensure that it is actually helpful. Patients’ skin should continue to be examined thoroughly in common places where ulcers could arise, the standardized pressure ulcer risk assessment should be used, and the proper care should be distributed once evaluated. The team should continue to record its progress and also provide company update emails to inform the facility, as well as send the appropriate data to the higher ups for public posting.
While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).
Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced
In order to facilitate understanding of process data and outcome data, this essay will focus on the context of hospital-acquired pressure injury (PI). PI, also referred to as decubitus ulcers, bed sores or pressure sores, is defined as soft-tissue ischaemic necrosis localised in an area caused by prolonged pressure higher than the capillary pressure with or without skin tear or breach, related to posture over a bony prominence. The aetiology of pressure ulcers include: (1) pressure – weight of the skin against contact area; (2) shearing; (3) friction; (4) moisture; (5) position of the patient; (6)immobility; (7) neurological factors; (7) metabolic and nutritional factors; (9) oedema; and (10) age. PIs affects not only in infirmed older people,
Pressure ulcers that occur in the long term care setting are increasing in the number of incidences each year in the United States. Consequences and complications of pressure ulcer development include pain, sepsis, cellulitis, bone, and joint infections. Pressure ulcers are also associated with an increased morbidity and mortality rate, negative emotional and physical effects on patients and caregivers, and are the second leading cause of litigation in long term care facilities. The cost of treatment for pressure ulcers in the United States is estimated at 11 billion dollars annually. This has led to many programs that focus on education and intervention to prevent the development of pressure ulcers, even being addressed in public initiatives such as Healthy People 2010. Appropriate information and education for healthcare providers, patients, and families has proven to be a key factor in the prevention of pressure ulcer development. Wound management is an area of healthcare that must include a comprehensive plan for the best outcome. A care plan that includes a well-educated care team composed of various disciplines working together for holistic care of each patient has seen the best results for patients who suffer from pressure ulcers.
Skin tears are traumatic wound that have been described as the “underestimated” wound and a
Pressure Ulcer is a breakdown of skin appears on the skin over a very thin or bony prominence
Pressure ulcers are; damage to the skin or underlying structures from either inadequate perfusion or tissue compression. (Taber’s Cyclopedic Medical Dictionary, 2009, p. 1889). Those at an increased risk for pressure ulcer formation: older adults, persons with spinal cord injury, surgical patients, obese patients, underweight patients, children and patients at end of life. (Ruth & Nix, 2012, p. 125). The Braden Scale, is a tool used to help identify a patient’s risk of developing a pressure ulcer.
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the