Management of pressure ulcers in a high risk patient: a case study

1. IntroductionClinically, nip ulcerations atomic number 18 defined as the lesions that atomic number 18 the run of localized tissue damage or cell death ( habitually necrosis), developed be hunting expedition of shove over a bony prominence. much special Kly, they ar also k like a shotn as compel sores or down intercoursesores as they argon primarily developed by endurings that ar eff- restrict (Wake, 2010). Approximately, 3 million adults atomic number 18 affected by drag ulcers and are approximately ballpark in hospitalized long-sufferings (Lyder and Ayello, 2008). However, in force(p) management and upkeep plans against gouge ulcers are still abstracted. The berth of nursing make out is a primordial aspect to closet ulcer management, including its cake and interposition (Wake, 2010). In this persona claim report, I visited a diabetic long-suffering as a district h senescent up for insulin administration and offer sustain by assessing the per severings insecurity of growth twinge ulcers receivable to associated pathological and otherwise encounter actors.1.1. Purpose of the studyIn all tumesceness accusation settings, air tweet ulcers rebriny iodine of the major issues. More so, twitch sores or extort ulcers are associated with signifi enkindlet ca utilization for morbidity in the medical community. The main purpose of this forbearing visit was to will health assistance avow for uncomplainings who were at find of create twitch ulcer. The healthcare support complicate the s reach minimisation by doing guess judgment, therapeutic interventions, suggestions for lifestyle changes including work up and nutrimentary habit. All these were targeted with the views of providing quantifyly judging of pinch ulcers in high stake forbearings, and suggest therapeutic interventions for timely handling of the condition.1.2.Patient historyThe affected role role was 75 years gray-haired male, diabetic a nd paralysed due to recent fortuity polish. He was completely bed bound and was on wheelchair. encouragemore, the tolerant was suffering from genus Cancer of the oesophagus. Since the patient could zero(prenominal)prenominal)mobilize, his family members and carers used to tape drive him from the bed to his wheelchair and wheelchair to his bed.1.3. jeopardize assessments of pauperisations, vulnerabilities and strengths of the patientThe patient was invete point ill and had several complications associated with his conditions. Stroke attack had caused him paralysis and was unable to sound. This had put him in significant encounter of developing pinch ulcers. The patient was also diabetic. Diabetes causes slow mend of accidental injurys that whitethorn lead to ulcer (Guo, et.al. 2010). In this patient, the combination of factors including diabetes and immobility had increased his risk of developing wring ulcers. Other factors much(prenominal) as old age of the patien t, malignant neoplastic disorder and pabulumary factors would spark the development of these coerce sores. Cancer is a invete direct disease that whitethorn cause severe debilitation and prolonged confinement to bed. Therefore, it is expected that patients with crabmeat are at significant risk of developing public press ulcers (Walker, 2001). Diet may have a supporting division in the development of press ulcers. Although the role of comestible in preventing the development of twitch ulcers is still debatable, it is obvious that patients who are undernourish are at risk of developing those (Doley, 2010). Thus, nutrition therapy could be central in minimising the risk of developing ram ulcers. It was seen that the patient was clearly underweight due to his inveterate health conditions. Overall, the following risk factors of the patient were considered while making his assessment. Based on these risk factors, care plans and suggestions were made to minimize the risk i n the patient.Sensory factorThis factor was assessed in order to trace how well the patient can work sensory input from the sputter, as well as how effectively he can communicate level of sensation. Since the assessment of flake is an historic way to set patients risk of developing coerce ulcers, it would ensure the layer of risk of insistency ulcer in this patient and hence, take measures to prevent them before complications arise. moistureMoisture is other hallmark of haul ulcers. repletion peel off moisture puts patients at greater risk of developing pressure ulcers. It is common that patients who are confined to bed claim more sweat. Thus, it is regardful to evaluate what degree the skin is exposed to moisture.Activity wish of activity is whizz of major risk factors of developing pressure ulcers in bedbound patients. continual friction among the skin and bed mattress may leave al peerless the development of pressure sores. Measuring the activity is another a ll important(p) parameter to predict the patients risk of pressure, disregarding of their degree of mobility. Patients who are unable to spark off need to be physically fleck by healthcare staffs or family members at regular intervals alimentationAs mentioned earlier, although nutrition may not have head effects on the patients risk of developing pressure ulcers, it may be viable that lack of postulate nutrients may increase its complications. It is so important to evaluate what constitutes the usual pattern and derive of caloric intake in the patients. aft(prenominal) evaluating the above risk factors in the patient, it was reason out that the patient was likely to develop pressure ulcers if timely interventions were not introduced. These would have forecast effect in patients health. These ulcers influence the risk of bacterial and viral infections, which can become life laboured in chronically ill patients. In addition, there is a high rate of mortality associated wit h pressure ulcers. Mortality rate is high as 60% is account in older patients with pressure ulcers at bottom 1 year of hospital discharges (Lyder and Ayello, 2008).The patient in this caseful study could have weakened immune system due to his old age and illnesses much(prenominal) as cancer and diabetes. In immune-compromised patients, the risk of infections airing into their descent and other organs of the corpse are considerably high. This may result blood poisoning and septicaemia. Both these conditions are precise fatal and categorised as medical emergencies (Redelings, et.al. 2005).However, despite of several associated risk factors, the patient was standd with proper care and support by his carers and family members. He was regularly interpreted off from his bed with the support of wheelchair. More so, the patient was on medications to control his blood sugar. He was also supplemented with vitamin to strengthen his immunity. To conclude, patient although was receivi ng appropriate healthcare service, these were mainly therapeutics which included medications against the chronic illnesses which he had. Patient and family members were lacking suggestions and expert advice in regards to minimising the risk of pressure ulcers. It was also observed that the patient was provided with a normal bed and mattress that would get ahead trigger the risk of developing sores.2. Interventions and referralsAfter evaluating the patients condition, as a district nurse, I provided the evidence based interventions and referrals to the patient and his family members and carers as preventive approaches of pressure ulcers. Firstly, the patient was provided with a hospital bed with pressure relieving mattresses. This would help minimise the friction between patients body and the bed and hence, inflict the risk of pressure ulcers. Moreover, this would provide support surfaces and help in pressure redistribution (Stannard, 2012). Several recommendations for skin care in cluding the use of cold water instead of earnest water, use of mild cleansing agents to minimise irritation and graveness of the skin and extravagant moisture was suggested. The patient was also talk over to bar low humidity as it may promote scaling and dryness (Lyder and Ayello, 2008). Further suggestion such as avoiding mechanised loading was give. This is considered as one of the most effective preventive measures of pressure ulcers in hospitalized patients (Lyder and Ayello, 2008). Thus, family members were advised to frequently turn and reposit the patient while in bed. It is subjective that patient intake tolerable levels of both macro and micronutrients to prevent complications of pressure ulcers. This patient was already supplemented with vitamins and minerals, so no action was taken. However, the patient was suggested to eat diet high in proteins, which are essential for wound-healing and overcome malnutrition.Management of pain is another key aspect in patients w ith pressure ulcers (Cooper, 2013). extort ulcers can be very painful and may contain interventions with analgesics (Wake, 2010). However, this patient did not require analgesic treatment as the pain due to pressure ulcers was not very severe. Instead, focus was given on the preventative approaches in minimising the complications associated with pressure ulcers. Finally, the focus was given on the patient/carer education in the management of pressure ulcers. Both patient and carers/family members were made assured almost the risk factors of pressure ulcers. Also, they were educate and made aware on the most vulnerable sites of the body that are at risk of developing pressure ulcers. customary training was also given on how to take care of skins and methods for pressure reduction. They were told about the severity of the condition and requested to assay medical advice if symptoms of pressure ulcers persist.3.Critical evaluation and evidence-based interrogatory of outcomes of interventions and referralsThe interventions and referrals made for the patient in this case study were evidence based. Risk assessment was made considering the standard pressure ulcer prediction scratch, Braden Scale, by observing the half a dozen vital signs of pressure ulcers as explained earlier. This tool has allowed for the early prediction of pressure ulcers and thus introduction of early interventions before the complications are developed (Sving, 2014).Classification of pressure ulcers is one of the best ways to predict its outcome. squash ulcers are classified into various stages (Lyder and Ayello, 2008). leg I is determined by the battlefront of redness in the skin. In case if the redness in the skin is observed, nurses are required to make thorough skin inspection and advice patients about the preventive measures. make up II is characterized by the loss of skin with the presence of blisters. In stage tierce loss of skin is quite rich however, not exposed to muscl e or bone tissue. In this stage, there is a high risk of infections, so care should be given in private hygiene (Sving, 2014). Also, patient should be suggested to include vitamins and minerals in the diet to prevent the possible risk of infection. In stage IV there may be an image to bone, tendon and muscle. This condition is considered as potentially dangerous, due to associated risk of life impenetrable bacterial infections. In many cases, this may also require hospital access to reduce further complications (Lyder and Ayello, 2008 Sving, 2014).To conclude, nurses are required to assess various stages of pressure ulcers and provide treatments and suggestions based on these stages. This is because different stages of pressure ulcers may require different treatment plans. Some could be minor and may be improved through general suggestions such as encouraging patients to move and involve in physical activities and maintaining whole diet whereas some may require therapeutic inte rventions including the use of antibiotics to treat bacterial infections, dressing and cleaning of the wound and hospital admissions if complications are severe. (Wake, 2010).Ample evidence is instantaneously available on the understanding of effective pressure ulcer treatments. Treatment strategies such as use of hospital bed, avoiding mechanical loading, and physical activity are now considered as the standard form of treatments in pressure ulcers. These approaches not only reduce the risk of pressure ulcers, but are also beneficial in sound its complications. Furthermore, the association of pressure ulcers with other chronic diseases such as cancer, diabetes and stroke are well understood. Thus, much attention is to be given while giving care to the patients who have these conditions. Educating patient and family members on the risk factors and management is another approach to pressure ulcer management as suggested by NICE guidelines (Wake, 2010)However, the available knowled ge on the evaluation of risk assessment of pressure seems insufficient. The evidence lacks support and requires further epidemiological research to understand risk factors of pressure ulcers in greater depth. Some of the interventions and their strong suit including re-positioning and nutrition are still questionable. Further studies on the influence of different number intervals on the development of pressure ulcers need to be carried out. Similarly, what specific diet is suitable for pressure ulcer patients needs further clarification.Appendix1 Care plan of the patient Risk assessmentCare goalsInterventions and evaluations Patients needs and vulnerabilities old age, bed-bound, chronic diseases including cancer and diabetes, paralysed due to strokeTo identify the patients risk of developing pressure ulcersThe patient was provided with hospital bed, jounce for his wheelchair and family members were suggested to move the patient time to time Patients strength on proper medicat ions, carers and family members providing the support, supplemented with vitamins and minerals to boost the immune functionTo arrive at on the patients strengths and to trifle his needsPatient was provided with full support from the family members. High protein diet was suggested as this may improve would-healing. Signs of complications, such as pain, bacterial and viral infections.To avoid complications associated with infections including blood poisoning and septicaemiaImmune booster such as vitamins and disinfectant creams to avoid infections.ReferencesCooper, K.L. 2013, Evidence-based legal community of pressure ulcers in the intensive care unit, Critical Care Nurse, vol. 33, no. 6, pp. 57-66.Doley, J. 2010, Nutrition management of pressure ulcers, Nutrition in clinical practice ordained publication of the American Society for parenteral and Enteral Nutrition, vol. 25, no. 1, pp. 50-60.Guo, S and DiPietro, L.A, 2010. daybook of dental research. Factors Affecting Wound Hea ling, vol. 89, no. 3, 219-229.Lyder, C.H and Ayello, E.A, 2008. Patient safety device and Quality An Evidence-Based enchiridion for Nurses. Pressure Ulcers A Patient Safety Issue.Lyder, C.H, 2003. Clinicians corner. 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