Managing the Prevention of Skin Breakdown

2012 ◽  
Author(s):  
Andrea Nelson
Keyword(s):  
Cardiovascular Disease ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Foot Ulcers ◽  
Severe Illness ◽  
Advisory Panel ◽  
Nursing Management ◽  
Nursing Role ◽  
Skin Breakdown

This chapter addresses the fundamental role of nurses in the prevention of skin breakdown. Every nurse should possess the knowledge and skills to identify people at risk of skin breakdown, to select and implement strategies to maintain skin integrity, and to review the effectiveness of these to inform any necessary changes in care. Skin breakdown is associated with long-term conditions such as diabetes, cardiovascular disease, and spinal cord injury, and with acute illnesses that cause mobility restriction such as surgery and severe illness. Diabetes is associated with foot ulcers, cardiovascular disease with leg ulcers, and acute or long-term mobility restriction is associated with pressure ulcers. This chapter focuses on these three categories of skin breakdown and illuminates the key responsibilities carried by nurses in each of these areas. The first section of this chapter provides detailed guidance on the nursing management of pressure ulcer prevention. This is followed by a subsidiary section on the prevention of diabetic foot ulcers. The final section provides a short overview of the nursing role in preventing or managing venous ulceration. Pressure ulcers, which are also called pressure sores, bed sores, and decubitus ulcers, have been defined as:…localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. (European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel, 2010)…Pressure ulcers may present as persistent redness (where the skin is damaged, but not yet broken), blisters, shallow sores, or necrotic wounds extending to the muscle and bone. An ‘avoidable pressure ulcer’ is one that developed and the provider of care did not do one of the following:…● evaluate the person’s clinical condition and pressure ulcer risk factors; ● plan and implement interventions consistent with the person’s needs and goals, and recognize standards of practice; ● monitor and evaluate the impact of the interventions; or ● revise the interventions as appropriate….

scholarly journals Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Manu Goyal ◽  
Saumya Kothiyal
Keyword(s):  
Case Report ◽  
Laser Therapy ◽  
Pressure Ulcer ◽  
Near Infrared ◽  
Pressure Ulcers ◽  
Treatment Time ◽  
Dose Range ◽  
Infrared Laser ◽  
Advisory Panel ◽  
Class Iv

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5-C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers. 

scholarly journals A Flexible Turning and Sensing System for Pressure Ulcers Prevention

Electronics ◽  
2021 ◽  
Vol 10 (23) ◽  
pp. 2971
Author(s):  
Ying Zhang ◽  
Xiaofeng Zou ◽  
Bin Zhang ◽  
Yi Han ◽  
Shuoyu Wang ◽  
...  
Keyword(s):  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Complex Structure ◽  
Continuous Increase ◽  
Measurement Monitoring ◽  
Cost Constraints ◽  
Infrared Reflection ◽  
Disabled Elderly ◽  
The Status

Pressure ulcers (PU) are one of the most frequent hazards of long-term bedridden patients. With the continuous increase of aging, the number of long-term bedridden disabled and semi-disabled elderly people is increasing. At the same time, there is a serious shortage of professional pressure ulcer nursing staff. There is also a lack of flexible turning equipment for PU prevention. The research in the field of pressure ulcer prevention at home and abroad is carried out steadily, and the equipment for turning over by pneumatic or mechanical drive is developed. However, these devices often have insurmountable defects, such as complex structure, cost constraints, difficult control, weak body feeling, and so on. Under these circumstances, a set of pneumatic turnover mattresses based on clinical nursing methods have been developed. The mattress is divided into a turnover area and two support areas. The turnover airbag is linked with the support airbag to improve the patient’s comfort when passively turning over. The turnover amplitude and interval can be adjusted to provide a personalized turnover experience for bedridden patients. To improve the safety of the turning mattress during automatic turning, we also add a temperature sensor based on the principle of infrared reflection to monitor the status of bedridden patients, which can realize real-time temperature measurement, monitoring of getting out of bed and monitoring of the turning process.

scholarly journals Biomechanical changes on the typical sites of pressure ulcers in the process of turning over from supine position: theoretical analysis, simulation and experiment

2021 ◽  
Author(s):  
Peng Su ◽  
Qinglong Lun ◽  
Da Lu ◽  
Qiulong Wu ◽  
Tian Liu ◽  
...  
Keyword(s):  
Theoretical Analysis ◽  
Contact Pressure ◽  
Pressure Ulcer ◽  
Supine Position ◽  
Pressure Ulcers ◽  
Pressure Curve ◽  
Element Analysis ◽  
Simulation And Experiment ◽  
Biomechanical Changes

Abstract Background Pressure ulcer is a typical disease, which is common in long-term bedridden patients and difficult to cure. It is necessary to study the biomechanics of the typical sites of pressure ulcers in turning over from supine position, which is an important reference for clinical medical nursing and and guides an assisted exoskeleton robot design. Methods The typical sites of pressure ulcers mainly focus on the scapula and the hip-sacrum of the trunk in turning over from the supine position. Based on the requirements of rehabilitation technical aids and the anatomy theory, the simple model of the scapula and the hip-sacrum were established for a force analysis in the process of turning over from the supine position, and the theoretical contact pressure between the human body and the bed surface was obtained. Then, three-dimensional models of the scapula and hip- sacrum were reconstructed and the maximum stress under different boundary conditions was obtained by finite element analysis. Finally, the pressure distribution sensor was used to carry out the human experiment of turning over from the supine position, and the pressure cloud diagram and the maximum contact pressure curve of the shoulder blade and the hip were obtained under different angles of turning over. Results The results from theoretical analysis, simulation and experiment were almost the same change trends, and the curves and the stress diagrams showed the contact pressure change of the typical sites of pressure ulcers in turning over. The angle threshold of the optimal comprehensive pressure can improve the use efficiency of the equipment to assist human turning over and reduce the incidence of pressure ulcers in the use of assisted bed in long-term bedridden patients. Conclusions In response to the less research on the mechanism of pressure ulcer, biomechanical changes have been revealed, which helps to explain the causes of pressure ulcer disease and provide basis for improving clinical nursing, and the relevant results provided a reference that contributes to the man-machine coupling design of the assisted rollover robot.

Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury

2016 ◽  
Vol 31 (7) ◽  
pp. 871-880 ◽  
Author(s):  
Alison M Cogan ◽  
Jeanine Blanchard ◽  
Susan L Garber ◽  
Cheryl LP Vigen ◽  
Mike Carlson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Educational Interventions ◽  
Included Study ◽  
Community Dwelling ◽  
Inclusion Criteria ◽  
Skin Breakdown ◽  
Cord Injury

Objective: To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). Data sources: Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. Review methods: Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. Results: The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. Conclusions: At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

scholarly journals cEEG electrode-related pressure ulcers in acutely hospitalized patients

2016 ◽  
Vol 7 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Lidia M.V.R. Moura ◽  
Thiago S. Carneiro ◽  
David Kwasnik ◽  
Valdery F. Moura ◽  
Christine S. Blodgett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Pressure Ulcers ◽  
Hospitalized Patients ◽  
Severe Illness ◽  
Medical Complication ◽  
Skin Breakdown ◽  
Cox Proportional Hazard ◽  
Continuous Eeg ◽  
Major Predictor

AbstractBackground:Pressure ulcers resulting from continuous EEG (cEEG) monitoring in hospitalized patients have gained attention as a preventable medical complication. We measured their incidence and risk factors.Methods:We performed an observational investigation of cEEG-electrode-related pressure ulcers (EERPU) among acutely ill patients over a 22-month period. Variables analyzed included age, sex, monitoring duration, hospital location, application methods, vasopressor usage, nutritional status, skin allergies, fever, and presence/severity of EERPU. We examined risk for pressure ulcers vs monitoring duration using Kaplan-Meyer survival analysis, and performed multivariate risk assessment using Cox proportional hazard model.Results:Among 1,519 patients, EERPU occurred in 118 (7.8%). Most (n = 109, 92.3%) consisted of hyperemia only without skin breakdown. A major predictor was monitoring duration, with 3-, 5-, and 10-day risks of 16%, 32%, and 60%, respectively. Risk factors included older age (mean age 60.65 vs 50.3, p < 0.01), care in an intensive care unit (9.37% vs 5.32%, p < 0.01), lack of a head wrap (8.31% vs 27.3%, p = 0.02), use of vasopressors (16.7% vs 9.64%, p < 0.01), enteral feeding (11.7% vs 5.45%, p = 0.04), and fever (18.4% vs 9.3%, p < 0.01). Elderly patients (71–80 years) were at higher risk (hazard ratio 6.84 [1.95–24], p < 0.01), even after accounting for monitoring time and other pertinent variables in multivariate analysis.Conclusions:EERPU are uncommon and generally mild. Elderly patients and those with more severe illness have higher risk of developing EERPU, and the risk increases as a function of monitoring duration.

Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper

2014 ◽  
Vol 22 (3) ◽  
pp. 301-304 ◽  
Author(s):  
Cindy Tew ◽  
Heather Hettrick ◽  
Sarah Holden-Mount ◽  
Rebekah Grigsby ◽  
Julie Rhodovi ◽  
...  
Keyword(s):  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
White Paper ◽  
Advisory Panel

Role of multi-layer foam dressings with Safetac in the prevention of pressure ulcers: a review of the clinical and scientific data

2016 ◽  
Vol 25 (Sup1) ◽  
pp. S3-S23
Author(s):  
Phil Davies
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Clinical Data ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Scientific Data ◽  
Advisory Panel ◽  
Care Providers ◽  
Prevention Measures ◽  
Prevention Strategies

Background Despite the implementation of prevention strategies, pressure ulcers (PUs) continue to be a challenging health problem for patients (and their carers), clinicians and health-care providers. One area of growing interest is the use of prophylactic dressings (which were originally designed for the treatment of PUs and other wound types) as a component of standard prevention measures. Over the past few years, a large amount of scientific and clinical data relating to this subject has been published in peer-reviewed journals and presented at international meetings and conferences. A substantial proportion of these data relate to one group of dressings: multi-layer foam dressings with Safetac, which are manufactured by Mölnlycke Health Care (Gothenburg, Sweden). This evidence pool has influenced the experts involved in updating the Clinical Practice Guideline, produced by the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, on the prevention and treatment of PUs. The updated Guideline, published in 2014, recommends that, as part of their PU prevention regimens, clinicians should consider applying prophylactic dressings to bony prominences in anatomical areas that are frequently subjected to friction and shear. Aims A literature review was undertaken to identify clinical data from the entire evidence hierarchy, as well as scientific data from laboratory studies, on the use of multi-layer foam dressings with Safetac in the prevention of pressure ulceration. Method The MEDLINE (National Library of Medicine, Bethesda, US) and EMBASE (Elsevier BV, Amsterdam, Netherlands) bibliographic databases were searched. In addition, abstract books and proceedings documents relating to national and international conferences were scanned in order to identify presentations (i.e. oral, e-posters and posters) of relevance to the review. Results Clinical and health economic experts have undertaken numerous studies, including randomised controlled trials, to assess the efficacy and cost-effectiveness of using multi-layer foam dressings with Safetac as a component of standard PU prevention strategies. The results of these studies indicate that the application of multi-layer foam dressings containing Safetac can reduce the occurrence of PUs on anatomical locations such as the sacrum and the heel, and underneath medical devices. Scientists have also developed and used laboratory methods to gain a better understanding of how prophylactic dressings work. The results of these studies indicate that the composition of foam dressings containing Safetac (i.e. their multi-layer structure) sets them apart from other dressings due to their ability to mediate the effects of physical forces (i.e. pressure, friction and shear) and control microclimate, all of which contribute to pressure ulceration. Conclusion The evidence pool clearly indicates that the prophylactic use of multi-layer foam dressings with Safetac as a component of standard prevention measures is beneficial to the clinician, the health-care provider and the patient. It should be noted that the findings outlined in this review may not be transferable to other products as their makeup and components are likely to differ significantly from those of multi-layer foam dressings with Safetac. As the importance of evidence-based practice and the need for cost-effective care continues to grow, clinicians and provider should carefully consider this point when selecting prophylactic dressings for PU prevention.

A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T

2019 ◽  
Vol 28 (20) ◽  
pp. S4-S8
Author(s):  
Matthew Wynn ◽  
Samantha Holloway
Keyword(s):  
Risk Assessment ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Evidence Base ◽  
Assessment Tools ◽  
Future Research ◽  
Advisory Panel ◽  
Evaluation Tool ◽  
Risk Assessment Tools ◽  
Patients At Risk

The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.

Risk Assessment for Pressure Ulcers: An Adaptation of the National Pressure Ulcer Advisory Panel Risk Factors to Spinal Cord Injured Patients

1993 ◽  
Vol 16 (3) ◽  
pp. 169-177 ◽  
Author(s):  
Paula A. Rochon ◽  
Marie P. Beaudet ◽  
Regina McGiinchey-Berroth ◽  
Linda A. Morrow ◽  
Margaret M. Ahlquist ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Spinal Cord ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Advisory Panel ◽  
Injured Patients ◽  
Spinal Cord Injured
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