ULCERS FOR PRESSURE

The Ulcer by Pressure (UP) can be defined as any area of hurt in the skin and underlying fabric caused by the pressure prolonged on a hard plane, not necessarily intense, and independent from the position.

 It is a common problem in the care of the patients with chronic diseases, especially in elders with limited mobility, with important morbidity and mortality and high economic and social repercussion.

The most important thing is that 95 % of the UP is avoidable and for it there is prior the prevention based fundamentally on methods that quantify factors of risk and that help to predict the affectation of the fabrics.

The most important factor in the development of the UP is the supported pressure. With her parallel and / or tangential forces of friction can be associated, as well as a series of factors of risk that depend fundamentally on the conditions of the patient.

 The UP need the existence of disorders of the micro traffic in zones of support of the body placed on a hard surface. For this motive the areas with bony prominences are the most frequent zones of UP's appearance.

RISK FACTORS

1 path physiological

2 derived from the treatment:

3 of environment

4 Situational

 CLINICAL ASSESSMENT

The pressure ulcers do not heal unless the underlying causes are effectively addressed. A comprehensive assessment must include the identification and effective treatment of the disease, health problems, nutritional status, degree of pain and the psychosocial aspects that may have located the person at risk for developing pressure ulcers.

NORTON PREASURE ULCER SCALE

REVIEW

* Score of 5 to 9: very high risk •

* Score of 10 to 12: high risk •

* Score of 13 to 14: medium risk •

* Score greater than 14: minimal risk/no risk

VALUATION OF THE INJURY: ESTADIAJE

Stadium I: (degree 1) intact Epidermis, adherent and eritem that does not disappear when the pressure eliminates

Stadium II: (degree 2) Sore with aspect of grazes flictena or crater slightly deep

Stadium III: (degree 3) total Loss of thickness of the skin with injury or necrosis of the subcutaneous fabric, being able to spread up to the underlying fascia but without crossing it. If there is affectation of the fascia already it belongs to a stadium the IVth.

Stadium  IV: It concerns the muscle and can come to the bone. Total loss of the thickness of the skin with necrosis of the fabric or muscular, bony hurt or of structures of support (tendon, capsule to articulate, etc.). Also it can associate to a hole and tracts fistula in the adjacent fabric.

DIAGNOSIS OF INFECTION

Diagnosis of wound infection is primarily based on clinical criteria. The valuation must understand the assessment of the patient, of the tissues surrounding the wound and the wound itself for signs and symptoms of infection, as well as on factors that are likely to increase the risk and severity of the infection.

OVERALL MEASURES OF TREATMENT

1. - Implement protocols

2. - Unify care

3. - treatment based on scientific evidence

4. - Make decisions based on cost/benefit

To conclude and in a nursing point of view we must know that pressure sores, also called decubitus ulcers or bed sores, are a big problem in hospitals, nursing homes and patient homes. Pressure ulcers are areas where the skin has broken down. They can go very deep to the bone. Pressure ulcers can cause pain and very serious infections that can lead to death.

Pressure ulcers make a hospital stay longer than it should be. They raise the costs of patient care. Most pressure ulcers result from the lack of mobility. Patients and residents who stay in the bed or a chair are at high risk for pressure ulcers. Nursing assistants and other healthcare workers can prevent them. We must prevent pressure ulcers with proper skin care, by looking at the patient and their skin, by giving our patients a good diet and a lot of fluids, by helping them walk, and by turning and positioning them often. 

BIBLIOGRAPHY:

1.NHS Choices; [quoted the 23/04/13] and available in:
 http://www.nhs.uk/Conditions/Pressure-ulcers/Pages/Introduction.aspx

2.Nursing homes abuse blog; [quoted the 23/04/13] and available in:
http://www.nursinghomesabuseblog.com/bedsores-pressure-sores-decubitus-ulcers/sepsis/understanding-pressure-sores-in-nursing-homes-other-medical-facilities/

3. - HOFFMAN, Gloria Basic Geriatric Nursing 5th Edition. Elsevier 2012.