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Pressure Ulcers

 

Introduction

Pressure ulcers occur when external tissues are exerted with excess pressure, which is not adequately relieved. The tissues that are exerted with pressure are mostly due to bony prominence. It is a common occurrence that pressure ulcers mostly inflicts the heel and the sacrum. The outcome of the pressure ulcers at the heel has some immense consequences, because it is expensive to treat and it is very painful, and mobility of the victim is severely limited. Older adults have increased chances of being diagnosed with heel pressure ulcers. Others who are likely to suffer from the disease include those who are paralyzed, incontinent, debilitated, and those who are suffering from metastatic cancer. Others include patients who are in the intensive care unit (ICU), those on ventilator, and those with diabetes mellitus. All these have similar level of peripheral vascular compromise, which adversely affect blood circulation, which can contribute to neuropathy and deformities on the foot. This report describes a program for the management of pressure ulcers among the older adults.

Clear Innovation goals and outcomes

            Based on what researchers have found, it is obvious that all the devices are not 100% effective in reducing the tissue interface pressure to the minimum level. The devices normally produce some limited protection on the heel against bony prominences, shear, and friction. This is mostly when the patient is lying on the side. To some degree, the foam boats are effective because the exterior surface aides in reducing friction. If the foam boot is more rigid, there is a high potential of developing pressure areas in the heel plantar surface or the lateral ankles. The booty type devices can reduce internal and external rotation, but have limited potential but can only manage to reduce the rotation only if they are more rigid (Dennis, Bowen & Cho, 2012). The air boot weighs less and does aid in lessening the internal and external rotation, but cannot completely prevent it. Feet sweat in air bags, thus these bags are required to have venting holes to enhance air circulation. Boots have surfaces that make them easier to slip around on the bed surface; however, these allow more positioning checks. Straps ensure the boots stay on, but the straps should not be very tight. Tight straps can cause unnecessary pressure on the dorsum of the feet or the lower leg. Therefore, the boots should be removed at regular intervals, and allow time for the feet to be assessed. Nurses should also check the pressure redistributing device to evaluate whether it is worn correctly (Graff, Bryant &Beinlich, 2000).

Detailed design

Among the treatment procedures being carried out on patients suffering from heel pressure ulcers, or the vulnerable aged adults, repositioning or turning the patient frequently is a recommended procedure aimed at preventing the occurrence of the ailment. Defloor et al. (2005) found that a turning schedule on either viscoelastic foam mattresses or standard mattress proved to be effective after following a preset schedule.

In regards to the heel pressure, it is imperative that this is controlled by use of pressure relief devices. Among the old people who are at risk of heel pressure ulcers, it is important that such individuals use pressure-redistribution device. This device plays a critical role in ensuring that the heel tissue does not breakdown, and remains protected from the adverse effects of the pressure, shear forces and friction (Black, 2004). Patients with boot type devices are mostly those who have been diagnosed with diabetes mellitus, or those with neuropathy; those with limited or poor mobility, and those who are immobile while recovering. There are varieties of boot type devices for all the diverse clients intending to distribute their pressure, and thus play it safe for their heels.

Implementation steps

Most of the medications used for treatment of heel pressure ulcers are similar to the ones used for prevention of the problem. Before the health care providers begin to carry out treatment, it is important for them to perform some risk assessment on the person. Among those who require risk assessments include those with mobility problems or their mobility is impaired, have impaired sensation, are diagnosed with diabetes mellitus, have foot deformities, or their lower extremities have circulation problems. It is unfortunate that most of the assessment scales lack the required parameters required for evaluation of the non-movement in the lower extremity as a result; there could be some instances where one can suffer a leg fracture, but the risk of pressure ulcer when assessed could be lacking. More so, the classification of those at risk is not standardized. Nonetheless, most scholars agree that the older adults who have suffered leg or hip fractures are among those who are at risk. Therefore, appropriate preventive measures should be put in place to guarantee full recovery until they have made full recovery, even if formal risk assessment does not identify the risk (Gilcreast, et al, 2005).

Evaluation process

It is important that full assessment is done on older patients to evaluate their level of risk when they are being admitted to a facility. The patients who are a higher risk should be monitored closely and frequently. It is required that those in the acute care should be assessed every 12 hours in order to evaluate any significant change in their condition.  For those in the long care, they should be assessed every week, but that can be changed depending on the conditions of the patient. Nurses can use the heel pressure ulcer assessment tool to assess the patient risk level. Upon carrying out the assessments, patients whose have damaged skin or reddened skin should be handled with care, and heel protectors should be used to prevent further damage of the heel.

            The focus for the treatment and prevention of the heel pressure ulcers is the connection between the heel vasculature and the external pressure. In order to prevent cases of heel ulcers from arising, comprehensive strategies should be employed, especially among the vulnerable populations. These may include identifying the comorbidities that comprise of skin assessment, the dietary intake, early use of pressure distribution devices, and use of evidence based interventions, among other interventions


 

References

Black, J. (2004). Preventing heel pressure ulcers.Nursing, 34, 17.

Defloor, T.,DeBacquer, D., &Grypdonck, M.H. (2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers.International Journal of Nursing Studies, 42, 37-46.

Dennis, M., Bowen, W. T., & Cho, L. (2012). Mechanisms of clinical signs.Chatswood, NSW: Churchill Livingstone/Elsevier.

Gilcreast, D.M.,Warren, J. B., Yoder, L. H., Clark, J. J., Wilson, J. A., & Mays, M. Z.(2005). Research comparing three heel ulcer-prevention devices. Journal of Wound Ostomy Continence,32, 112-120.

Graff, M.K., Bryant, K.,&Beinlich, N. (2000). Preventing heel breakdown.Orthopedic Nurse, 19, 63-69.