Nursing Practice: Pressure Ulcers

In this post I'm going to talk about what we covered in one of our first nursing practice lectures which was about pressure ulcers.

Nursing Practice

•Guideline – A general rule, principle or piece of advice
•Policy – A proposed or adopted course or principle of action. Something you must follow otherwise you may be disciplined
•Standards – A required or agreed level of quality. Recommended by regulating/professional bodies and must be followed EG The code of practice.

What is stroke?

A stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke also is sometimes called a brain attack or a cerebrovascular accident (CVA).

Pressure Ulcers
Pressure ulcers, also sometimes known as bedsores or pressure sores, are a type of injury that affects areas of the skin and underlying tissue. They are caused when the affected area of skin is placed under too much pressure.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

How pressure ulcers develop
Pressure ulcers develop when a large amount of pressure is applied to an area of skin over a short period of time. Or, they can occur when less force is applied but over a longer period of time. They can develop within two hours. So it is important to move a patient at least once every two hours.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected area of skin becomes starved of oxygen and nutrients. It begins to break down, leading to the formation of an ulcer.

Healthy people do not get pressure ulcers because they are continuously and subconsciously adjusting their posture and position so that no part of their body is subjected to excessive pressure.

However, people with health conditions that make it difficult for them to move their body often develop pressure ulcers. In addition, conditions that can affect the flow of blood through the body, such as type 2 diabetes, can make a person more vulnerable to pressure ulcers.


Preventing pressure Ulcers
•Change a patient’s position at least once every two hours
•Use equipment such as mattresses or pillows to relieve pressure on vulnerable areas

Vulnerable areas for pressure ulcers
If a patient is bedbound (unable to get out of bed) they are at risk of developing pressure ulcers on their:
•shoulders or shoulder blades
•elbows
•back of your head
•rims of your ears
•knees, ankles, heels or toes
•spine
•tail bone (the small bone at the bottom of your spine)

If they are sitting or they are a wheelchair user, they are at risk of developing pressure ulcers on:
•the buttocks
•the back of your arms and legs
•the back of your hip bone

Other reasons for patient discomfort:
•If a patient is incontinent, urine is acidic which may burn their skin
•Hospitals can also become very warm which may cause them to sweat which can in turn cause discomfort

Hygiene needs of a patient

Assessment
•Check the nail beds and the skin to check for capillary refill time and circulation – press on the skin and check how long the skin takes to return to its natural colour
•Skin can be an indication of dehydration – this is obvious if the skin is dry, if, when the skin on the back of the hand is pinched, the skin takes some time to return to its normal state. And also if the tongue is dry.
•Check the patient for ulcers
•Find out if the patient is diabetic – because you must not cut diabetics nails in case you catch the skin because of slow wound healing which could make them more prone to infection
•Is their skin a healthy colour?
•Check health of nails – are they yellow or horn-like?

Nutritional assessment
•Is the patient overweight or underweight?
•Maintain holistic care whilst bathing – involve them in conversations by asking them how they are feeling, asking them what their name is. Make them feel at peace and comfortable.

However…
Allow them independence as much as possible. If they can, allow them to dress themselves or wash themselves without help. This also allows them to maintain dignity and self-respect

Social assessment
•Integrate them into the conversation if with another nurse and use a nice calming tone of voice

Evidence based practice
•Do not wear gloves unnecessarily (each box costs £8!!) and if there is no clinical reason to as this might frighten the patient or put up a psychological barrier between the nurse and the patient
•Do not touch intravenous infusions!!
•Pat a patient dry instead of rubbing – especially if the patient has dry skin as you do not want to aggravate the skin
•Check the skin for sores of ulcers
•You should work with your mentor approximately 40% of placement and you should have three meetings with them. One at the beginning, one two/three weeks in and one at the end.

Emily