Pressure Ulcers Case Study

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Pressure Ulcers Case Study



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Putting Nutrition Guidelines into Practice: AHRQ Preventing Pressure Ulcers in Hospitals Toolkit

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If you cannot eat enough foods containing key vitamins and minerals then you may need to take a supplement. If you are managing to eat a full and varied diet then there is no benefit in taking high levels of vitamins and mineral supplements - in fact, this can be harmful. Dehydrated skin can become dry and fragile. It is important that your skin is kept moist from the inside. You should aim for 1. This could include any liquid tea, coffee, milk, water, juice but not alcohol. If you are overweight avoid drinks that contain sugar, choosing sugar free alternatives or using lowcalorie sweeteners in hot drinks. Losing weight could help to reduce the risk of pressure ulcers and protect a newly healed pressure ulcer.

However, if you restrict your intake too much whilst a pressure ulcer is healing it could delay the healing process. It is important that you maintain a balance to your diet so that your body continues to get all the nutrients it needs. Simple changes that you could make to your diet if you are overweight are:. Pressure ulcers need a lot of nutrients to help them heal. If you are underweight you may not have enough nutrient stores in your body so you will need extra nutrition from your diet. Without nutrients the healing process may take longer. Some changes that could help to increase your intake are:. If your food intake remains low, it may not be enough to help heal the pressure ulcer. If this is the case, it may be necessary for you to have some prescribed oral nutritional supplements.

These types of drinks provide a rich source of energy, protein and other nutrients. A dietitian may be available to discuss with you the most appropriate one and how many you will need. You should not take additional vitamins and mineral supplements if you are taking three or more oral nutritional supplements per day. Poorly controlled diabetes can delay healing.

Diet and medication may need to be adjusted to achieve good diabetic control. Speak to your GP, nurse or dietitian if you require help with this. Eating a balanced diet and having a healthy body weight will help to reduce the risk of developing a pressure ulcer. If you have a pressure ulcer, eating and drinking well will help it to heal. If you are overweight then it would be beneficial to try to lose weight gradually. If you are underweight then weight gain will help improve the padding over the bones. This can be best achieved by eating small and frequent meals and snacks. Langer, G. DOI: NICE Pressure ulcer: prevention and management of pressure ulcers. NICE clinical guideline ; www.

Emily Haesler Ed. Cambridge Media: Osborne Park, Australia; It is not a substitute for proper medical diagnosis or dietary advice given by a dietitian. If you need to see a dietitian, visit your GP for a referral or: www. To check your dietitian is registered check www. This Food Fact Sheet and others are available to download free of charge at www. Return to listing.

This is because: Being overweight can reduce mobility and increase the weight bearing load through pressure areas such as the bottom. Being underweight can mean there is less natural padding on bony areas such as the bottom and hips. The skin needs a good supply of fluid and nutrients to maintain its circulation and keep it supple. Nutrition and pressure damage Once a pressure ulcer has developed, nutrition plays a vital role in the healing process.

Protein Your body may need more protein if you have a pressure ulcer. Iron Iron is important for the healing process by helping to maintain adequate blood haemoglobin levels. Friction and shear — caused by sliding down in the bed, for example, or being moved improperly from a stretcher to a bed — can exacerbate the problem. Categorized by severity according to a scale developed and periodically updated by the Washington, DC-based National Pressure Ulcer Advisory Panel , pressure ulcers range from Stage I — the earliest sign of skin redness — through Stage IV, deep craters that damage muscle and bone, and sometimes tendons and joints, often requiring surgery. But individual motivation has yet to translate into widespread success because the prevalence of pressure ulcers in health care facilities is actually increasing, with some 2.

Pressure ulcer incidence rates vary considerably by clinical setting — ranging from 0. All sedentary patients are vulnerable, but elderly and severely compromised patients whose skin can fail just as other organs do are especially at risk. Worse, nearly 60, US hospital patients are estimated to die each year from complications due to hospital-acquired pressure ulcers. Research shows that most pressure ulcers are preventable. Nursing leaders who have introduced effective prevention programs say that leadership, training, and relentless focus on making skin care a priority are all key.

Save Our Skin SOS combines training programs with visual reminders such as stickers on the charts of at-risk patients and regular reporting and sharing of data across units about the prevalence of pressure ulcers. There is an SOS nurse champion assigned to every adult unit, and an SOS skin care team meets monthly to review progress and provide additional support or training in areas still experiencing problems with pressure ulcers. Griffin also consults with unit managers to help them make and maintain progress. The effort has worked: OSF St. The name itself is an acronym that prompts nurses to remember four key elements of good skin care: S urface selection, K eep turning patients, I ncontinence management, and N utrition.

One way her organization is doing that, she says, is by developing two multi-media learning courses — on bed functions such as built-in alarms, turn-assist devices, and pressure redistribution features; and on the SKIN Bundle — that will be available to staff for ongoing education. Experts say there are two main tasks in preventing pressure ulcers: identifying patients who are particularly at risk, and using a combination of equipment and vigilance to relieve pressure on vulnerable parts of the body. Hospitals with a strong focus on preventing pressure ulcers assess all patients on admission for their risk of skin breakdown, and reassess throughout their hospital stay. Mary Brunton at Baystate Medical Center says that when her hospital got serious about preventing pressure ulcers, it instituted guidelines that help clinicians know when to reassess patients.

Scott-Williams has focused on pressure ulcer prevention for more than 20 years. At the VA Medical Center in Memphis, where the current pressure ulcer prevalence rate is less than one percent, Scott-Williams has championed some of the lessons she learned in Little Rock, starting with the importance of comprehensive risk assessment for patients throughout the hospital. Documenting all the information is another challenge. At Genesis Medical Center in Davenport, Iowa, for example, an evaluation revealed that while most staff were reasonably proficient at scoring each element in the Braden Scale, they were not always sure how to document skin abnormalities accurately. This is especially true for acutely ill patients, who are at increased risk for skin breakdown.

Experts recommend building this risk assessment into other daily care tasks, and prompting it by adjusting the forms used for daily clinical notes. Because skin can begin to deteriorate within a matter of hours, patients who are at risk for developing pressure ulcers must receive a daily inspection of all skin surfaces. Wet skin due to perspiration, incontinence, or wound drainage is more vulnerable to deterioration.

Fortunately, new products are helping nurses stay on top of this challenge. Bevette Griffin at St. Because good hydration helps maintain healthier skin, some hospitals have protocols that call for clinicians to offer patients water whenever they turn them. Minimizing pressure on vulnerable body parts requires a combination of physically repositioning or turning patients at regular two-hour intervals — a labor-intensive but critically important process — and making sure they are resting on pressure-reducing surfaces.

Hospitals use a range of methods to remind nurses. Baystate Medical Center is in the process of developing a pilot program that would incorporate visual cue signs and badges to remind nurses to turn patients, says nurse clinician Kathleen Tierney. This program will emphasize teamwork: Nurses and technical associates will reposition patients every two hours, turning patients in even-numbered rooms on the even hours, and patients in odd-numbered rooms on the odd hours. How or even whether patients can be repositioned depends on their condition. For bariatric or other large and heavy patients, for example, OSF St.

Francis Medical Center calls in a special team. They bring special equipment that helps them move the patients. Advanced, pressure-reducing surfaces are also helping nurses prevent pressure ulcers, and many hospitals are making it universal by replacing all their beds with these new mattresses. Francis in Peoria. After that, it loses its ability to redistribute weight over time.

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