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Pressure Ulcer

Transcript: Nursing Diagnosis BMI: 16 History of left sided stroke. Bedbound Suspected Deep tissue Injury on Left heel Stage 3 pressure ulcer on sacral area Braden score: 9 Patient consumes less than 30% of her meals. Patient complains of a throbbing sensation located on the bottom of her Left heel Patient states she has an irritation in her lower back Pain scale is 7/10 overall. Patient states she feels a "pressure". Patient states she has trouble repositioning herself in bed. Patient is 91 years old. Impaired skin integrity as related to immobility as evidenced by presences of pressure ulcers and Braden scale score of . Pressure Ulcer A pressure ulcer is localized injury to the skin or the underlying tissue, usually over a bony prominence and at sites susceptible to prolonged pressure or friction. Decubitius Ulcer Concept Map Nursing Diagnosis Acute pain related to skin trauma as evidenced by patient rating pain a 7/10 on the numerical pain scale. Subjective Data Activity intolerance as related to acute pain as evidenced by patient pain scale 7/10 and patient grimacing upon movement. Objective Data Nursing Diagnosis

Pressure Ulcer

Transcript: Risk Factors and Prevention Nutritional Interventions & Medications Behavioral & Lifestyle Changes Thank You Very Much! Anatomy & Physiology of the Skin Interventions Aaron, Andrea, Anjila, April, John, Jocelyn Interventions Group 4 Pressure Ulcer

Pressure Ulcer

Transcript: suspected deep tissue injury. Also known as bedsores or decubitus ulcers Symptoms/Tests Stages Source Stage 2 Pressure Ulcer 10% to 18% in acute care, 2.3% to 28% in long-term care, and 0%-29% in home care Treatment Stage 4: The pressure ulcer has become so deep that there is demage to the muscle and bone, and sometimes to tendons and joints. www.nlm.nih.gov/medlineplus/pressuresores.html Stage 3 Deep Tissue Injury: the skin is purple or maroon-red, appears as a blood-filled blister. as of 2010, pressure ulcers resulted in about 43,000 deaths. Stage 1: A reddened area on the skin that,when pressed, does not turn white.- sign of ulcer forming. The effected skin looks red and my feel warm to touch. it may also burn, hurt or itch. Red skin that gets worse over time The area forms a blisterc then an open sore Tests- Blood Test, Tissue Cultures (diagnose a bacterial or fungal infection, also for cancerous tissue A pressure ulcer is an area of skin that is damaged from staying in a position for to long. Pressure ulcers form on your ankles, back, elbows, heels, hips, butt, shoulders, and at the back of your head. Prevention Causes Stage 2: The skin blisters or forms an open sore. the area around the sore may be red and irritated. Stage 3: the skin now develops an open, sunken hole or crater. The tissue below the skin is damaged. Change position at least every 2 hr to relieve pressure. Eat well-balanced meals that contain enough calories to keep you healthy. Drink plenty of water every day. Exercise daily Keep the skin clean and dry www.mayoclinic.com/health/bedsores/ds00570/dsection=symptoms umm.edu/health/medical/ency/articles/pressure-ulcer Relieve the pressure on that area. Treat the sore avoid further injury or friction to the area. Eat healthy foods. Clean the ulcer the way your doctor or nurse told you to. Rinsed with a salt-water- removes looes, dead tissue. Stage 1 Unstageable pressure ulcers: The damage can't be estimated. www.logicalimages.com/publichealthresources/pressureulcer.htm Stage 4 The pressure on the skin reduces blood flow to the area. Without enough blood, the skin can die and an ulcer may form. Also staying in bed for a long time can cause ulcers. People with fragile skin and paralyzed people have a higher chance of getting ulcers. Additional Information unstageable pressure ulcers

Pressure Ulcer

Transcript: Pressure ulcers occur most commonly over a bony prominences Pressure ulcers may develop on ANY part of the body under a splint or cast external fixations devices tubes pulse oxymetery meters Full thickness tissue loss with exposed bone, tendon or muscle, tissue necrosis, or damage to muscle, bone, or supporting structures; tendons and joints Objectives GEL PADS FOR EVERYONE! Pressure Ulcer Care Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). Maryland Heights, MO: Elsevier. Mayo Clinic, (2001). Bedsores (Pressure Sores) Prevention. Mayo clinic. Retrieved from: http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=prevention The NPUAP, (2013). Pressure Ucler category/staging illustrations. The National Presure ucler Advisory Panel. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-ulcer-categorystaging-illustrations/ POSITION, POSITION, POSITION!!! Thank you! How often should you turn a patient to prevent pressure Ulcers? What stage is an ulcer when you can see fatty tissuse but no bone or muscle? Name two risk factors for developing a pressure ulcer? Partial thickness loss of epidermis and dermis. The ulcer is superficial and appears as an abrasion, blister, or a shallow crater. A shiny or dry shallow ulcer without slough or bruising Patients older than 65 years old Diabetes Mellitus Edema Vasoconstrictive diseases Stage 4 Stages of Pressure Ulcer Inspect integrity of skin especially under and around any protective devices used Use proper turning and transfer techniques and devices to avoid sliding friction and shear Document any skin discrepancies and report, take a picture! Contact wound care specialist to inspect and treat the ucler Regularly inspect and clean skin in contact with probes, drains ,cannula and tubing. Provide patient with proper nutrition Stage 2 incontinence Skin discomfort( pain, Itching, loss of sensation) Skin blanching, abscess or absence of skin layers Care Tissue tolerance- The integrity of the skin Shear – occurs when the patient slides downwards with gravity while the skin remains in the original position, stretching and tearing the blood vessels causing tissue ischemia. Friction- occurs when two surfaces moves across each other removing superficial layers of the skin usually over a bony prominence. Gel pad arm on arm boards to relieve pressure on elbows Gel pad on the heels of patients in suspension slings Gel pad head ring to protect occipital area Pillows to protect boney promiences Prevention of Pressure Ulcers Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Risk Factors 3 Keep patient dry with no creases under patients skin Change patient position every 2 hours Apply the appropriate topical agent or dressing in relation to the ulcer characteristics as ordered. Reassess skin to check for any change in skin integrity Pressure Points Skin hygiene Skin moisture Skin temperature Skin integrity Skin scarring REFERENCEs If possible re-position the patient every 2 hours to relieve pressure from the affected areas Avoid high semi-fowlers position for extended periods as it increases the shear and pressure forces in the sacral area. Position high risk patients on specialty beds if possible Intact skin with non-blanchable redness/erythema of intact skin of a localized area usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness may also be used as indicators, particularly on individual with darker skin. Stage 3 jk QUIZ 1 OTHER PRECAUTIONS Sarah Mason Michelle Rees Avoid pooling of fluids and/or secretions under patients keep skin dry at all times Take special care of blood pressure cuff areas and rotate site if necessary Sheets, patient gown and linen must have no creases or folds beneath patient Stage 1 A pressure ulcer is an area of localized damage to the skin and underlying tissue that is caused by pressure, shear, friction and or a combination of these. Identification of patients risk of developing pressure ulcers How to Identify the stages of Ulcers How to prevent Ulcer formation Pressure Ulcers Assessment.Prevention.Care Factors in the formation of pressure ulcers Pressure Ulcer 2

Pressure Ulcer

Transcript: pressure from a hard surface – such as a bed or wheelchair pressure that is placed on the skin through involuntary muscle movements – such as muscle spasms moisture – which can break down the outer layer of the skin (epidermis heat redness tenderness discomfort feeling of burning dark scab ulcer of ankle ulcer of heel and midfoot ulcer of hip ulcer of tailbone bleeding chronic wound fever swelling What are the symptoms? What is the disease? Pressure Ulcer Selena Estay 1st 10-5-15 An area of skin that breaks down when something keeps rubbing or pressing against the skin. What causes it? Institution Reduction in development of new pressure ulcers. Increased number of risk assessments performed. Cost-effective prevention protocols developed. Provider/Nurse Nurses will accurately perform PU risk assessment using standardized tool Nurses will implement PU prevention protocols for clients interpreted as at risk for PU. Nurses will perform a skin assessment for early detection of pressure ulcers Patients Skin will remain intact Pressure ulcer(s) will heal management of local distant infections removal of necrotic tissue,maintenance of a moist environment for wound healing possibly surgery. What is the treatment? What is the expected outcome?

Pressure ulcer

Transcript: stage4 stage 3 NHS reported that just under 25000 reproted to develop pressure ulcer from 2014 -205 20% of people in acute care & 30% of people in community at risk. pressure ulcer treatment is a costly process . The UK spends around 1.4 to 2.1 billion yearly. (Bennett, at al,. 2004). objective prevention pressure ulcer mostly occur as a result of inadequate care, following the principle of prevention help protecting people at risk from developing pressure ulcer Nonblanchable erythema of intact skin heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, oedema, induration or hardness may be indicators. kareema alabri References Thank you mobility problem poor nutrition underlying health condition being over 70 years old incontinence : urine/ bowel serious mental health condition Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia. The ulcer presents clinically as deep crater with or without undermining of adjacent tissue (Ellis, 2016) How it occurs The extra pressure disrupts the blood flow through the skin. Without the blood supply, the effected skin areas became starving of oxygen and nutritions.it began to breakdown leads to formation of ulcer which can be infected by bacteria. stage 2 content stages 1 areas of damaged skin and tissue that developed from sustained pressure usually laying in bed or sitting in wheelchairs. Range in severity from patches of discoloration skin to open wounds that expose the underlying muscle or bone . (Morison, 2001) (Ellis, 2016) Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow canter. (Ellis, 2016) sites (Keller, et al., 2002) At the end of this session the student will be able to define pressure ulcer. states the causes and how it occur. identify the sites and stages. list the measures to prevent it. (Ellis, 2016) Toward reducing the pressure ulcer incident throw implementing the prevention measurement. At risk Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g, tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers. (NHS Choices information) Pressure ulcer Conclusion What is pressure ulcer How it happen At risk Sites and stages Braden scale Prevention Bennett, G., Dealey, C. and Posnett, J., 2004. The cost of pressure ulcers in the UK. Age and ageing, 33(3), pp.230-235. Bergstrom, N., 1994. Treatment of pressure ulcers (No. 95). DIANE Publishing. Cannon, B, & Cannon, J 2004, 'Management of pressure ulcers', American Journal Of Health-System Pharmacy, 61, 18, p. 1895, Academic Search Premier, EBSCOhost, viewed 24 November 2016. Lyder, C.H., 2003. Pressure ulcer prevention and management. Jama, 289(2), pp.223-226. Langer, G., Knerr, A., Kuss, O., Behrens, J. and Schlömer, G.J., 2003. Nutritional interventions for preventing and treating pressure ulcers. The Cochrane Library. Bergstrom, N., Braden, B.J., Laguzza, A. and HOLMAN, V., 1987. The Braden scale for predicting pressure sore risk. Nursing research, 36(4), pp.205-210. House, K.W. and Johnson, T.M., 2014. Prevention of Pressure Ulcers. In Pressure Ulcers in the Aging Population (pp. 27-45). Humana Press. Morison, M. J. (2001) The prevention and treatment of pressure ulcers. London: Mosby. Ellis, M 2016, 'Understanding the latest guidance on pressure ulcer prevention', Journal Of Community Nursing, 30, 4, pp. 29-36, CINAHL Complete, EBSCOhost, viewed 25 November 2016. https://i.ytimg.com/vi/9AvCUJgT2zI/hqdefault.jpg (accessed on 7/12/2016). http://www.nhs.uk/Conditions/Pressure-ulcers/Pages/Causes.aspx, (accessed on 7/12/2016). Keller, P.B., Wille, J., van Ramshorst, B. and van der Werken, C., 2002. Pressure ulcers in intensive care patients: a review of risks and prevention. Intensive care medicine, 28(10), pp.1379-1388. What is pressure ulcer? Aim

pressure Ulcer

Transcript: Zoom out for more assets Asset library What to include in Skin Assessment? STAGES Skin color Skin temperature Edema Turgor Moisture Skin integrity Unstageable –full thickness skin and tissue loss Stage 2 - some skin loss or damage involving the top-most skin layers Stage 1- skin discoloration, usually red, blue, purple or black Measuring the wound To prevent bed sores REPORTING Deep tissue pressure injury Read-Maroon or purple color Intact or non intact with localized effected area Stage 3 -necrosis (death) or damage to the skin patch, limited to the skin layers Stage 4 -necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone 1- Use air mattress 2- Make sure the bed sheets clean 3- Make sure the patient clothes are clean and dray. 4- Keep the skin clean & evaluate the skin 5- Change position 2 hours if patient obese every hour 6- Make sure patient take good nutrition Mucosal membrane pressure ulcer Injury caused by Medical device Causes and risk factors of pressure ulcer 1- patient long time without changing position 2-patient not cleaning & bed sheets not cleaning 5- Wetness from urine, faeces, sweat or wound fluid 3- poor nutrition 4-diseases conditions ( DM - COPD obstructive pulmonary disease - Heart failure problems ) Sites Skin Lesion: Wounds that are usually result from impact (or relate incident) to extremely fragile skin. Areas of the skin that are different from the other surrounding skin. 1-Primary- lesions are abnormal skin conditions present at birth or acquired over a person's lifetime 2-Secondary -are the result of irritated or manipulated primary skin lesions. PRESSURE ULCER PREPARED BY: Roaya Othman Bushra Alotabi Saudi Patient Safety Taxonomy A Pressure Ulcer- localized injury to the skin and/or underlying tissue, that are primarily caused by prolonged pressure or pressure with shear on the skin Documentation B Mechanical Device Related Pressure ulcer- results from the use of devices designed and applied for diagnostic or therapeutic purposes. Documentation Reference: MMH Policy and procedure NPIAP- National Pressure Injury Advisory Panel https://woundcareadvisor.com/comprehensive-skin-assessment-vol4-no4/ https://emedicine.medscape.com/article/190115-treatment#d8 Pressure ulcer grade Description of the skin damage if applicable. The provided patient & family education Wound care plan The provided wound care Note: Document the progress of the pressure ulcer, including stage,measurement, exudate, odor, type of dressing. Pressure ulcer grade Description of the skin damage if applicable. The provided patient & family education Wound care plan The provided wound care

Pressure Ulcer

Transcript: Quality Improvement Strategies For Pressure Ulcer Patients In Long Term Care Facilities What are Pressure Ulcers? Pressure ulcers, also known as bedsores, are a tissue condition that occurs when constant pressure is applied to a region of the body. Without the relaxing of the pressure, the skin and muscle tissue starts to degrade and die. How Does the Condition Affect Health Care? Without the relaxing of the pressure, the skin and muscle tissue starts to degrade and die. This issue affects around 2.5 million patients each year and contributes to 11 billion dollars in health care spending. The estimated cost doesn’t reflect the additional costs that may come from potential neglect of care lawsuits that have been filed. Some of the high risk patients include the elderly and patients with mobility issues. This is a also a concern because some elderly patients also have mobility issues. This will involve performance of tests, implementing and executing of the plan, documenting any observations made and recording the data for residents in Long Term Care facility. MEASUREMENT (POST-IMPLEMENTATION) B) Measure the percentage of patients receiving a complete pressure ulcer preventive care (weekly) D) Measure the number of patients receiving daily pressure ulcer risk assessment (daily) DO Daily inspection of skin Ensure proper cleaning and managing of skin (cleaning and moisturizing ) Ensure proper nutrition feeding Reposition every 2 hours Use of pressure-relieving materials C) Measure pressure ulcer incidence per 100 patients days (monthly) Objective: To reduce the incidence of pressure ulcer in Long Term care Facility residents by 50% within 4 months by October 13, 2016 Predictions: Addition of risk assessment tools to aid the nurses caring for patients in long term care facility is likely to enhance timely detection of pressure ulcers risk at time of admission and hence ensure compliance. A) Measure the number of patients receiving pressure ulcer admission assessment (weekly) Using the risk assessment guidelines, all patients with LOS less than 24 hours will be assessed daily using a standardized form with guidelines that tracks residents pressure ulcer details from admissions/discharge from ER to transfer into LTC. ACT PLAN Here we will determine what changes need to be made Modify the plan to continue to improve the system for incidence of pressure ulcer in Long Term Care Facility We will repeat the PDSA cycle as necessary to ensure accuracy. It was determined that nurses needed more education and guidance on staging pressure ulcer. Therefore another cycle for PDSA was set to ensure the nurses are competent in this area. STUDY This aspect will focus on assessment of the process and resulting outcomes with an aim of drawing useful conclusions. It will answer questions such as how the cycle’s outcomes are in agreement with the predicted outcomes and further, summary of the fresh knowledge that has be gained during the PDSA cycle. Using the pressure time-log/activity form to track activities of interventions, new incidence of pressure ulcers and the effectiveness of the intervention strategies assess skin to identify existing pressure ulcer. using the risk assessment tool to assess and identify high risk patients for pressure ulcer. What Are We Trying To Accomplish? How will we know a change is an improvement? What changes can we make that could lead to improvement?

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