Effectively Managing Pressure Ulcers

Pressure ulcers have the greatest occurrences in individuals whom are immobile due to an acute or chronic illness. When a person is unable to move, the area of their skin that has the pressure applied begins to break down due to the lack of blood circulation to that particular area. This can lead to a serious ulcer that could ultimately lead to the demise of this individual. According to Duhon, RN, MSN (2007), "Potential complications of pressure ulcers include sepsis, osteomyelitis, infectious arthritis, urethral fistulas, and renal failure" (25). The goal of the article "Taking the Pressure out of Pressure Ulcer Therapy"is to increase the education level to provide quality patient care to either prevent or speed the healing of these types of ulcers.

As a health care provider do you know enough about pressure ulcers that you can prevent or assist in the healing process of them? There are many underlining illnesses and injuries that can lead to pressure ulcers. Duhon RN, MSN (2007) stated, "Knowing who's at risk and what to do is essential to your care with this type of wound" (25). If a sore is present you need to be able to know what stage of healing the ulcer is currently in.

In order to be able to clearly judge your skills as a health care provider you not only need to know how to properly care for these wounds but you need to accurately document about the wound. During your assessment you need to be sure to document information about the "ulcer's location, the size of the skin opening, and the presence of any surrounding maceration or induration" (Duhon RN, MSN, pg 26). This will assist the other health care providers in giving appropriate care.

Proper knowledge about the stages of the wound will assist you in proper care. There could be partial thickness or full thickness wounds. This is determined by the different layers of skin that is involved in the ulcer. A partial thickness ulcer involves the top two layers of skin being the epidermis and dermis, where as a full thickness ulcer involves more tissue that could include the subcutaneous tissues, muscle, and in some cases even the bone. According to Duhon RN, MSN (2007) to determine the type of wound you need to do the following:

Use a clear, disposable, bull's eyed-type measuring device to measure the ulcer's length and width. With a gloved hand or sterile cotton swab, evaluate the depth of the wound, and the extent of tunneling or undermining, a separation of the skin from subcutaneous tissue.(p26)

Documenting the color and odor will also help to promote healing of the wound by knowing what treatments need to initiated. She stated "An easy way to assess the color of a wound is to use the red-yellow-black method" (Duhon RN, MSN, 2007 p26). The way that I remember and use this method is red is right, yellow is yucky, and black is bad.

The color of the tissue will ultimately determine the type of dressing and treatment that will be needed. The yellow and black tissues will need to be taken off or debrided. This will promote healthy tissue to grow. According to Duhon RN, MSN, (2007) "An effective ulcer care plan usually includes cleansing the wound initially and then with each dressing change". (p27) These wounds need proper care and dressing to promote healing. If a wound is kept clean there should be signs of healing in about two to four weeks.

When dealing with wounds, knowing how to care for them is important, but preventing them from occurring in the first place is more important. It is a know fact by medical professionals that it is vital to turn and reposition your immobile patients frequently and according to Duhon RN, MSN (2007) "is the single most effect intervention for preventing pressure ulcers". (p26) The typical rule of thumb on a clinical unit is to turn a patient every two hours. This needs to be individualized between patients because some patients may need turned more often. Another way to help prevent ulcers is to shift the pressure to different areas by placing a pillow behind their back. It is also important to keep the heels and elbows propped up to relieve pressure.

Skin assessments need to be preformed daily. In doing these assessments they need to be properly documented on so others have information for comparison. You need to do proper skin care and take care of incontinence promptly to prevent skin break down.

If healthcare workers just stop and take a few moments to care for things that are sometimes missed they may help to sustain and promote better health for acutely or chronically ill patients. By taking care of the skin before it becomes a wound you will be saving your patient the agony from the debridements, infections, and possibly life threatening aliments.

References

Duhon, Jennifer, RN, MSN. (2007). Taking the Pressure out of Pressure Ulcer Therapy. RN, vol.

70 (No.2), 25-30.