Best Practice for Pressure Ulcers by yurtgc548


									Best Practices for Pressure
    Ulcers to Promote
 Uncomplicated Healing
   Pressure ulcers are major health problems
    in the U.S.
   Affects approximately 1.3 to 3 million adults
   Over 11 billion dollars is use to treat ulcers
    per year.
Introduction (cont.)
   Increased awareness is important in the
    health care setting to prevent ulcers.
   It is imperative to find the best research to
    prevent and treat the occurrences of ulcers
    in the healthcare setting.
   We found 2 sources that were ranked high
    on level of evidence that had
    comprehensive information.
   The first source is a Retrospective cohort
    study with convenience sampling.
Sources (cont.)
   There were 4 themes that were examined in this
   The relevance of nutrition to wound healing.
   Pressure ulcers cleaned with saline or soap
    compared to those cleaned with other cleansers
    such as antiseptic, antibiotic, or commercial
   The therapeutic effectiveness of debridement on
    the wound bed.
   Evaluating whether dry or moist dressings is more
    advantageous to healing.
Sources (cont.)
   Our second source is a clinical guideline.
    We used this article to support the
    evidence found in our other source.
   This clinical guideline identified the best
    practices for pressure ulcer management
    from 41 studies and articles related to
    pressure ulcer treatments.
   Nutrition is considered a significant factor in
    both the prevention and treatment of
    pressure ulcers.
   Protein, carbohydrates, vitamins, minerals,
    and trace elements are required for wound
   A nutritional assessment
    should be performed on all
    newly admitted patients and
    whenever there is a change
    in a patient condition.
   Nutritional support should be
    given only to patients with
    identified nutritional
    deficiencies, and only when
    not contraindicated.
   Pressure ulcers need to be assessed and reassessed
    for signs of infection.
   Infection complicates the healing process of pressure
   Early recognition along with prompt and effective
    interventions is needed to address the infection.
   Assessment of the wound must be done to evaluate the
    healing and the treatment of the wound.
Infection (cont.)
   Necrotic tissue must be removed and
    present infection must be treated for
    healing to occur.
   The necrotic tissue may be removed by
    different types of debridement.
   Why is it needed for pressure ulcers?
       To promote healing
       To allow the healing process to occur
       To protect against bacteria
       To remove dead tissue
Types of Debridement
   Enzymatic

   Surgical

   Autolytic

   Mechanical
Debridement (cont.)
   Enzymatic debridement
       Use of exogenous
        proteolytic enzymes to
        removed dead tissue.
       Used in wounds with large
        amount of debris.
       Advantages
            Minimal damage to
             healthy tissue
            Bleeding disorders
            Very effective in most
       Disadvantages
          Expensive

            Topical agents
            Needs to be softened
Debridement (cont.)
   Surgical debridement                Advantages
      Removal of layers of
                                             Best used for larger
       necrotic tissue using a
       laser, scissors forceps, or            wounds and infected
       curette using sterile                  pressure ulcers.
       technique.                       Disadvantages
      Sharp debridement can be
                                             Painful
       done by nurses with
       training.                                 EMLA cream as a local
                                                 Costly
                                                 Contraindicated in patient
                                                  receiving anticoagulants,
                                                  and clotting disorders,
                                                  lack of experience, sepsis
Debridement (cont.)
   Autolytic debridement
        Stimulation of natural enzymatic
         activity by the use of the
         endogenous enzymes used to
         digest the dead tissue.
        Used for larger pressure ulcers
         and deep wounds.
        Semi-occlusive or occlusive
         dressing using transparent films,
         hydrocolloids, hydrogels
        Advantage
            Selective

            Painless

        Disadvantages
            Time

            Risk for infection
Debridement (cont.)
                    Mechanical debridement
                       The removal of slough or
                        necrotic tissue by use of
                        wet-to-dry dressing or
                        whirlpool treatment.
                       Used in wounds with a
                        great amount of necrotic
                       Advantages
                              Cost
                         Disadvantages
                              Painful
                              Takes off healthy tissue
                              Trauma to wound
                              Infection (whirlpool)
                              Least recommended
   Select the appropriate dressing for the wound
       Consider the wound’s characteristics: location, phase
        of healing, infection, frequency of dressing changes,
        product availability, cost.
       The choice of the dressing should change as the
        wound heals.
   Moist wound dressings
       Advantages
            Keeps the wound bed moist.
            Eliminates dead space.
            Controls the exudates.
Dressings (cont.)
   Nondraining Wounds
       Use transparent film,
        hydrocolloid, or
        hydrogel dressings.
   Draining Wounds
       Use foam, alginate, or
        collagen dressings.
Dressings (cont.)
   Hydrocolloid dressings
       Shown to have a lesser risk of infection than gauze dressings.
       Should not be used on infected wounds or wounds with
        undermining, tunneling, or sinus tracts.
       Hydrocolloid dressings have a greater affect on wound healing
        than saline gauze or paraffin gauze.
   Infected wounds
       Do not use occlusive dressings when an anaerobic bacterial
        infection is present or suspected.
       Positive correlation between gauze dressings and rates of
        infection, because they lower wound temperature and impede
        fluid evaporation.

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