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(solved) Hospital Acquired Pressure Ulcer

(solved) Hospital Acquired Pressure Ulcer

Hospital Acquired Pressure Ulcer


Pressure ulcers, sometimes called bedsores or Decubitus ulcers, are skin and tissue breakdown that arises from the exertion of incessant pressure on the skin. Continuous stress on the skin’s integrity will eventually cause skin breakdowns.

The development of pressure ulcers is an example of such skin damage. The most common sites of injuries are the bony prominences of the body, such as the heels, knees, elbows, and sacrum.

There are different stages of pressure ulcers in terms of severity. Not all stages of pressure ulcers present with open sores. The National Pressure Injury Advisory Panel (NPIAP) has coined the most appropriate term, “pressure injuries”.

Problems with mobility, and poor nutrition, among others, predispose patients to have this condition.

Signs and Symptoms of Pressure Ulcer

The general clinical manifestations of pressure ulcers include:

Unusual skin colour or texture discrepancies

Erythema or redness

Oedema or swelling in the affected area or limb

Discharges – foul in odour, can be fluid or pus-filled

Warm or cold to touch – An area of the affected region that feels different to touch than surrounding areas

Tenderness and pain on site

Causes and Risk Factors of Pressure Ulcer

Pressure ulcers are caused by relentless pressure against the skin, thereby limiting blood flow to the skin and surrounding tissues.

Inactivity and limited movement, particularly in bedridden patients, makes the skin vulnerable to developing pressure ulcers.

There are three contributing factors to its development, and they are:

Pressure. Constant pressure on any part, specifically on the skin of the bony prominences of the body, will lessen the blood supply to the tissues. This lack of blood supply will deprive the tissues of needed nutrition from circulation and, in turn, will cause damage and injury to the body.

Friction. Friction happens when the skin is rubbed against clothing, making the skin more fragile and vulnerable to injury. This is especially true if the skin is moist.

Shear. Shear occurs when two surfaces move away from opposite directions. This action complicates the damage incurred from pressure ulcers.

The risk factors of pressure ulcers are the following:

Immobility – may be due to poor conditions, such as spine injuries.

Incontinence – skin breakdown is more apparent with prolonged exposure to excreta and urine.

Lack of sensory perception – problems with tactile and pain receptors from medical conditions (e.g., spinal cord injuries) will delay the response to early warning signs of skin breakdown.

Poor nutrition and hydration – inadequate supply of fluid and improper nutrition will prevent the body from healing properly and will therefore aggravate the condition.

Medical conditions affecting blood flow – diabetes makes the blood slower to circulate, thereby delaying the risk of tissue damage.

Complications of Pressure Ulcer

Complications of pressure ulcers are debilitating, some even life-threatening:

Cellulitis. An infection of the skin, connective tissues and its surrounding soft tissues. It is characterized by swelling, erythema and warmth in the affected area.

Osteomyelitis. Osteomyelitis or Bone infections are severe infections that have burrowed deeper into the body’s bones, causing damage. The damage brought by this infection will limit the mobility and functions of the affected bones.

Cancer. Marjolin’s ulcer, a type of long-term and non-healing wound, may develop into squamous cell cancer.

Sepsis. A severe complication of decubitus ulcer arising from overwhelming infection of wounds that compromises the hemodynamic stability of the body.

Diagnosis of Pressure Ulcer

Medical History: Comprehensive medical history will be collected to assess the extent of the injury and address factors that contributed to its development. History of pressure ulcers, the type of assistance needed by the patient, and inquiries about ADLs are some focus questions in history taking.

Physical Examination: Assessing the affected area is the primary method in diagnosing decubitus ulcers. The NPIAP staging system is as follows:

Stage 1 – intact skin with a localized area of nonblanchable erythema; may appear differently pigmented from surrounding tissue. Colour changes do not involve purple or maroon discolouration.

Stage 2 – partial-thickness with skin loss and exposed dermis that is either pink or red and usually moist; may also be intact or ruptured blister; fat and muscles are not visible; no slough or eschar present.

Stage 3 – total thickness with skin loss; exposed fat tissue; granulation observed surrounding the injury; depth may vary depending on location; muscle and other connective tissue not observed; injury undermining and tunnelling may be observed.

Stage 4 – total thickness with skin and tissue loss; exposed fascia, muscle, and bone; slough or eschar; injury undermining and tunnelling.

Unstageable – there is total thickness skin and tissue loss, but the damage cannot be determined due to eschar or slough.

Deep tissue injury is characterized by intact or non-intact skin, localized and persistent non-branch able deep red, maroon, or purple discolouration, and skin separation revealing a dark wound bed or blood-filled blister.

Laboratory tests will be ordered to determine the extent of damage and the patient’s overall health.

CBC – baseline lab work to detect infection (elevated WBC and ESR rate will mean inflammation or infection)

Albumin, prealbumin, transferrin, and serum protein levels are measured to determine nutritional status for adequate wound healing after wound debridement.

Urine and culture are used to determine the causes of urinary incontinence.

Stool examination – identify diarrhoea causes, such as C. difficile infection.

Blood cultures are used to detect the presence of sepsis.

Imaging studies determine the extent of tissue injury, particularly in the muscles and bones.

Biopsy: A biopsy of chronic wounds may be performed to rule out cancer.

Pressure Ulcer Treatment

Pressure reduction. The first step in treating pressure ulcers is to limit further pressure damage. This can be accomplished by:

Repositioning entails turning patients in their beds every 2 hours.

Examples include support equipment such as alternating mattresses, pressure-relieving or “air” mattresses, and trochanter rolls on bony prominences.

Physical therapy encourages the patient to move from bed to chair and perform appropriate exercises.

Wound cleaning and dressing This will be determined by the stage and severity of the pressure injury.

Cleaning – wash and pat dry, unbroken skin with a mild cleanser; for open sores, saline irrigations may be performed after each dressing change.

Bandaging: Bandages help protect the affected area. They will be in various forms, such as films, foams, etc.

Tissue viability nurse team referral These nurses specialize in properly staging decubitus ulcers and recommending appropriate dressings, particularly if medicated dressings are required.

Debridement. This entails surgically removing dead and necrotic tissues to allow new tissue to grow. This is usually done for severe pressure ulcers (stages 3 and 4). It may also include reconstructive surgery for more extensive wounds, which will require the use of flaps to cover.

Medical treatment

Antibiotics – Topical antibiotics with broad antimicrobial spectrum coverage may be required.

Analgesics – anti-inflammatory medications – will be used to alleviate pain, particularly during dressing changes and wound care.

Hospital Acquired Pressure Ulcer


Hospital Acquired Pressure Ulcer

Do nursing interventions for healthcare acquired pressure ulcer (HAPU) demonstrate decreased ulcers in patients/ patient fall in a hospital setting

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