Pressure Ulcers

Pressure Ulcers

Addressing the overall treatment or prevention of bed sores or pressure ulcers is a prominent healthcare issue because the disease has affected people for ages. In fact, decubitus ulcers are still one of the leading causes of mortality despite the advancement in medical technology, nursing care, and surgery. Particularly, pressure sores affect the elderly and bed-ridden patients (Brandeis et al., 2011). Furthermore, immobilized individuals that engage in limited activities due to post-operational caution are at risk of bed sores.

Etiology

A pressure ulcer is an injury that affects underlying skin tissue due to constant application of excessive pressure on one spot.  Doctors have discovered that this disease develops due to skin necrosis over a bony prominence, especially when a continual pressure obstructs the free flow of blood. In severe cases, the disease causes a localized abrasion on the underlying tissue, hence a partial thickness and loss of dermis and epidermis. When the patient’s blood vessels dilate in the skin, the doctor will observe a swollen crater characterized by abnormal skin redness. Even after the pressure has been relieved, the redness can remain for more than an hour. An in-depth understanding of the causes and treatment of pressure ulcers is relevant for caregivers, given that it significantly reduces the sufferer’s quality of life. Subsequently, it affects the patient’s social activities and psychological life.

Studies indicate that pressure ulcers can occur in any part of the body, especially where it comes into contact with the bed or other objects. A prolonged contact such as this leads to friction and trauma. When a patient moves periodically from one position to the other, he relieves the pressure in knees and arms, thus preventing the formation of pressure ulcers (Reddy et al., 2013). Therefore, nurses should regularly check and change the sleeping positions of the patients to minimize the risk of bed sores.

Moreover, urination and high moisture content are some of the major contributors of pressure ulcers. There are different groups of people susceptible to the disease. The elderly weak individuals with learning disabilities are mostly confined to their beds, hence the vulnerability. Additionally, patients with acute illnesses are at risk because they spend many days in bed during treatment. Lastly, pressure ulcers affect people with spinal cord damage hardly feel pain in their knees and lower body area (Fuhrer et al., 2013). Therefore the neurological deficits make them unaware of increasing pressure and blood flow restriction.

Causes and Symptoms

            Both extrinsic and intrinsic factors contribute to ulcer formation. In exceptional cases, some patients diagnosed with bed sores have a poor nutritional condition, had an accident in the past, or had undergone a surgical operation. The role of microorganism in the development of pressure ulcers cannot be understated. Specifically, bacteria accelerate the rate of wound infection as they grow and multiply in the absence of oxygen (Allman et al., 2013). The early symptoms of bed sores include the skin discoloration and an eventual open wound. On the other hand, elbow, ankles, sacrum and elbow are some of the most susceptible body parts to the disease.

            Malnourishment not only lowers the immune system but also increases the risk of pressure ulcers. Notably, eating nutritious food improves the soundness of mind and clarity of conscience. Besides, healthy food improves the body’s immune system for an easier repulsion of chronic illnesses. It is a common knowledge that food rich in proteins speed up the rate of healing of injuries and wounds. If a patient maintains a balanced diet, his body will receive the much-needed vitamins and nutrients to prevent skin damage and breakdown. Therefore, if the caregivers observe that a patient lacks nutrients, they must introduce ideal food supplements or refer the sufferer to a professional dietician for further assistance.

            It is true that pressure ulcers are preventable, but they disrupt the rehabilitation process and prevent persons with learning disabilities from contributing to the society. If the condition of decubitus ulcers chronic, the sufferers are subject to extended re-hospitalization.  The physicians consider this illness as unavoidable when they have implemented all risk assessments and preventive care yet it still occurs. Furthermore, the pressure ulcers are terminal when a victim has an end-of-life skin changes often followed by coma.

            Bed sores can cause unending suffering and can trigger other diseases because the bacteria can spread to other parts of the body. The resultant medical expenses can be too high to bear, especially if the patient is a low-income earner (Bennett et al., 2014). Consequently, the victim is in danger of cancerous diseases, bone infection, anemia, and malignant transformation. Potentially, the ulcers may recur is the patient does not strictly adhere to doctor’s instructions. Terminal pressure ulcers cause wound dehiscence and seromas that are life- threatening.

            The ailment can manifest in different stages. In the first stage, the skin is intact but the patient observes different patches of redness. In the second stage, the victim loses dermis and endodermis as the skin partially thickens. As the disease graduates to a third stage, the skin thickens fully, leading to sub-coetaneous tissue damage. The necrosis may extend to the underlying fiscal. In stage 4, there is a complete destruction of the bone, muscle, and support structures like a joint capsule and tendons. Without adequate medical attention, the condition may worsen to “unstageable” phase, where slough fully obscures the extent of pressure ulcer. If there is a stable noticeable eschar on the heels, the doctor should not remove it because it protects the inner tissues from re-infection.  

Treatment

Pressure ulcers are treatable through debridement, which entails the removal of necrotic tissue. If a patient’s limb has an inadequate supply of blood, the doctor should not remove the tissue from the heel (Robinson et al., 2012). Notably, necrotic organs are ideal for bacterial regeneration. Therefore, it compromises the wound’s healing process unless the physician performs autolytic, biological or chemical debridement.

            Autolytic debridement is recommendable for patients with high immune systems. It entails the use of moist dressings in promoting autolysis between body’s red blood cells and enzymes. Although it is a gradual process, it is painless and the majority of the patients respond positively. On the other hand, the biological debridement (also referred to as maggot debridement therapy) involves feeding medicinal maggots with necrotic tissue to minimize the number of harmful bacteria. Enzymes can also be used to rid the affected area of necrotic tissue.

            It is important for medical professionals to assess the level of risk to reveal the contributing or causative factors that can eliminate pressure ulcer’s negative effects. During the admission time, the nurses should assess the patient’s skin condition for regular care. In particular, they should encourage patients to turn frequently or to adopt a different position. They can further relieve the pressure by preventing contact between support surfaces and prone areas through the use of soft materials like foams, mattresses, and pillows.

            A pressure ulcer PUSH tool is applicable (especially in the case of high-risk persons) but with caution and professional judgment. Given that the tool is valid and reliable, nurses can use it to absorb moisture and relieve pressure in patients from different cultures and age brackets. The application of PUSH score leads to observable positive changes within three months (Reddy et al., 2012). However, it is advisable that the patients or caregivers should not vigorously rub their skin to avoid superficial tissue damage.

Antibiotics and painkillers can be used as alternative forms of treatment. Pressure ulcers are not only unpleasant but are also challenging and upsetting to the patients. Doctors recommend the use of naproxen and nonsteroidal anti-inflammatory drugs as painkillers before and after dressing changes, repositioning, and debridement procedures. Non-allergic patients can use topical pain medications as well. On the other hand, the use of oral antibiotics is advisable if the infected pressure sores are unresponsive to other therapies and medications.

Use of negative pressure therapy and hydrocolloid wound dressing minimizes wound infections and remove unnecessary fluids to boost the rate of recovery. A hydrocolloid dressing has a gel-forming material that is attached to a foam backing or a semi-permeable film. Besides, it has absorbent materials like gelatin and pectin. On the other hand, a negative-pressure wound therapy entails the application of vacuum dressing in healing chronic pressure ulcers and wounds (Cuddigan et al., 2011). The doctor controls the application of sub-atmospheric pressure as per the environment of a local wound using a vacuum pump connected to a sealed wound dressing.

In summary, it is clear that people are at risk of developing pressure ulcers due to modifiable and non-modifiable factors. However, there are numerous ongoing researches to improve the treatment and preventive measures. In spite of the existence of evidence that proves the effectiveness of risk assessment tools, the patients must seek professional advice on the best treatment methods to eliminate the chances of ulcers recurrence. Furthermore, the caregivers should empower the patients with adequate and useful information on their ailment to minimize recovery time.

References

Allman, R. M., Goode, P. S., Burst, N., Bartolucci, A. A., & Thomas, D. R. (2013). Pressure Ulcers, Hospital Complications, and Disease Severity: Impact on Hospital Costs and Length of Stay. Advances in Skin & Wound Care, 12(1), 22-30.

Bennett, G., Dealey, C., & Posnett, J. (2014). The Cost of Pressure Ulcers in the UK. Age and Ageing, 33(3), 230-235.

Brandeis, G. H., Morris, J. N., Nash, D. J., & Lipsitz, L. A. (2011). The Epidemiology and Natural History of Pressure Ulcers in Elderly Nursing Home Residents. Jama, 264(22), 2905-2909.

Cuddigan, J., Berlowitz, D. R., & Ayello, E. A. (2011). Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. Advances in Skin & Wound Care, 14(4), 208.

Fuhrer, M. J., Garber, S. L., Rintala, D. H., Clearman, R., & Hart, K. A. (2013). Pressure Ulcers in Community-Resident Persons with Spinal Cord Injury: Prevalence and Risk Factors. Archives of Physical Medicine and Rehabilitation, 74(11), 1172-1177.

Reddy, M., Gill, S. S., & Rochon, P. A. (2013). Preventing Pressure Ulcers: A Systematic Review. Jama, 296(8), 974-984.

Reddy, M., Gill, S. S., Kalkar, S. R., Wu, W., Anderson, P. J., & Rochon, P. A. (2012). Treatment of Pressure Ulcers: A Systematic Review. Jama, 300(22), 2647-2662.

Robson, M. C., Phillips, L. G., Robson, L. E., Thomason, A., & Pierce, G. F. (2012). Platelet-Derived Growth Factor BB for the Treatment of Chronic Pressure Ulcers. The Lancet, 339(8784), 23-25.