Dashboard Analysis and Nursing Plan



Dashboard Analysis and Nursing Plan

Pressure Ulcer

A pressure ulcer-also called a pressure sore, bedsore, or decubitus ulcer - is the deterioration of skin and underlying tissue caused by unrelieved pressure. The severity ranges from reddening of the skin to a large open wound. Healthy individuals continually shift their weight when sitting or lying down, but individuals who are debilitated are unable to change position, and consequently an adequate blood supply does not get to the compressed skin. If left untreated, pressure ulcers may become infected and painful, further limiting movement. Without treatment, pressure ulcer infections rapidly spread into the underlying muscle, sometimes to the bone (Bennett, 2004).

Pressure ulcers occur predominantly among those who are not able to move on their own. They can develop at home, in the emergency room, in the hospital, or in the nursing home. Elders who are incontinent and are confined to bed or to a chair are at increased risk of a pressure ulcer. Those who are obese, underweight, malnourished, incontinent, diabetic, confused, or highly sedated, and those with circulatory problems, are also at high risk for pressure sores. Excess fat tissue does not have many blood vessels, which makes the skin of the obese more susceptible to pressure sores. Those who are very underweight do not have sufficient fat or muscle to cushion bony protuberances. The localization of bedsores depends on whether the person is sitting or lying. The most likely locations for bedsores are on the heel, lower back, knee, pelvis, hip, and buttocks (Houghton, 2010).

The amount of pressure and time needed to produce an ulcer depend on the condition of the individual. Changes in the skin can occur with as little as two hours of pressure on an area. A sore may begin with a reddened area of the skin and, if not attended, can progress to a deep cavity of dead tissue that is highly susceptible to infection and ultimately gangrene. Once the skin ulcerates, healing can take weeks, months, or even years. If ulcers are left untreated or the elder is very frail, severe disability and death can result. Most people see pressure sores as an indicator of poor care when they occur in an institutional setting. Failure to prevent or heal pressure sores could lead to legal action (Nickoley, 2007).

Treatment for pressure sores is time-consuming and complex. The sore must be kept clean and free of dead tissue and covered with a dressing so it does not worsen. Many kinds of coverings and ointments can be placed in the wound to promote healing. Some have to be changed multiple times a day, and others can be left in place for days. Foam pads or wedges, special mattresses, and frequent turning can reduce pressure on the wound, prevent further breakdown, and aid healing. Antibiotics are needed if the ulcers become infected. Patients recovering from pressure ulcers need a high-protein diet to build up immunity and repair the wound. Serious pressure ulcers are treated with surgery (Payne, ...