Advanced Nursing Practice

Advanced Nursing Practice

Pressure Ulcer in HIV Patients

Introduction

In order to critically analyze the role of a consultant nurse the author feels it is important to look at the definition of a nurse consultant role, discuss and examine events leading to the existence and development of such roles (history) and finally the impact on quality of patient care of a consultant nurse. The author's current area of practice- a nine bedded adult intensive care unit, where no such role currently exists. However, the author will examine the potentialities of such a role, the possible benefits to patient care and barriers which may be encountered by a consultant nurse in this environment.

Pressure Ulser

Pressure ulcers, otherwise known as decubitus ulcers, comprise a significant portion of wounds requiring specialized care and presenting additional costs, so prevention is critically important. A pressure ulcer is any lesion caused by unrelieved pressure resulting in damage of underlying tissue. Pressure ulcers usually occur over bony prominences and are graded or staged to classify the degree of tissue damage observed. Stage 1 pressure ulcers are defined as nonblanchable erythema of intact skin — the heralding lesion of skin ulceration. Stage 2 is defined as partial thickness skin loss involving epidermis and/or dermis; Stage 3 as full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia; and Stage 4 as full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures.

The Wound, Ostomy and Continence Nurses Society (WOCN) says that pressure ulcer prevention is best accomplished by identifying patients who are at risk for the development of pressure ulcers and initiating early preventive measures. According to the WOCN, “This requires an understanding of risk factors, the utilization of research-based risk assessment tools, knowledge of appropriate preventive strategies and access to essential medical equipment such as therapeutic support surfaces.”

Patients who have already developed pressure ulcers require assessment and interventions to identify and correct the causative factor(s) and treatment modalities to assure optimal wound healing. Regular follow-up assessment and modifications of the treatment plan when indicated are also necessary to assure optimal wound repair and efficient use of resources, including supplies.

The difference between colonization and infection of wounds is decided by the concentration of organisms in the wound; an infected wound contains a larger number of microorganisms than a contaminated wound. According to clinical guidelines from the Agency for Healthcare Research and Quality (AHRQ), stage 2, 3 and 4 pressure ulcers should all be considered as colonized with bacteria. Proper wound cleansing and debridement should prevent bacterial colonization from proceeding to the point of clinical infection.

Strategies to manage pressure ulcers and facilitate healing include proper tissue load management (which includes proper positioning and the use of support surfaces) as well as appropriate ulcer care and management of infection.

Initial ulcer care involves debridement, wound cleansing, dressing application and possible adjunctive therapy. Debridement should be performed to remove moist, devitalized ...