NURSING PRACTICE IN THE PREVENTION OF PRESSURE SORES

Nursing practice in the prevention of pressure sores

Nursing practice in the prevention of pressure sores

Literature review

Pressure ulcers are areas of local skin and tissue injury, usually developing over bony prominences such as the sacrum and heels. Pressure ulcers are also known as pressure sores, decubitus ulcers, and bed sores. Although friction, shearing forces, and moisture have also been implicated in the development of skin injury, pressure ulcer reflects the primary cause and is the preferred term for the problem (Allman, 2003, 44).

Pressure ulcers are classified by the depth of visible damage. Fat, muscle, and blood vessel cells are sensitive to pressure and shearing forces and can be injured or die after exposure to 2 hours of persistent pressure. A sign of early tissue damage is unblanchable erythema, a reddened area of intact skin that does not lose its colour when an examiner presses on the area. In darkly pigmented skin, erythema presents as a purple, blue, or darkened area. These types of pressure ulcers are classified as Stage 1 ulcers (Langer, 2003, 66).

Shallow ulcers, involving loss of only the epidermis and dermis, are classified as Stage 2 ulcers. Stage 3 ulcers involve deep tissue injury extending into subcutaneous tissue or fat. Ulcers extending into muscle or bone are classified as Stage 4 ulcers. Ulcers covered with necrotic tissue cannot be staged accurately. (Cullum 2004)

Critical Appraisal

Most pressure ulcers develop during acute care hospitalizations. Among persons whose activity is limited to a bed or chair, as many as 30% may develop at least Stage 2 pressure ulcers during hospitalization. Nearly a quarter of persons in nursing homes have pressure ulcers, most of which are Stage 1 or Stage 2.

Besides decreased mobility and activity levels, incontinence, nutritional factors, and altered level of consciousness have been consistently documented to increase the risk of pressure ulcers. More than 50% of pressure ulcers occur in persons over 70 years of age.

Appropriate Management of Pressure Ulcers

Less than half of Stage 2 ulcers heal after 1 month. Even after 6 months, up to 40% of Stage 3 and Stage 4 ulcers do not heal. Therefore, prevention should be the priority of every pressure ulcer management program.

Persons with impaired ability to reposition in a bed or chair should be assessed for additional risk factors on admission to any health care facility. Assessments should be repeated on a regular basis and when a change in activity or mobility is noted. Interventions targeting identified risk factors reduce pressure ulcer occurrence (Langer, 2003, 88).

Repositioning every 2 hours has been the primary method used for preventing pressure ulcers. If a person with limited ability to change position needs to sit in a chair, he or she should not remain in the chair for more than 1 hour at a time. When possible, individuals should be taught to shift their weight every 15 minutes while seated. The head of the bed should be maintained at the lowest degree of elevation and for the shortest periods of ...