Pressure Ulcers, Part 1: Prevention Strategies

Pressure ulcers are a costly health concern. Many can be prevented by conscientious, vigorous nursing care. The nurse practitioner (NP) is an ideal professional to direct preventive care and to manage the treatment of ulcers. This article reviews the multiple risk factors and dynamics involved in the development of pressure ulcers, and preventive measures that can be implemented. The role of an NP related to pressure ulcer prevention and specific NP interventions are discussed.     

压疮小组在临床压疮管理中的运行及效果

目的探讨压疮小组在临床压疮管理中的运行及效果。方法以压疮小组成立前2011年的压疮高危和院外带入压疮患者共145例为A组,采用传统防治压疮的方法;以压疮小组成立后2012年的压疮高危和院外带人压疮患者共199例为B组和2013年的压疮高危和院外带入压疮患者共380例为c组,由压疮小组制定压疮预防与治疗方案并监督实施;各护理单元推荐1名临床护士作为科室压疮督导员,共30人,成立压疮小组后进行统一培训与管理。比较压疮小组成立前后患者住院期间难免压疮发生率、院外带入压疮治愈率及压疮督导员的压疮相关知识水平。结果A、B、C组难免压疮发生率分别为76．20％、17．02％、14．61％,带人压疮治愈率分别为54．84％、86．84％、87．97％,B、C组与A组比较,差异均有统计学意义（P〈0．01）。护士压疮相关知识水平明显提高（P〈0．001）。结论成立压疮小组使临床压疮管理更具科学性和客观性,能有效降低压疮发生,提高护理质量,保障患者安全。     

压疮护理团队管理模式的构建与实施

目的探索压疮护理团队管理模式,构建高危压疮防范管理体系,为科学有效地实施压疮护理提供依据。方法解放军第117医院制定高危压疮护理团队准入标准,建立4个高危压疮护理团队模块,明确其职责,规范高危压疮患者评估与质量监控流程。结果实施压疮护理团队管理模式后,院内压疮的发生率低于实施前,压疮的转归情况优于实施前,团队成员的压疮专科护理知识考核成绩高于实施前,差异均有统计学意义(均P0.05)。结论团队管理模式是促进高危压疮护理标准化的重要途径,是提高压疮护理质量的有效方法。     

Nursing Management of Pressure Ulcers Using a Hydrogel Dressing Protocol: Four Case Studies

People with spinal cord injury (SCI) are at risk for developing pressure ulcers throughout their lives. Pressure ulcers can lead to significant morbidity, prolonged hospitalization, and diminished quality of life. Rehabilitation nurses play a vital role in preventing and treating pressure ulcers in these clients. In this article, the authors describe four case studies of clients with SCI who have pressure ulcers and discuss the implementation and outcome of a nursing management protocol based on the use of hydrogel dressings. These dressings have been found to promote wound healing, protect against contamination and infection, and reduce pain. They also are usually acceptable to the client and are cost-effective. Hydrogel dressings should be considered as one component of an individualized plan of care for the development of pressure ulcers.     

专人皮肤管理在ICU压疮预防中的应用

目的探讨ICU预防压疮的方法。方法将349例ICU压疮高危患者进行分组,将2012年1月-2012年6月的161例高危患者设为对照组,每位护理人员交接班时交接患者皮肤情况,由护理人员自行选择预防压疮的措施;将2012年7月-2012年12月188例高危患者设为观察组,由经过ICl5专科培训的专人评分及制定护理措施,并对护理人员进行压疮知识培训,每月总结,持续质量改进。比较2组患者的压疮发生率及满意度。结果观察组压疮发生率明显低于对照组（P〈O．05）,患者及家属满意度高于对照组（P〈O．05）。结论由经过系统培训的专人进行皮肤管理能降低压疮发生率,提高患者满意度。     

两种鼻胃管固定方法对鼻翼部压疮发生率的影响

目的 观察胃切除术后留置鼻胃管患者鼻翼部压疮的发生情况,寻找更好的鼻胃管固定方法.方法 方便性抽样选取第二军医大学长海医院普外科胃切除术后留置胃管行胃肠减压患者1869例,按患者住院先后时间分为:对照组826例,采用易撕敷料(3M transporeTM white)胶带交叉粘贴于胃管再固定于鼻翼部;观察组1043例,采用黏着性棉布伸缩包带(3M multipore-light brown)“Y”型粘贴于鼻翼部再交叉粘贴于胃管上;统计两组患者留置胃管3～6 d和7～20d时段中鼻翼部压疮发生率.结果 对照组与观察组鼻翼部压疮总体发生率差异有统计学意义(P＜0.01),但两组内留置胃管3～6 d和7～20 d鼻翼部压疮发生率的差异无统计学意义(P＞0.05).结论 采用黏着性棉布伸缩包带“Y”型固定鼻胃管,可降低鼻胃管留置患者鼻翼部压疮的发生率,值得临床推广应用.     

老年患者发生褥疮的危险因素及预防

褥疮是临床老年患者尤其是长期卧床者的顽固并发症之一。作者综述了老年患者的皮肤特点及发生褥疮 的危险因素,包括：运动能力减弱、感觉功能障碍、血液循环不良、营养不良以及皮肤环境等因素。通过正确地评估提出针对性的预防措施：缓解局部压力，减少磨擦力和剪力，避免潮湿，增加营养。     

应用人体力学预防褥疮

引起褥疮的危险因素有６ 种,其中压力、摩擦力、剪力在褥疮的发生中起重要作用。介绍如何应用人体力学避免力学因素损害皮肤的方法。这种方法可使护士根据病人的情况灵活而有效地采取预防措施,并有利于新的预防褥疮的工具及设备的研制。     

外科术后患者发生压疮的危险因素分析

目的 分析外科术后患者发生压疮的危险因素,探讨有效的预防措施。方法对211例择期手术患者的一般资料,术前、术中和术后相关指标进行非条件Logistic回归分析。结果年龄、术前血红蛋白、淋巴细胞总数和术后首次下地时间是外科术后患者发生压疮的危险因素,OR值分别为0．950、0．952、0．288、1．021。结论术前的营养状况与术后压疮的发生密切相关,术前应对患者的营养状况进行全面评估,并进行有针对性的干预;术后在病情允许的前提下应鼓励患者尽早下地活动。     

Prevention of Pressure Ulcers in the Surgical Patient

Pressure ulcers (PUs) are a serious health care problem, and it is crucial to assess how patients acquire pressure ulcers after admission to a health care facility. In the OR, factors related to positioning, anesthesia, and the duration of surgery, in addition to patient-related factors, all can affect PU development.This article reviews current practices, including AORN recommended practices, regarding pressure ulcer prevention efforts for surgical patients.All surgical patients should be considered at-risk for pressure ulcer development; therefore, perioperative departments should develop and implement strategic plans for pressure ulcer prevention. AORN J 89 (March 2009) 538-548. © AORN, Inc, 2009.     

Skin Integrity in the Pediatric Population: Preventing and Managing Pressure Ulcers

purpose . To summarize clinical and empirical knowledge about pressure ulcers in infants and children and to describe an approach developed at Children's Hospital, Boston, to prevent and manage pressure ulcers
population . Acutely ill children with potential or actual alteration in skin integrity due to pressure ulcers
conclusions . The three-pronged approach for pressure ulcer prevention and management developed by the Skin Care Task Force at the Children's Hospital, Boston, decreases unnecessary variation in practice surrounding the prevention and care of pressure ulcers in acutely ill children.
practice implications . The Skin Care Task Force recommends use of the Braden Q for pediatric risk assessment, a skin care algorithm for prevention of pressure ulcers, and a pressure ulcer algorithm for staging and managing pressure ulcers.