Predicting and preventing pressure ulcers in surgical patients

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PRESSURE ULCERS, regardless of their origin, represent negative outcomes for patients, including pain, additional treatments and surgery, longer hospital stays, disfigurement or scarring, increased morbidity, and increased costs.

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THE OR IS A HIGH-RISK environment for the development of pressure ulcers. Preoperative identification of patients at risk for pressure ulcer development is imperative if cost-effective, evidence-based preventive measures are to be implemented.

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THIS ARTICLE PRESENTS a review of the literature pertaining to pressure ulcer development in surgical patients. Recommendations for future research and implications for practice are provided. AORN J 81 (May 2005) 986-1006.

     

Assessing risk and preventing pressure ulcers in patients with cancer

OBJECTIVE: To identify risk factors for pressure ulcers that may place the patient with cancer at higher risk. The role of nursing to provide pressure ulcer preventive measures will be discussed. DATA SOURCES: Current research and published literature CONCLUSION: Research suggests that comprehensive prevention programs are effective in reducing pressure ulcer incidence rates and can be cost-effective. Comprehensive pressure ulcer prevention guidelines include risk assessment, skin care, offloading, and nutrition. Immobility places patients with cancer at greater risk. IMPLICATIONS FOR NURSING PRACTICE: Nurses are at the forefront of predicting patients at risk for pressure ulcers and working with the multidisciplinary team to implement a pressure ulcer preventive program. There remains a dearth of research related to pressure ulcers and cancer. Research in this area is strongly suggested.     

足部压疮预防装置的制作及应用

压疮是长期卧床患者常见的并发症,足部血液循环较其他部位差,长期卧床的患者足跟及内、外踝等处容易发生压疮,且发生的压疮较其他部位愈合差,严重影响患者的生活质量.     

New guideline on preventing and managing pressure ulcers

New guidance on the prevention and management of pressure ulcers has been developed collaboratively by the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Nursing. Julie Stevens and Will Gray provide the background to its development and discuss the key recommendations.     

The effectiveness of massage with and without dimethyl sulfoxide in preventing pressure ulcers: a randomized, double-blind cross-over trial in patients prone to pressure ulcers

Background

Although guidelines advise against massage, it is one of the methods widely regarded and used by nurses to prevent pressure ulcers (PU).

Objectives

The purpose of this study was to examine the effectiveness of different variations of massage in preventing pressure ulcers.

Methods

A randomized, double-blind cross-over design, in which patients of nursing homes who are prone to PU underwent two of the three possible interventions; ‘position changes only’, ‘massaging with an indifferent cream’ and ‘massaging with a dimethyl sulfoxide (DMSO) cream’.

Results

The results of three interventions did not differ significantly. DMSO did not fulfil the expectations raised by literature and a previous pilot-study.     

The role of alternating air and Silicore overlays in preventing decubitus ulcers

Patients with chronic neurological diseases who were at high risk of decubitus ulcers were randomly assigned to alternating air on silicore mattress overlays for a period of 3 months. Of 148 subjects who completed the trial, more than 50% in each group developed one or more ulcers. No statistically significant differences between groups were found in the incidence, severity, healing duration or the location of the ulcers; with the exception of a significant difference (p less than 0.001) in the categorical location of the trochanters.     

肠内外营养支持在老年重症胰腺炎治疗中的应用

目的：研究营养支持对老年重症胰腺炎的治疗作用。方法：选择２５例术后老年重症胰腺炎患者随机分成传统补液组（对照组）和肠内外营养支持组（治疗组），观察病死率和疗效。结果：①病死率对照组为６６．６７％，治疗组为２５．００％，２组比较有显著性差异（Ｐ＜０．０５）。②２组死亡病例术后平均存活时间对照组为（３．３３±２．３４）天，治疗组为（１６．７５±９．９２）天，２组比较有显著性差异（Ｐ＜０．０５）。③２组严重并发症发生率比较无明显差异（Ｐ＞０．０５）。结论：营养支持可降低老年重症胰腺炎的病死率，延长死亡病例术后伴严重并发症的存活时间，为进一步救治提供了时间和机会。     

The nursing role in preventing delay in patient discharge

This article uses a case scenario of a delayed patient discharge to explore multidisciplinary discharge planning. The common causes of delayed discharge are described and the importance of effective multidisciplinary team-working is emphasised through a review of a 'whole systems approach' to discharge. The role of the nurse in discharge planning is examined, as are the effects of poor interprofessional communication and documentation, and their link to hospital readmission. Issues of patient power, choice, participation and control are emphasised. The value of good information-giving is highlighted, both for the patient and the patient's carers.     

白蛋白加胰岛素湿敷在老年糖尿病患者并发压疮中的疗效观察

目的探讨白蛋白加胰岛素湿敷在老年糖尿病患者并发压疮中的疗效。方法对11例老年糖尿病患者并发的压疮采用白蛋白加胰岛素湿敷治疗2周,观察局部变化及定量分析压疮面积,评价其疗效。结果经过2周治疗,11例患者压疮逐渐结痂愈合,面积由治疗前的（36．65±8．37）cm2,缩小为（11．89±4．86）cm2,差异有统计学意义（t=8．198,P=0．000）。结论自蛋白加胰岛素湿敷对老年糖尿病患者并发压疮有较好的疗效,值得在临床中推广应用。     

Managing pressure ulcers in the neuroscience patient

Neuroscience patients, even with vigorous preventive efforts, are often at risk for developing pressure ulcers. Recognition of risk factors and institution of preventive techniques are essential aspects of initial management. Neuroscience nurses familiar with current treatment principles and products will be better prepared to offer their patients comprehensive skin care.     

老年卧床患者骶尾部压力及皮下脂肪厚度与压力性损伤的相关性研究

目的 探讨老年长期卧床患者骶尾部压力及皮下脂肪厚度与OH评分的相关性.方法 应用OH评估法对2018年1月至2019年1月在南京医科大学第一附属医院老年科住院的87例老年卧床患者进行压疮风险评估,同时测量患者骶尾部压力及皮下脂肪厚度,分析其与OH评分的相关性.结果 骶尾部压力与OH评分呈正相关(P<0.001);骶尾部...     

全面流程管理在老年住院患者医院获得性压疮预防中的应用

目的 :探讨全面流程管理在老年住院患者医院获得性压疮(HAPU)预防中的应用效果。方法 :通过成立流程管理小组,采用优化、再造流程方法循证制订压疮管理规范,把握运行中的关键环节和问题,实施全面流程管理。比较实施全面流程管理前后老年住院患者HAPU的预防效果。结果 :经过1年的临床实践,老年住院患者HAPU的发生率由0.28%下降为0.16%,符合难免发生压疮申报条件的老年住院患者难免HAPU发生率由8.4%下降为6.2%,差异具有统计学意义(P<0.01)。结论:实施全面流程管理使压疮预防及管理工作流程化、标准化、科学化,有效降低了老年患者HAPU的发生率,提升了老年专科压疮防治护理工作质量。     

肠内营养预防和治疗压疮效果的Meta分析

目的系统评价肠内营养预防和辅助治疗压疮的效果,为指导压疮患者合理补充营养提供循证依据。方法计算机检索Cochrane图书馆(2014年第1期)、CINAHL、MEDLINE、EMbase、CBMdisc、CNKI和万方数据库中符合纳入标准的随机对照试验。由3名研究者按纳入和排除标准独立筛选文献并对其质量进行评价及提取资料,对符合质量标准的随机对照试验采用Rev Man 5.0统计软件包进行Meta分析。结果纳入14篇随机对照试验共计1 851例患者,6篇涉及肠内营养预防压疮的研究,11篇涉及肠内营养辅助治疗压疮的研究,其中3篇随机对照试验均涉及到压疮的预防和治疗。Meta分析结果显示,肠内营养可明显降低压疮发生率(RR=0.84,P=0.006),缩小压疮面积(SMD=-1.23,P=0.000),不增加压疮患者的不良反应发生率(RR=0.82,P=0.69);但不能提高压疮治愈率(RR=1.46,P=0.05)及不能降低压疮患者的病死率(RR=1.57,P=0.06)。结论肠内营养能降低压疮发生率、收缩压疮面积,对压疮愈合有促进作用,但不能提高压疮治愈率及降低病死率。     

Assessment and management of chronic pressure ulcers in the elderly

Pressure ulcers remain a complex and costly problem to the health care system. As the population ages, a greater number of individuals will be at high risk for developing pressure ulcers. An understanding of the physiologic changes that occur with aging skin is important in preventing and treating chronic wounds. Risk factor assessment and modification, when possible, can help to reduce the development of pressure ulcerations. Although the goal continues to be prevention, once a pressure ulcer does occur, a systematic and comprehensive approach to assessment and treatment is necessary to reduce healing times.