NursingLife.net – Health Care Advices

General guidelines on the treatment of pressure ulcers was ordered under the following headings:

1 .- Poll
2 .- Relief of pressure on tissues
3 .- General Care
4 .- Ulcer Care
5 .- bacterial colonization and infection in pressure ulcers
6 .- repair pressure ulcers
7 .- Education and improving the quality of life
8 .- par Palliative care and pressure ulcers
9 .- Evaluation Indicators and Benchmarks
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1 .- VALUATION:

It would be inappropriate to focus exclusively on the assessment of pressure ulcers and not taking into account the overall assessment of the patient.
A comprehensive evaluation the patient with pressure ulcers requires a review in three dimensions:
“Patient State”, “injury” and “your care environment.

1.1 Initial assessment of the patient
History and complete physical examination, paying particular attention to:
· Risk factors for pressure ulcers (immobility, incontinence, nutrition, mental status ,…)
· Identification of diseases that may interfere with the healing process (and collagen vascular disorders, respiratory, metabolic, immunologic, neoplastic, psychosis, depression ,…)

Advanced age ·
· Habits Toxic snuff, alcohol.
· Habits and health status
· Drug therapy (corticosteroids, nonsteroidal antiinflammatory drugs, immunosuppressants, cytotoxic drugs, …

Nutritional assessment
· Use a simple tool for identifying nutritional assessment and malnutrition (calories, protein, serum albumin, minerals, vitamins ,…)
· Regularly reassess

Psychosocial Assessment
· Check the capacity, ability and motivation of the patient to participate in their treatment program.

1.2 Assessment of the care environment
Identification of the primary caregiver. Assessment of attitudes, skills, knowledge and possibilities of the caregiver (family, informal carers ,…)

1.3 Assessment of injury
When assessing an injury, it should be able to be described by unified parameters to facilitate communication between different professionals involved, which in turn will allow the properly verify your progress. It is important to the assessment and registration of the injury at least once a week and whenever there are changes they suggest.

2 .- PRESSURE RELIEF ON THE TISSUE

Relieving the pressure is preventing tissue ischemia, thereby increasing the viability of soft tissue injury or placing optimal conditions for healing. Each performance will be directed to reduce the degree of pressure, friction and shear.
This decrease in pressure can be achieved by using techniques of position (lodging or sitting) and the choice of a suitable surface.

2.1 Techniques position

2.1.1. With the patient sitting.
When an ulcer has formed on the seating surfaces should be avoided that the individual remains seated. As always exceptional and could ensure the pressure relief devices using special support that position will allow for limited periods of time, thereby maintaining good functionality of the patient. The sitting position of individuals that showed no injury at that level must be changed at least every hour, by facilitating exchange for support of their weight every fifteen minutes with postural change or conducting drives.  If it was not possible to change the position every hour, must be sent back to bed.

2.1.2. With the patient bedridden.

Bedridden individuals should not support on pressure ulcers. When the number of injuries, the patient’s condition or treatment goals will prevent attainment of the above guideline, you should reduce the exposure time or increasing the frequency of pressure changes. You can use a wide variety of support surfaces that can be helpful in achieving this goal.

In both positions:
Never use float or ring-type devices.
Always make a written individualized plan.
The different levels of care and especially in the context of community care will be necessary to involve the carer in the implementation of activities aimed at relieving pressure.

2.2. Support Surfaces

The practitioner must consider several factors when selecting a support surface, including the patient’s clinical status, characteristics of the institution or the level of care and the very nature of that surface. The use of support surfaces is important from the standpoint of prevention, as measured from the perspective of helping in the treatment of lesions in place.

The choice of support surfaces should be based on its ability to counter the elements and forces that may increase the risk for these injuries or worsen, and the combination of other values such as ease of use, maintenance, costs, and patient comfort.   The bearing surfaces can act at two levels, surfaces reduce pressure, lower levels of the same, though not necessarily below the values that prevent capillary closure. In the case of systems of pressure relief is a reduction in the level of pressure in soft tissue below capillary occlusion pressure in addition to eliminating friction and shear.

It is important to remember that support surfaces are a valuable ally in relieving pressure, but in no case replace the “repositioning”.

In this sense, the guidelines are:
Use a surface that reduces or relieves the pressure, according to the specific needs of each patient.
Use a static area where the individual can assume various positions without supporting your weight on pressure ulcer.
Use a dynamic support surface if the individual is unable to assume various positions without the weight falls on the / s ulcer / s by pressure.

It is recommended that resource managers of different levels of care, both in hospitals and communal, where patients are treated with pressure ulcers or susceptible, the desirability of some of these areas for the benefit of its use can obtained.

It recommend the allocation of resources according to patient risk, so we suggest the systematic use of a rating scale of the risk of developing pressure ulcers that are validated in the scientific literature that fits the needs of context reference assistance.