...-Based Practice September 6, 2015 PRESSURE ULCERS An essential part of nursing care of hospitalized patients is skin integrity maintenance. As markers of the values or products of care most affected by the assessment and interventions delivered by nurses, the rate of PUs is being screened thoroughly now than ever before (Manning, 2015). Pressure ulcers (PUs) are preventable, but PU rates persist to increase disturbingly fast, according to an article by Gary and Hampton published in 2015, the incidence of PUs has increased in the US between 1995 and 2008. The purpose of this paper is to review the incidence of PUs and how to prevent its occurrence and nurses’ responsibility. Practice Setting Problem Pressure ulcer occurs when part of the skin and the tissues underneath are impaired as a result of being placed under enough pressure to impair blood supply. Immobility-related pressure ulcers are defined as localized areas of tissue damage that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged time. The most common sites were the sacrum, the heel, the ischium and the trochanter. Pressure is where the weight of the body squeezes the tissues between a bony prominence (such as heel, elbow, sacrum or ischials etc) and a hard surface (such as bed, chair or, in the case of heels, the floor). There are four critical factors contributing to the development of pressure ulcers: pressure; shearing forces; friction and moisture...
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...Evaluation of a Guideline for Prevention and Management of Pressure Ulcers I. Introduction: A. Pressure Ulcer 1. Any area of skin or underlying tissue that has been damaged by unrelieved pressure. 2. Occur when soft tissue is compressed between a boney prominence and an external surface for a prolonged time A. Importance 3. Prevention of pressure ulcers has become a major interest in hospitals. 4. Pressure ulcers are costly to treat. 5. Complication associated with pain and a decrease in quality of life. 6. Nearly 80% increase from 1992 to 2006 in hospital stays of patients with pressure ulcers. 7. Annual costs of $11 billion for treatment related to the ulcers. B. Guideline: Prevention and Management of Pressure Ulcers 1. Guideline structured to improve cost-effective patient outcomes. 2. Assessment 3. Prevention 4. Treatment C. Nursing concepts 5. Man 6. Health 7. Nursing II. Theoretical Foundation: Roy's Adaptation Model A. Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation III. Review of Literature A. Databases 1. CINAHL Plus with Full Text 2. PubMed 3. ScienceDirect ...
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...Introduction Pressure sores are very important health issue, and its management and impediment in both primary and secondary care is extreme on the clinical program. The pressure ulcers could be very major health issue, were perceived to increase hospital stays and resulted in ongoing treatments. Background of the study Pressures ulcers are number one misjudge circumstances in acutely ill patients. In spit of the institution of Clinical practice regulations and innovation in medical science; the occurrence in hospitalized patients, of pressure sores continues to rise. At presence, concord is missing on the risk aspects for pressure sores in critical care patients, and there are no risk measurement scale particularly for pressure sores in these patients is existing. Objective To decide the major risk elements that projective of pressure sore in adult critically ill persons. At present Braden scale is the most common method of risk assessment for pressure ulcers. Braden scale is covering only six components, which are sensory acuity, moisture, nutrition, activity, mobility, and friction/shear. Potential grade from 6-23; lower numbers reveal high risk. Numbers of 15-18 shows mild risk; average risk were 13-14; scores of ten to twelve denotes more danger; and scores of 9 or less means extreme danger.. Other elements which are not included in the Braden Scale, cause raise the level of risk for pressure ulcers in patients, which is why it is very important to determinants...
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... In my workplace, we have recently implemented that if a patient is admitted from the ER or directly admitted from a physician’s office and they have any sensory impairment we must order them a “Stryker” overlay mattress. The stryker softcare overlay mattress is a single patient use mattress put in place in hope of preventing pressure ulcers. The mattress works by redistributing pressure to other areas by removing the constant pressure on pressure points along boney surfaces. This assist with minimizing the risk from getting a pressure ulcer prior to having a pressure ulcer. I think this is importance because some patients may have a disease processes that if a wound exist, the possibility of that said patient condition worsening is high. We also implement the evidence-based practice of putting the patients on a turn schedule. The nursing staff are to turn the patient every 2-hours in hope of preventing pressure ulcers. Some best practices utilized to prevent medical device-related pressure ulcers are: Choosing the correct size Cushioning and protecting the skin Assess the site and observe for edema and skin breakdown. References Pressure Ulcer Fact Sheet. (2014). Just the Facts. Retrieved from http://www.npuap.org/wpcontent/uploads/2014/09/STOP-PU-Day-Fact-Sheet-color-20141.pdf Stryker Mattress. (2015). General Information Page. Retrieved from http://www.stryker.com/enus/products/PatientHandlingEMSandEvacuationEquipment/Beds/index.htm ...
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...JAN ORIGINAL RESEARCH Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives Karen Spilsbury1, Andrea Nelson2, Nicky Cullum3, Cynthia Iglesias4, Jane Nixon5 & Su Mason6 Accepted for publication 5 September 2006 Karen Spilsbury PhD RN Research Fellow Department of Health Sciences, University of York, York, England, UK Andrea Nelson PhD RN Reader School of Healthcare, University of Leeds, Leeds, England, UK Nicky Cullum PhD RN Professor Department of Health Sciences, University of York, York, England, UK Cynthia Iglesias PhD Research Fellow Department of Health Sciences, University of York, York, England, UK Jane Nixon PhD RN Deputy Head Clinical Trials Research Unit, University of Leeds, Leeds, England, UK Su Mason PhD RN Principal Research Fellow Clinical Trials Research Unit, University of Leeds, Leeds, England, UK Correspondence to Karen Spilsbury: e-mail: ks25@york.ac.uk 6 5 4 3 2 1 SPILSBURY K., NELSON A., CULLUM N., IGLESIAS C., NIXON J. & MASON S. ( 2 0 0 7 ) Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing 57(5), 494–504 doi: 10.1111/j.1365-2648.2006.04140.x Abstract Title. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives Aim. This paper reports a study exploring patients’ perceptions and experiences of the impact of a pressure ulcer and its treatment on their health and quality...
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...Pressure Ulcers Donna Long Grand Canyon University NRS 433V Introduction to Nursing Research February 11, 2012 Shahin E. S. M., Dassen T., & Halfens R. J. G. (2009). Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. International Journal of Nursing Studies 46: 413–421 Introduction Pressure ulcers refer to damage that occurs to the skin of a patient. Pressure, shear and friction are among the known causes (Shahin, Dassen & Halfens, 2009). Pressure ulcers mostly affect the lower part of the body, the elderly and patients with spinal injuries (Shahin et al, 2009). They are expensive to treat, require long periods of time and numerous treatments to heal. As a result, the cost incurred is very high and ranks among one of the most expensive ailments in the world to treat (Shahin et al, 2009). Background of the Study It is estimated that around 13% of patients in the ICU develop pressure ulcers (Shahin et al, 2009). “Pressure ulcers are the third most expensive disorder after cancer and cardiovascular diseases” (Shahin et al, 2009, p.414). This study looks into the prevalence of pressure ulcers in ICU patients, the factors related to it, and the treatment measures. Overcoming the problem of pressure ulcers is vital especially among critically ill patients who are at the most risk of developing pressure ulcers (Shahin et al, 2009). Educating nurses can reduce the occurrence of pressure ulcers...
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...Evidence Based Practice & Pressure Ulcers Matthew Slawter Chamberlain College of Nursing NR451 RN Capstone Course November 2014 Evidence Based Practice & Pressure Ulcers Evidence based practice (EBP) gives nurses a method to use critical appraised data and scientific evidence that is proven to confirm the delivery of quality health care to a patient population. Pressure ulcer prevention continues to be a major and growing concern among todays patients and healthcare providers. This problem is a concern because prevention of pressure ulcers can be accomplished through good skincare techniques and increased education of nurses. The field of nursing along with the healthcare industry can benefit from simply decreased the occurrence of pressure ulcers. The general purpose of this proposal is to determine if the value nurses place on skincare and pressure ulcer prevention can decrease the incidence pressure ulcers. Change Model Overview The John Hopkins Nursing Evidence-Based Practice Process is simply related to the complex challenges organizations and nurses face with the implementation of evidence-based practice and translation. Furthermore, this process provides guidelines for managing the process, structure, and evidence translation among various healthcare settings and outcomes of EBP projects. Nurses should use this process as a guide to facilitate change as it suggest leadership and planning for EBP measurement, identification, evaluation and monitoring...
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...Pressure Ulcer Prevention In US acute care facilities alone, an estimated 2.5 million pressure ulcers are treated each year3 The average cost per day per patient to treat a pressure ulcer is $23.54, while the average cost to prevent a pressure ulcer is only 47 cents4 In 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for nosocomial pressure ulcers.1 In a national pressure ulcer prevalence audit, it was determined that nearly 70% of patients who spent any time in the ED developed at least 1 nosocomial pressure ulcer.2 Now, more than ever, it is important to prevent pressure ulcers throughout the patient’s entire hospital stay. Did You Know? Stryker offers solutions to enhance patient comfort while helping to prevent and treat pressure ulcers. • Pressure redistribution mattresses for preventative skin care • Stretcher overlays that help prevent and treat up to stage IV pressure ulcers • Drop seat on stretcher to help reduce shear stresses • Glide™ Lateral Transfer System Mkt Lit-643 122811 Rev A 1. Sylvia, Lindstrom, Laura Grisanti, and Thomas P. Stewart. “Is Length of Stay in the Emergency Department Associated with Hospital-Acquired Pressure Ulcers?” presented at SAWC Conference. 2010 2. "CMS - Hospital Acquired Conditions Guidelines." Premier, Inc. Home Page. Premier. Web. 28 Dec. 2011. . 3. Reddy, Madhuri, Sudeep S. Gill, and Paula A. Rochon. "Preventing Pressure Ulcers: A Systematic Review." JAMA (2006): 1-12. JAMA. 1...
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...Pressure ulcers in long term care if occurs and are unavoidable can impose substantial implications of neglect for the facility. Pressure ulcers per federal guidelines comes with a F-Tag according to federal regulations for pressure ulcers entails that residents who become residents and enter a long -term care facility must not develop a pressure ulcer unless it is unavoidable. The guideline further entails those residents in a long -term care facility who have the presence of a pressure ulcer receive adequate and necessary treatment to promote the process of healing and provide preventative measures in the prevention and formation of additional pressure ulcers (CMS.gov). After being selected by IPRO to participate in the Gold Stamp Program, the interventions of the institution has changed to reassess and implement interventions that are geared towards the prevention of potential patients at risk of developing pressure ulcers and healing those nosocomial pressure ulcers that were acquired. Currently, our facility has a total of 11 nosocomial pressure ulcers that were acquired in house. Of those 11 nosocomial pressure ulcers, they can be accounted for as previously healed areas and patients who have risk factors predisposing them to the acquisition of a pressure ulcer, and some were avoidable. The plan to purchase alternating air mattresses from H & R Healthcare will prove beneficial to the facility and will help to heal nosocomial pressure ulcers. Currently, we have 29 patients...
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...Introduction Pressure ulcers are very common in chronic and acute care. "A pressure ulcer is an injury to the skin that occurs when a patient lies or sits too long in the same position. The pressure keeps blood from getting to the tissue, causing cells to die and the skin to break down" (stoppain.org). As the tissue dies, an open sore forms, and this can even be painful or become infected where in severe cases, the muscle, tendon, or bone may begin to show. Pressure ulcers usually occur on bony areas of the body, such as the tailbone, back, buttocks, back of the head, elbows, heels, hips, and shoulders. The patients that are high risk for pressure ulcers are the patients that are unable to ambulate. According to Defloor and Grypdonck, the first pressure ulcer assessment was designed and tested in 1962, which was the Norton Scale. According to this scale, each item is scored on a four-point scale, where the minimum score is a 5 and the maximum score is a 20. This scale has been tested in particularly older patients. Since the 1980s more scales have developed and at least 38 alternative risk assessment scales have been described in the literature. The most frequently used scale in research is the Braden scale. This scale consists of six items which are activity, sensory perception, moisture, mobility, shear and nutritional status. The scores on this scale vary between 6 and 23 where the original cut-off point is 16. Defloor and Grypdonck researched the American National Pressure Ulcer...
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...Health Promotion Proposal Plan to Reduce Obesity in Children Mabel Di Mare South University America spends more than two trillion annually on healthcare, more than any other nation. Tens of millions of Americans still suffer every day from preventable illness and chronic disease. (healthyamericans.org, 2016). Many factors contribute to the health care crisis. One of the most important is our health care system's focus on caring for people after they have become sick or harmed (healthyamericans.org, 2016). Solutions to the problem must begin with stopping illness or damage before they occur (healthyamericans.org, 2016). The goal of this project is to development a promotional health plan that improves nutrition and promotes physical activity inside of the community. To address the objective of this project will be the focus of interventions to reduce or eliminate obesity in children. Approximately twenty-five million U.S. children are obese or overweight. Rates of childhood obesity have more than tripled since 1980 (cdc.gov). Interventional strategic proposal towards healthy children: * Promote the selection of food service guidelines and nutrition standards. * Promote physical activity in early childcare centers, schools, and work sites. * Increase access to breastfeeding friendly environments. The project is...
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...المبتـعـثـيـن بـالـخـارج بقلم الاستاذ/ نهار الرشيدي طالب ماجستير تمريض جامعة سالفورد المبتعث للدراسة في المملكة المتحدة : يحتاج الطالب الذي يستعد للدراسة في المملكة المتحدة إلى اجتياز اختبارات اللغة التي تعد شرطا أساسيا من شروط قبوله في الجامعة التي يود الدراسة فيها وعاملاً للتفاهم والتعامل في المجتمع الجديد الذي سيعيش فيه، من أجل ذلك ينبغي على الطالب أن يعد نفسه إعداداً جيدا لهذا الأمر وأن يبدأ في دراسة اللغة وهو في المملكة ولا ينتظر إلى حين وصوله لمقر البعثة. اوصي اخواني واخواتي المبتعثين والمبتعثات بالتحاق بالمعهد التابع للجامعة التي ينوي الطالب الدراسة فيها أو التي يكون لديه قبول أكاديمي فيها وذلك لعدد من الاعتبارات منها: 1 ـ أن التحاق الطالب بالمعهد التابع للجامعة ربما يعفيه من شرط تحقيق درجة عالية في اختبار التوفل او الايلتس والاكتفاء بإتمام برنامج اللغة الذي تقرر له. 2 ـ أن معاهد اللغة التابعة للجامعة ربما تكون أقوى من غيرها لكونها تخضع لإشراف الجامعة ومتابعتها ولديها الإمكانات المادية والبشرية المؤهلة لإدارة برنامج دراسي قوي. وتعتبر الدراسة في معاهد المملكة المتحدة بمثابة استثمار كبير للطالب حيث أن القيمة الدراسية التي يحصل عليها الطالب ستكون أكبر بكثير من التكاليف الباهظة التي قام الطالب بتسديدها خلال دراسته العليا . . ** مشاكل المبتعثين بالخارج : طوال السنوات الماضية حاول بعض خصوم برنامج الابتعاث تصويره بأنه مشروع (تغريبي) و لكني على العكس منهم أرى بأنه مشروع (تشريقي)!، ووصف هذا المشروع الرائد بأنه تشريقي لا ينبثق من كون بعض وجهات الابتعاث تقع إلى الشرق منا مثل الصين وكوريا الجنوبية وماليزيا، بل لأن هذا المشروع الضخم يشرب النهر من منبعه إلى...
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...achieved during the module, I could have chosen such accomplishments as VAC (Vacuum Assisted Closure) therapy, Maggot therapy or Nutrition and Dietetics. But I wanted to go back to basics and review and fully expand a skill that I knew of, which is Pressure Ulcers (also called pressure sores or bed sores). A stated by the NHS Choices website “It is estimated that in any given year fewer than half a million people in the UK will develop at least one pressure ulcer. About 1 in 20 people who are admitted to hospital with acute sudden illness will develop a pressure ulcer; this is usually people with underlying health conditions.” I have been a H.C.A (Health Care Assistant) for over 17 years to now, and I have always been aware of pressure ulcers, and how to try to avoid them but never really knew the complete details of What, How or When of them. I have been on many different courses for H.C.A’s through the years, but they have all really skimmed over the subject of pressure ulcers. I now work on a vascular ward of the hospital where many of the patients are bed or wheelchair bound due to lower limb amputations, caused by complication from diabetes mellitus to circulatory problems. So I thought that by widening my knowledge on pressure ulcers and skin viability, I can and will improve services to the patients I come into contact with. When trying to conduct my research for adequate literature I decided to contact the hospital Tissue Viability Nurses Specialist. When I explained to...
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...Intro: What are Pressure Ulcers? Cayuga Medical Center’s Initiative Ideally, in modern medicine patients with wounds are bought to treatment facilities and when they leave they are healthier than when they came in. However, one problem threatens to change this. Pressure Ulcers, which form because of skin pressure reducing blood flow to an area of the body, have a habit of forming in patients with a variety of long-term problems as they are cared for in hospitals and nursing homes. The result of this is that in addition to whatever other problems a patient may have, the ulcer causes the skin and the tissue beneath the skin to die, and if the dead tissue is not quickly removed it can cause additional problems and pain for the patient. There are several factors that put one at risk of pressure ulcers, and these conditions are often difficult or impossible to treat. A typical pressure ulcer patient: suffers from mobility problems, is an older adult, has a spine or brain injury or disease such as multiple sclerosis, has a disease or condition that affect ones mental status, has fragile skin, has urinary incontinence or bowel incontinence or does not get enough nutrition. As most of these conditions are symptoms of old age or mental illness, these people will always be at risk of pressure ulcers, meaning the pressure ulcer prevention is there best chance of living comfortably. Pressure Ulcers can be treated but they are painful and if untreated they can result in death. They are...
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...Pressure Ulcers: Wound Care Assignment Harman Unitek College Foundations of Nursing VNSG 100 Mr. Dhanda November 10, 2015 Pressure Ulcers: Wound Care Assignment Have you ever wondered what it looks and feels like if our skin gets torn up? You haven’t right? There are approximately 2.5 million who get pressure ulcers from hospitalization each year. From those 2.5 million patients, 60 thousand patients die from complications (Cooper & Gosnell, 2015, para. 4). In this essay, I will be explaining the normal causes, common treatment (tx), and prognosis for healing. Pressure Ulcers (PU) overall usually occur when there is sufficient pressure on the skin over bony prominences causing blood vessels in an area to collapse. Pressure ulcers result in ischemia or lack of oxygen and nutrients to the cells. PU usually take place over bony prominences such as: sacrum, scapula, elbows, heels, inner and outer knees, back of the head, and the hips. Since we are talk about stage III pressure ulcers, PU involves full thickness tissue loss where the subcutaneous fat is sometimes visible, but bones, tendons and muscles are not exposed. Stage III pressure ulcers vary depending on the location which also include: bridge of nose, ear, and the occiput. Deep stage 3 PUs develop in areas within layers of deep adipose tissue. The two main factors that play a role in development for pressure ulcers are shearing force & friction. Shearing force involves when the tissue layers of the skin...
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