NURS5044 Pressure Ulcers in Elderly Assignment Sample

Exploring Nursing Practice

Introduction to Chosen Area

An ulcer is defined as localized damage to skin and the tissues causing a wound (Wound, 2017). Pressure injuries and ulcers are common in the patients who are bedridden and even more frequent in the elderly patients who have limited mobility due to health conditions restricting the movement (Walker et al., 2017). The ulcers are also known as the decubitis ulcers, bedsores, or pressure injuries that can result in chronic wounds. The cause of development can be identified with both intrinsic and extrinsic factors (Ocampo et al., 2017). The intrinsic factors associated with pressure injury development include skin structure and vascular system, oxygen delivery, age, nutrition, and skin conditions of an individual with extrinsic factors like shearing force, pressure and friction, etc (Aloweni et al., 2017). An inverse relationship is observed in time and pressure in terms of shear stress and pressure injuries in the patients. Delicate skin in the elderly due to reduced metabolism is one of the major causes of pressure injuries in the patients (Ramundo & Pittani, 2018). In immobilized patients, recovery and healing of pressure injuries takes longer due to reduced circulation of the blood and constant pressure on the injury (Haesler, 2017). Stage II ulcers are known to heal in the elderly more effectively than stage III and IV (Walker et al., 2015).

This document will assess the case of Mr. Sam (pseudonym) who has been admitted in the residential nursing care facility at the age of 85. The case will discuss the wound management and care in the patient.

Patient Background

Sam is an 85-year-old elderly patient who has been admitted in the care facility after his stroke induced paralysis. The patient has medical history of diabetes, hypertension, cardiac problems, and chronic depression. The patient was admitted in the care facility after his treatment of stroke in the local city hospital. The patient has lost his mobility due to his health condition and his completely dependent on care services for his daily care and sanitary needs. On the second day of his admission, it was observed that the patient had developed an ischemic heel pressure ulcer on the left foot with the size of 4cm X 3cm. The patient was suggested to undergo follow up consultations for wound treatment and care by the podiatry department of the nursing home. The patient was given the treatment through aseptic conditions for seven days.

Analysis of Pressure Ulcers in Elderly

In the initial observation, the heel ulcer was mildly exudative but the wound was large and deep. A thick tissue had developed around the wound and was indicative of inflammation. Application of medication and cleansing with betadine helped in prevention of infection development and facilitated the process of healing. The bedridden patient like Sam requires extensive care for the management of wounds for several reasons (Padula et al., 2019). First, the patient is elderly and thus dry skin can limit the process of healing (McInnes et al., 2019). Second, no movement in the patient affects the circulation and makes the tissues prone to ulceration and thus this not only increases the risk of ulceration but also limits the process of healing (Santamaria et al., 2018). With regular wound care and management the ulceration that was developed in Sam was treated and this assisted in limiting the development of infection or risk of sepsis. The protocol for wound care and management was followed that helped in the healing for Sam. However, certain areas of improvement are required that could further enhance the care of the patient and enhance the procedure of healing. Medication administration could be considered for the patient to enhance the process of healing (Armour et al., 2018) Further, to enhance the process of healing in the patient, nutritional intervention should have been applied complimentary to the wound care. The process of wound healing is facilitated with the proper care of diet and nutritional management in the patients (Floríndez et al., 2020). Use of heel protectors was a suitable intervention has it helped in preventing any physical injury on the patient. Proper assessments were also conducted for the wound that helped in timely interventions and care. In future, the care of the patient can be enhanced by standardization of the process of wound care in the facility. The process of standardization will facilitate the application of interventions and improve the quality of care received by the patients (Haesler, 2017). A policy can be drafted in the acre facility where management of the wound care can be enlisted to improve the overall quality of care in the patients. This will also promote future practice and promote healing. Positioning of patient should also have been facilitated for effective wound care and management. Positioning is a suitable intervention as it releases the pressure from the body of the patient and also facilitates circulation of the blood at the site of pressure injury (Floríndez et al., 2020).

Inclusion of these changes in the residential care facility will help in improving the quality care that is received by the patients, enhance the service, and promote the well being of the patient.

Conclusion on Pressure Ulcers in Elderly

Wound care and management is crucial for the well being of patient who have limited mobility. Pressure injuries and ulcerations are common in the patients in elderly patients who have limited mobility due to several medical conditions as they have reduced metabolism, dry skin, and blood circulation. However, proper care should be ensured to prevent risk of infection that may arise. This paper analyses the case of an 85 year old patient, Sam who has been admitted in the care facility after his treatment of stroke and is paralytic. A pressure injury was observed at the left heel of the patient and was treated with care for complete recovery in the span of 7 days after observation. This paper also suggests how further improvements can be made to enhance the quality of care.

References for Pressure Ulcers in Elderly

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Aloweni, F., Lim, M. L., Chua, T. L., Tan, S. B., Lian, S. B., & Ang, S. Y. (2017). A randomised controlled trial to evaluate the incremental effectiveness of a prophylactic dressing and fatty acids oil in the prevention of pressure injuries. Wound Practice & Research: Journal of the Australian Wound Management Association, 25(1), 24. https://search.informit.com.au/documentSummary;dn=745447724886743;res=IELHEA

Armour, D. J., Preston-Hsu, E., & Tailor, Y. (2018). Management of Pressure Ulcers and Pressure-Related Injury. Current Physical Medicine and Rehabilitation Reports, 7(2), 170-177. https://link.springer.com/article/10.1007/s40141-019-00222-x

Floríndez, L. I., Carlson, M. E., Pyatak, E., Blanchard, J., Cogan, A. M., Sleight, A. G., ... & Clark, F. A. (2020). A qualitative analysis of pressure injury development among medically underserved adults with spinal cord injury. Disability and Rehabilitation, 42(15), 2093-2099. https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1552328

Haesler, E. (2017). Evidence Summary: Pressure Injuries: Preventing medical device related pressure injuries. Wound Practice & Research: Journal of the Australian Wound Management Association, 25(4), 214. https://search.informit.com.au/fullText;dn=299648201809835;res=IELIAC

Haesler, E. (2018). Skin care to reduce the risk of pressure injuries. Wound Practice & Research: Journal of the Australian Wound Management Association, 26(2), 111. https://search.informit.com.au/documentSummary;dn=733777798688975;res=IELHEA

McInnes, E., Jammali-Blasi, A., Cullum, N., Bell-Syer, S., & Dumville, J. (2018). Support surfaces for treating pressure injury: A cochrane systematic review. International Journal of Nursing Studies, 50(3), 419-430. https://www.sciencedirect.com/science/article/pii/S0020748912001794

Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019). Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132-141. https://qualitysafety.bmj.com/content/28/2/132.abstract

Ramundo, J., Pike, C., & Pittani, J. (2018). Do prophylactic foam dressings reduce heel pressure injuries?. Journal of Wound, Ostomy and Continence Nursing, 45(1), 75-82. https://www.ingentaconnect.com/content/wk/won/2018/00000045/00000001/art00014

Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi‐layer silicone foam dressings for the prevention of pressure injuries in high‐risk aged care residents: the border III trial. International Wound Journal, 15(3), 482-490. https://onlinelibrary.wiley.com/doi/abs/10.1111/iwj.12891

Walker, R., Aitken, L. M., Huxley, L., & Juttner, M. (2015). Prophylactic dressing to minimize sacral pressure injuries in high‐risk hospitalized patients: a pilot study. Journal of Advanced Nursing, 71(3), 688-696. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12543

Walker, R., Huxley, L., Juttner, M., Burmeister, E., Scott, J., & Aitken, L. M. (2017). A pilot randomized controlled trial using prophylactic dressings to minimize sacral pressure injuries in high-risk hospitalized patients. Clinical Nursing Research, 26(4), 484-503. https://journals.sagepub.com/doi/abs/10.1177/1054773816629689

Wound, O. (2017). WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers). Journal of Wound, Ostomy and Continence Nursing, 44(3), 241-246. https://www.ingentaconnect.com/content/wk/won/2017/00000044/00000003/art00007

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