Management Of Pressure Ulcers In Elderly Patients

Management Of wedge Ulcers In gray Patients pinch ulcerations be an injury that damages cutis and the layer(s) of create from raw material beneath, which adopt been exposed to ram (NHS, 2014). They sens occur in uncomplainings of varied ages however, the around vulnerable age group who be at put on the line of develop compress ulcers atomic number 18 patients aged 75 and above (Hope, 2014). antiquated patients prevail to discombobulate co-morbidities out-of-pocket to the ripening process, which bottom mosttimes leave them with special mobility or bedridden and this then fuel put them at foster risk of developing printing press ulcers (Jaul, 2010). Due to having a growing antique population, it is extremely important to address the risks of thrust ulcers. There is no concomitant environment in which pressure ulcers occur, as they are a contact in all settings where cordial sustentation is world provided, aesculapian treatments are carried out inclu ding private homes. This paper leave alone review the separate regarding the risks and counseling of pressure ulcers. The focus of this paper will be time-worn patients and the following topics will be discussed risk sagaciousness, patient assessment, pressure recognition and removal, non-surgical treatments/advice, complications of pressure ulcers and surgery.On recognition of a pressure ulcer or the contingency of one developing on a patient, a suitably skilful wellness or medical checkup exam professional should do a attested risk assessment (NICE, 2014). This risk assessment should cover two link battlefields, risk factors and signs/symptoms. It is important to assess an time-worn patients current health status and not just the status of their health as documented previously on re stacks or on admittance to see a professional, as a variety of factors can affect the development of a pressure ulcer some factors to a greater extent rapidly than differents. Questioni ng into previous medical history and as well as looking at previous medical notes is a lot very informative and usually allows the professional to know of all co-morbidity which could bequest a further risk or act as an confirmatory seduce of the development of a pressure ulcer. Diabetes and musculoskeletal disorders are a lot flagged up on assessments as a factor which can affect a pressure ulcer (Benbow, 2012). Sometimes due to the fourth-year patient suffering from a type of dementia, their ability to communicate or record life events deteriorates and therefore they cannot provide the professional assessing the ulcer with key medical information. Also, some patients whitethorn be in trauma or are not conscious this, again, makes the information gathering stage of the patients current health status fractious for the assessing professional. In such(prenominal)(prenominal) complex cases, the patients wider network such as relations or the multi-disciplinary team of heal th and social good sustaining professionals who have previously holded the patient may have more(prenominal) knowledge on the patients life history. Nursing home staff are required by the look at Quality Commission to keep records of their residents care plans and more specialist homes have routine logs written about their residents these very muchtimes can act as a good indicator of physical, moral and behavioural status and changes which have occurred with the elderly patient (CQC, 2015).Determining any other condition which an elderly patient may suffer from is important, because this require to be considered in the patients care plan and counselling of the Pressure ulcer as it could have direct clash on the healing of a pressure ulcer. For example, if the elderly patient has diabetes, their suffer healing process possibly pro farseeinged (Leik, 2013). Furthermore, as elderly psyches have thinner fight this already puts them at greater risk of skin damage due to p ressure. musculoskeletal disease such as osteoarthritis is usually diagnosed in elderly individuals and it can limit the mobility of the patient or their ability to do peculiar(prenominal) activities (NHS, 2014). This may result in patients being in the same sic for long periods of time, which may then put pressure on that area of the body, putting them at greater risk of developing a pressure ulcer. Also, elderly individuals who are less mobile are more probably to have poor circulation, which can impact on the time interpreted for a pressure ulcer to heal. Therefore, blood flow should also be taken into consideration when doing the risk assessment. Above are some examples of how the steering of Pressure ulcers can become complex there are more diseases such as terminal diseases and other medical conditions that neediness to be taken into consideration when planning the care or measure of a pressure ulcer.Often both the lack of nutritional intake and redness of weight are two interrelated common concerns in elderly patients, unless the cause is due to a various factor such as underlying pathology of disease. Therefore, in addition to including these factors in the risk assessment, health upbringing to encourage the patient to eat inevitably to be provided to the patient, their relations and health and social care staff financial patronize the patient. Health advice/education/ instruction is important because an underweight elderly individual is more likely to have less tissue around their bones and possibly poorer blood watercraft quality, hence qualification them more at risk of damage from pressure and also poorer healing (MNT, 2014). Also, a lack of protein in an elderly patients diet, which brooks tissue growth and rep tonal pattern, can also cause greater damage to their skin from pressure. Low nutritional intake can also cause fag and frailty in elderly individuals and this can impact an elderly individuals plight and ability to do daily activities (Morelli and Sidani, 2011), hence impacting their psycho-social status, which may disengage them from supporting their own health, whether it be by following the guidance of a medical practitioner or by being active in their health care decisions generally (Morelli and Sidani, 2011). This then can make patient centred care difficult for those providing care for the elderly patient, as patient choice/preference is compromised and characteristic of discommode, which is usually expressed verbally via description or recommended pain scales such as Braden or Waterlow, may not also be provided by the patient (Nice, 2014 and Benbow, 2012). Therefore, the patients involvement in managing the pressure ulcer is zippy.Pain management is difficult in Pressure ulcer management if the elderly individual has an altered perception of pain due to a spinal cord injury or other related nerve damage injuries. This may prevent the patient from recognizing that they have an ulcer developi ng, hence delaying the treatment of the ulcer (MNT, 2014). Therefore, it is good practice if the elderly individual is a patient in hospital to routinely ask the patient if they have seen any abnormalities on their skin and also recommend them to change positions regularly.Alongside the detailed risk assessment, a pressure ulcer assessment/skin assessment should be done on recognition of a pressure ulcer developing. This is not only to manage the Pressure ulcer barely also to be aware of those individuals who may have difficulty, as mentioned above, in detecting changes in their skin or possibly even possess a disability. Complaints of pain from the patient should be considered in the skin assessment, followed by a smorgasbord of the ulcer as a stage 1,2,3 or 4 Pressure ulcer (NICE, 2014). This will include assessing discolouration, variations in heat, firmness and skin moisture. The categorisation of the Pressure ulcer is extremely important because it allows suitable preventati ve measures to be put within the individuals care planning, to try to maintain the skins integrity and to support healing (NHS, 2014).The overall patient assessment will directly impact decisions on the frequence of positioning for the patient and the suitability of the support bulge on which the patient is sitting or lying (Benbow, 2012). These changes are vital to pressure removal and hence, managing the development of the Pressure ulcer better because they will be included in a repositioning timetable that health and social care professionals will work to as part of the care plan. The frequency of positioning varies based on the risk, patients physical ability/state and also their acceptance to be regularly repositioned for example, a patient in a wheelchair may need to be repositioned every 15 minutes due to the pressure of sitting in the same position for long periods of time. Elderly patients who are bedridden should be repositioned every couple of hours, depending on the ne ed determined in the risk assessment (NICE, 2014). A physiotherapist can often advise on repositioning that will be safe and that will also allow pressure release. Equipment can also support pressure removal. Cushions on wheelchairs not only provide comfort but they can also lessen the pressure on the hip and fastness leg area of the body. However, some specialists advise that air, water or bubble filled support devices are better than traditional cushions (Benbow, 2012). Small pillows/ fizz pads can also support areas of the body from touching each other, such as between the knees or ankles. These can also be use for comfort and support when laying in different angled positions for example, when a patient is lying on their side, their legs may need further support (Benbow, 2012). Reclining chairs/automated chairs can also be set at different positions to support pressure removal. Patients, relatives and supporting professionals need to ensure that the skin of the patient is regul arly checked, as repositioning regularly can also cause skin damage due to the skin of an elderly individual being thinner.Specialised mattresses can also reduce pressure in par to standard mattresses. Furthermore, some specialist mattresses can be connected to an air flow system which can automatically regulate the pressure, hence making the care and management of pressure ulcers in bedridden patients easier for health professionals or carers/relatives. This may be a change that medical/health professionals recommend to elderly patients at home or even for patients in long term care/rehabilitation however, research is still lacking on how much contribution mattress change actually has on directly lessen the risk of pressure ulcer development (Vanderwee et al, 2008 and UCSF, 2011) in comparison to other cost effective changes.Depending on the wound of the ulcer and the skin damage, often dressings and ointments are employ to manage the pressure ulcer and to manage infection. Anti biotics may be prescribed, but not often, as usually antiseptic creams can be applied directly on the wound to prevent the dish out of infection to connecting tissues. Ointments and creams may also be used to prevent or treat skin damage such as incontinence-associated dermatitis. The skin assessment should be able to identify those at risk of developing such dermatitis, as these patients often have one or more of the following conditions incontinence, oedema or dry skin (NICE, 2014). Dressings which have been specially knowing to further wound healing and cell regrowth should be used on a pressure ulcer wound. Examples of suitable dressings include hydrocolloid dressings and aliginate dressings (NHS, 2014). These dressings also can support the regulation of skin moisture, which is important to manage the Pressure ulcer. question and development into wound repair technology is advancing and specially designed dressings give less trauma to the patient upon removal. Therefore, the correct dressing is vital as unsuitable dressings may cause further skin breakdown. As briefly mentioned earlier in this paper, the patients diet may need repair to ensure that the elderly patient is taking nutrients which will support wound healing. Hydration is also important to maintain skin moisture and avoid gonzo skin (Convatec, 2012). Hydrotherapy can also be used to keep skin clean, with possible natural removal of dead cells.In some cases, the wound healing process may be compromised due to necrotic tissue and this dead tissue will need to be take via a debridement method. Debridement methods vary depending on the clinical situation. Larvae therapy can be used as an alternative method to debridement this therapy consists of putting maggots on the wound for a few days via a dressing and gauze. Maggots can also promote healing due to the release of a substance that kills bacteria. Sometimes when physique 3 or 4 Pressure Ulcer wounds do not heal or they become complicated cases, surgery is needed. This is usually each surgery which directly closes the wound or flap reconstruction.To conclude, this paper has assay to cover the overall management of pressure ulcers in elderly patients. Despite, the treatments and clinical practice carried out by medical/health professionals being connatural to younger patients, the risks of pressure ulcer development and healing due to the ageing process are different. Also, co-morbidity is more identifiable in elderly patients and skin structure/composition differs due to the thinning of the skin. There are pass on guidelines on managing pressure ulcers by NICE however, further research needs to be done to optimize the management of pressure ulcers in elderly patients (Cullum, 2013).BibliographyBenbow, M. (2012) Management of Pressure ulcers. Online accessible fromhttp//www.nursinginpractice.com/article/management-pressure-ulcersCare Quality Commission. (2015) canon 17 good governance. Online operational fromh ttp//www.cqc.org.uk/content/regulation-17-good-governanceConvatec. (2012) The Role of Modern affront Dressings in Stage I Pressure Ulcers and Patients at Risk of Pressure Ulcer Formation. Online Available fromhttp//www.convatec.co.uk/media/9572137/aquacel-foam-dressing-shown-to-protect-against-ski-11546.pdfCullum, N. (2013) Study reveals pressure ulcer research uncertainties. Online Available fromhttp//www.manchester.ac.uk/discover/news/article/?id=10016Jaul, E. (2010) Assessment and management of pressure ulcers in the elderly current strategies. Journal of Drugs and Aging. 27 (4). p. 311-325.Leik, M.T.C. (2013) Adult-Gerontology Nurse Practitioner deposition Intensive Review Fast Facts and Practice Questions. 2nd ed. Springer publish Company New York.Medical News Today. (2014) What are bedsores (pressure ulcers)? What causes bed sores? Online Available fromhttp//www.medicalnewstoday.com/articles/173972.phpMorelli, V and Sidani, M. (2011) Fatigue and Chronic Fatigue in the Elder ly Definitions, Diagnoses, and treatments. Clinics in Geriatric Medicine. 27 (4). p. 673 686. subject area Health Institute. (2014) Osteoarthritis. Online Available fromhttp//www.nhs.uk/Conditions/osteoarthritis/Pages/Introduction.aspxNational Health Service. (2014) Pressure ulcers Treatment. Online Available fromhttp//www.nhs.uk/Conditions/Pressure-ulcers/Pages/Treatment.aspxNational Institute for Health and Care Excellence. (2014) Pressure ulcers prevention and management of pressure ulcers. Online Available fromhttps//www.nice.org.uk/guidance/cg179/resources/guidance-pressure-ulcers-prevention-and-management-of-pressure-ulcers-pdfUniversity of atomic number 20 at San Francisco. (2011) A critical analysis of Patient Safety Practices evidence report no.43. Online Available fromhttp//archive.ahrq.gov/clinic/ptsafetyVanderwee, K, Grypdonck, M, Defloor, T. (2008) Alternating pressure air mattresses as prevention for pressure ulcers A literature review. International Journal of Nur sing Studies. 45 (5). p. 784-801