Pressure ulcers as stated by the European Pressure Ulcers Advisory Panel ( EPUAP, 2007 ) : “ A force per unit area ulcer is localised hurt to the tegument and/or underlying tissue normally over a cadaverous prominence, as a consequence of force per unit area, or force per unit area in combination with shear and/or clash. A figure of lending or confusing factors are besides associated with force per unit area ulcers ; the significance of these factors is yet to be elucidated. ” In add-on, National Institute for Clinical Excellence ( NICE, 2008 ) defines a force per unit area ulcers as “ A force per unit area ulcer is harm that occurs on the tegument and implicit in tissue. Pressure ulcers are caused by three chief things: Pressure – the weight of the organic structure pressing down on the tegument. Shear – the beds of the tegument are forced to skid over one another or over deeper tissues, for illustration when you slide down, or are pulled up, a bed or chair or when you are reassigning to and from your
wheelchair. Friction – rubbing the tegument ” .
Some of the force per unit area ulcers intrinsic causes ( built-in to single ) include decrease mobility, incontinency ( Horn, 2004 ) , old age, malnutrition, hapless hygiene, dry tegument, diabetes mellitus and surgery ( ex. hip break ) and anemia ( Gunningberg, 2000 ) . Some extrinsic causes include clash, shearing forces, hypothermia ( Scott, 2001 ) and length of surgery ( Houwing, 2004 ) . Pressure ulcers are a common complication of lessening mobility due to hip break with reported incidence of between 8.8 % and 55 % ( Baumgarten, 2003 ) . Harmonizing to Versluysen ( 1985 ) , 17 % of patients that is admitted to hospital for surgery had force per unit area ulcers upon admittance and that 34 % developed lesions during the first hebdomad of stay in infirmary. Versluysen ( 1986 ) conducted another survey that 66 % of the patients with hep break developed force per unit area ulcer, bulk of these force per unit area ulcers appeared during the first 48 hours of admittance. Incontinence increases the hazard of holding a force per unit area ulcer because of the inordinate wet on the tegument, moist tegument adhere to the mattress therefore consequences to increased shearing forces ( Defloor and Grypdonck, 1999 ) . Dry tegument besides increases the hazard of holding force per unit area ulcers because of the reduced snap of the tegument ( Gunnigberg, 2000 ) . Surgery itself ( Lindgren, 2005 ) and length of surgery of 4 hours or more ( Schoonhoven, 2002 ) have been reported to increase the hazard of developing a force per unit area ulcer.
In 2005, the National Institute for Clinical Excellence has issued clinical guidelines to the National Health Service ( NHS ) about force per unit area ulcers. The guidelines are about bar and intervention of force per unit area ulcers, which are recommended for the usage of physicians, nurses and other health care professionals working in the National Health Service in England and Wales. The guidelines were prepared by health care professionals, scientist, and people stand foring the position of those who have or attention for person with the status. The groups make a recommendation based on the grounds available at the clip the recommendation is made on the best manner of handling or pull offing the status, and these clinical guidelines are recommended for good pattern. Under these NICE guidelines ( 2005 ) , it recommends that healthcare professional work together with the patients in order for the patients to hold an active function in doing determination sing their program of attention with the pick to affect their carer if they wished to. It besides mentioned that health care squad should esteem and take into consideration the patient ‘s cognition, experience, and demands, particularly if the patient has have been at hazard of developing force per unit area ulcers for a long clip. Furthermore, it besides mentioned that patients and carer should be given developing and information as to the grounds why the patient is at hazard of developing force per unit area ulcer, parts of the organic structure most at hazard to hold force per unit area ulcer, how to inspect the tegument and acknowledge the alterations in the tegument, how to alleviate force per unit area, and supply information to the patient and carer where to happen aid, advice, and support. Pressure on the tegument over cadaverous prominence such as sacrum, hips, cubituss, mortise joints, heels and shoulder causes decreased blood flow to the tissue, therefore cut downing tissue oxygenation. If this force per unit area is non relieved, the affected country starts to alter coloring material, inflammation to patients with just skin tone and bluish for patients with darker tegument tone and deemed to be ‘at hazard ‘ ( EPUAP, 2009 ) and may turn out to be difficult to observe, which so advancement to a more intensive tissue hurt if no attention is given.
Members of the European Pressure Ulcers Advisory Panel and National Pressure Ulcer Advisory Panel ( 2009 ) have had on-going treatment about many similarities the two organisation ‘s force per unit area ulcer grading/staging systems. They developed a common international categorization system and definition for force per unit area ulcers. EPUAP and NPUAP attempted to happen a common word to depict the class and phase but to no help. The word class was recommended as a impersonal term against phase and class and has the advantage of being non-hierarchical. They recognize that there is a similarity to the words – phase and class, and hence, they suggested to utilize whatever is most clear and understood. The most important addition from this partnership is that the degrees of skin-tissue harm and definition of force per unit area ulcer are the same, even though they may be labelled otherwise.
Pressure ulcers are classified into four ( 4 ) stages/categories based on the EPUAP ( 2009 ) categorization system. Non-blanching erythema is labelled as grade/category I, the tegument is integral with inflammation that is non-blanching of a localised country over a bony prominence when light force per unit area is applied. The affected country may be painful, house, soft, and heater or ice chest compared to the environing tissue. As mentioned earlier, patients with dark skin tone may be hard to measure and hold ‘at hazard ‘ . Partial thickness skin loss of both or either one of the first or 2nd bed of the tegument called cuticle and corium is classed as stage/category II, this stage/category of force per unit area ulcer presents itself in many ways, it can be a ruddy or glistening shallow ulcer without gangrene ( bed of dead tissue separated from the environing ) , may besides show itself as an integral or ruptured sero-sanginous filled or serum-filled blister, or merely bruising. Stage/category III is characterized with full thickness skin loss ; it involves harm to or the loss of hypodermic fat but non musculus, sinew, or bone. Pressure ulcer in this stage/category varies harmonizing to the site affected. Stage/category IV portraits as force per unit area ulcer with full thickness skin loss with extended harm of tissue which may include musculuss, facia, and other supporting construction and may set the patient at hazard of developing osteomyelitis or osteitis.
NMC Code of Conduct ( 2008 )
EPUAP definition ( 2007 ) hypertext transfer protocol: //www.npuap.org/pr2.htm
Nice definition hypertext transfer protocol: //www.nice.org.uk/nicemedia/pdf/CG029publicinfo.pdf
Versluysen M. Pressure sores in aged patients. The epidemiology related to hip operations. J Bone Joint Surg Br 1985 ; 67: 10-3.
Versluysen M. How aged patients with femoral break develop force per unit area sores in infirmary. BMJ 1986 ; 292: 1311-3.
Defloor T, Grypdonck MH. Siting position and bar of force per unit area ulcers. Appl Nurs Res 1999 ; 12: 136-42.
Gunningberg L, Lindholm C, Carlsson M, Sjoden PO. The development of force per unit area ulcers in patients with hep breaks: unequal nursing certification is still a job. J Adv Nurs2000 ; 31:1155-64.
Lindgren M, Unosson M, Krantz AM, Ek AC. Pressure ulcer hazard factors in patients undergoing surgery. J Adv Nurs 2005 ; 50: 605-12.
Schoonhoven L, Defloor T, new wave der Tweel I, BuskensE, Grypdonck MH. Hazard indexs for force per unit area ulcers during surgery. Appl Nurs Res 2002 ; 15: 163-73.
EPUAP hypertext transfer protocol: //www.epuap.org/guidelines/Final_Quick_Prevention.pdf ( 2009 )
Lindholm C, Sterner E, Romanelli M, Pina E, Torra y Bou J, Hietanen H, Iivanainen A, Gunningberg L, Hommel A, Klang B, Dealey C. Hip break and force per unit area ulcers – the Pan-European Pressure Ulcer Study – intrinsic and
extrinsic hazard factors. Int Wound J 2008 ; 5:315-328.
Scott EM, Leaper DJ, Clark M, Kelly PJ. Effectss ofwarming therapy on force per unit area ulcers – a randomised test. AORN J 2001 ; 73:921-7,929-33,
Houwing R, Rozendaal M, Wouters-Wesseling W, Buskens E, Keller P, Haalboom J. Pressure ulcerrisk in hep break patients. Acta Orthop
2004 ; 75:390-3.
Gunningberg L, Lindholm C, Carlsson M, Sjoden PO. Effect of visco-elastic froth mattresses on the development of force per unit area ulcers in patients with hep breaks. J Wound Care 2000 ; 9:455-60.
Baumgarten M, Margolis D, Berlin JA, Strom BL, Garino J, Kagan SH, Kavesh W, Carson JL. Riskfactors for force per unit area ulcers among aged hip break patients. Wound Repair Regen 2003 ; 11:96-103.
Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, Cook AS, Sharkey SS, Voss AC. The National Pressure Ulcer Long-Term Care Study: force per unit area ulcer development in long-run attention occupants. J Am Geriatr Soc 2004 ; 52:359-67.
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