Pressure ulcers

[FNPhopeful]

Good freakin grief! Please tell me how people end up getting ulcers as bad as the ones in our textbooks! Is there no care where these patients are?! They must be people bed ridden at home.

I did a Yahoo image search on these and saw sores where I thought the person MUST be dead but apparently not.

Not on my watch!

[Fun2, BSN, RN]

We can sit in a car for 2 hours and not get pressure ulcers, but we are able to reposition our weight q 15 minutes....or however short/long of time our body tells us too. (I know every nursing student would be in trouble as much as we are studying!!)

Those who are immobile, comatose, etc can't move at all even if they feel their pressure points starting to hurt. It is a very sad thing, yet so common, I'm afraid!!

I saw pressure ulcers in two different patients on my very first clinical day!! One pt had them on both ankles/feet but were healing very well. The other pt had deep pressure ulcers covering the buttocks area and had tunneling present as well.

[Lisa CCU RN, RN]

I mean, look, they'll tell you, oh you gotta turn these people @ least q2hr or they'll get bed sores. So, the general perception is, if a pt gets skin breakdown, it's b/c they didn't get turned or cleaned. This may be true and I'm certainly not advocating giving less than adequate personal care (turning, keeping dry, etc.) but you have to think...we take car trips in excess of 2 hours all the time and don't wind up with pressure ulcers, why is that? It's because we don't have a compromised health status, meaning we have (as suzy253 indicated its importance) a good nutritional, mental and sensory status.

Again, pressure ulcers and other forms of skin breakdown are not always due to a lack of delivery of care...JMO

Well, people who ride in cars for two or more hours don't sit perfectly motionless either. They scoot around and most even get out of the car to take breaks and stretch their legs. Sitting motionless on one spot for just 8 hours can start a stage one. I've seen it happen.

You're right though, healthy people are prompted to move their limbs and butt when they get the pins and needles feeling from decreased circulation and diabetics and others don't have that, esp. in the feet.

[Lisa CCU RN, RN]

It's so sad isn't it? I have had my fair share of cleaning out stage 3/4's in just 2 semesters. The majority come in from the local nursing homes...where yup they arent being kept dry/moved enough/health problems/etc.

And I've also seen my fair share of ulcers come BACK from the hospital with a stage 2/3 after a hospital stay in my CNA days. It's not all nursing homes doing. Strechers are not easy on the elderly's skin.

[zahryia, LPN]

Wow, I like the way you broke this down! It makes so much more sense now.

This is sooo true! What's this person's albumin level (or better yet, in the elderly prealbumin level)? Do they have decreased colloid pressure thus contributing to extravasation of fluid and destruction to the tissues? Do they posses enough protein to aid in healing and the ability to maintain tissue health?

Also, you have to take into consideration what their circulation is like. Are they getting good tissue perfusion? Do they have any co-existing problems, i.e. HTN, increased SVR, PAD, DM, anemia, etc. that would contribute to decreased tissue perfusion? Too, you have to take into account with DM, (for lack of a better way to put it) an existing medium which encourages bacterial growth and tissue destruction with excess circulating glucose, you know?

Lots of times, these ulcers are, in fact, not due to poor personal care but rather a secondary result of an existing poor health status. Does that make sense?

I mean, look, they'll tell you, oh you gotta turn these people @ least q2hr or they'll get bed sores. So, the general perception is, if a pt gets skin breakdown, it's b/c they didn't get turned or cleaned. This may be true and I'm certainly not advocating giving less than adequate personal care (turning, keeping dry, etc.) but you have to think...we take car trips in excess of 2 hours all the time and don't wind up with pressure ulcers, why is that? It's because we don't have a compromised health status, meaning we have (as suzy253 indicated its importance) a good nutritional, mental and sensory status.

Again, pressure ulcers and other forms of skin breakdown are not always due to a lack of delivery of care...JMO

[Plagueis]

We've had pts. on the med-surg floors that had to be turned q15min or q30 min, they were that prone to skin breakdown.

Wow. I was taught during my CNA training that every 2 hours was the standard. I do think that the lack of staffing in most nursing homes is one reason that some people get pressure sores. For instance, a resident might not be able to get turned as often as they are supposed to, or she may not have her position shifted in her seat every 15 minutes, because there are only two CNAs for 65 residents.

[GR8LVN]

I agree 100%, ulcers are not always due to lack of care. In fact most times they are due to; paper-like skin (as seen with the elderly), poor circulation (tissue profusion), and #1- diet. Incorrect diet, lack of, and lack of vitamins. Just being elderly and having paper skin isn't enough, these poor souls don't have proper intake of food, vitamins and water. This is sooo important. WATER, WATER, WATER

[NaomieRN]

Last Saturday from clinical, I saw someone with an ulcer worst than the ones I saw in the Potter N Perry book. The patient was paraplegic.

[BoonersmomRN]

And I've also seen my fair share of ulcers come BACK from the hospital with a stage 2/3 after a hospital stay in my CNA days. It's not all nursing homes doing. Strechers are not easy on the elderly's skin.

Sorru- I wasn't trying to insinuate that it was ALL nursing homes doing...I was just saying the ones I have seen were.

[Kelly_the_Great]

Wow, I like the way you broke this down! It makes so much more sense now.

Hey, Zahryia, thanks...:wink2:

I wanted to illustrate that impaired skin integrity is a multifacected issue. Of course, there are many other factors to consider than just those I listed.

It's just, you know, wounds carry a lot of weight in emotion too. Something, I don't think we give near enough acknowledgement of. I mean, it's just not right. Depending on the severity, some of these people are literally rotting. There's something just so wrong about that and our first instinct (I think maybe without even realizing it) is to become enraged and then, of course, to place blame.

Believe me, I understand the feeling. My background is home health and I have certainly seen my share of stroke victims who have been put in back rooms and forgotten or paid very little attention to. It's so heart-wrenching.

But to say the only issue involved is personal care is a narrow, as well as inaccurate, view of the complex factors involved in the development of skin breakdown.

I also believe the view lends towards blame, as I indicated above, of others, i.e. it happened @ the nursing home, they got it while waiting in the ER, the floor nurses didn't ever turn the patient, etc. And I don't think that helps the patient at all and furthermore, I don't think it helps the profession of nursing.

Once again, JMO...

[Marie_LPN, RN, LPN, RN]

Wow. I was taught during my CNA training that every 2 hours was the standard. I do think that the lack of staffing in most nursing homes is one reason that some people get pressure sores. For instance, a resident might not be able to get turned as often as they are supposed to, or she may not have her position shifted in her seat every 15 minutes, because there are only two CNAs for 65 residents.

'Standard' doesn't work for everyone.

[Nurse`Chief~Chickie]

like several posters have said, i also learned to reposition a completely immobile pt q 15min. that's for someone who cannot shift their weight whatsoever. my honeys uncle is a bil bka and that's a big deal for him. even with the impressive pressure reducing cushion, he has to consciously constantly shift his body in his chair. wiggly pts can do with the q 2hr turns, but those people who we are responsible for and care for that can't move at all who need us to meet and exeed our standards, which some places just aren't high enough.

:pumpiron:

[luxcapWOCN]

Inadequate staffing is a problem at most nursing homes and turning every two hours simply is impossible at times. I've found that using the right specialty mattress can act as a hedge when there aren't enough nurses to go around. We use this mattress called the AirCell XL by Maximum Medical. Keeps the patient very comfortable and completely dispurses pressure on a continual basis. We have to turn half as much as before and the patients seem to be much happier.