Quote from suzy253
certainly no nurse wants to see pressure ulcers on their watch but they do happen. not only frequent turning, urine, feces but take into consideration the person's nutrition, mental status, sensory, plus in the elderly they have very thin skin so even the best of care can't necessarily prevent these from occurring.
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
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 :spin: