decubiti redux...

Bird2 · Jul 5, 2005

I would push for a low air loss mattress. I have had excellent results from them. I can only remember having residents breakdown while in a low air loss bed if they had skin to skin contact. For example we had a resident that always kept her ankles crossed so she had stage ones in those areas. We pay 8.95 a day to rent a low air loss mattress. Hospice does come to our facility and have gotten them for the residents but it took some pushing on my part. It's all about comfort and pressure ulcers are not comfortable.

NurseFirst · Jul 5, 2005

I would push for a low air loss mattress. I have had excellent results from them. I can only remember having residents breakdown while in a low air loss bed if they had skin to skin contact. For example we had a resident that always kept her ankles crossed so she had stage ones in those areas. We pay 8.95 a day to rent a low air loss mattress. Hospice does come to our facility and have gotten them for the residents but it took some pushing on my part. It's all about comfort and pressure ulcers are not comfortable.

Wow! Only $8.95? Seems extremely reasonable--great ROI, I would think.

NurseFirst

mebeafrn · Jul 5, 2005

Wow! Only $8.95? Seems extremely reasonable--great ROI, I would think.
NurseFirst

Hospice Medicare Benefit-HMB- if this is the payor source for your precious one in question-if the rules are the same from state to state- can elect to supply fully elec, bed w/ pressure reduction mattresses beyond the basic IRIS. As far as 24 hr. care givers, if your friends mom has long term care ins. perhaps this can be a way to get CNA level care from a person(s) who would perform q 2 hr. turning w/ skin care. Enc, your friend to be really assertive in asking what the resources are,both professional and community based.

mahjia · Jul 5, 2005

its so happened that last week i got that as my case study. and i wanna correct something, its not the bed that really treat or prevent the patient from such disease. rather its the q2h log rolling. it is believed to be the cornerstone for prevention and treatment.

but offcourse aside from that, dont let the decubitus to get moistend for a long time, it will worsen the condition, but most of all keep the area clean.

Nutrition status should be evaluated and optimized, too. for this is one of the only contributing factors that may be considered reversible.. so restore a positive nitrogen balance and a serum protein to facilitate wound healing.... :)

Bird2 · Jul 5, 2005

I guess I should clarify that I never intended to state that a mattress would replace turning/repositioning. I also stated the price because most places including our local Hosice and the Company that I work for have contracts with vendors so that we can reciece the mattresses at a reasonable price. Usually we just eat the cost of the mattress because it will not always be covered. Again comfort and safety should be a priorty.

mebeafrn · Jul 5, 2005

its so happened that last week i got that as my case study. and i wanna correct something, its not the bed that really treat or prevent the patient from such disease. rather its the q2h log rolling. it is believed to be the cornerstone for prevention and treatment.
but offcourse aside from that, dont let the decubitus to get moistend for a long time, it will worsen the condition, but most of all keep the area clean.
Nutrition status should be evaluated and optimized, too. for this is one of the only contributing factors that may be considered reversible.. so restore a positive nitrogen balance and a serum protein to facilitate wound healing.... :)

Yes,repositioning,even if it is just a few degrees, is the gold standard,along with good basic Nursing 101 skin care. Pressure reduction mattresses do play an integral part in decub prevention/tx. as well as over all comfort.Keep in mind this is metastic disease and the tumor activity gets the nutrition first,tissue does not maint. or heal as in non-metastatic situations. N/V often enter the picture and it simply is not possible due to disease process to maint. nutrition. Doing frequent labs to check pre-albumins/albumins is not the norm. Wt. loss is care planned as unavoidable. Nutrition interventions focus on favorite foods being made available and foods/fluids NOT BEING FORCED if the pt. becomes unable to swallow or declines/refuses....palliation is the name of the game.

CoffeeRTC, BSN, RN · Jul 5, 2005

Okay...hospice pt right?

The low air loss beds are realatively cheap...we rent ours for like 35 a month or you can buy them for 1,200 on up.

Lots of pillows for positioning. Turn frequently. Medicate for pain (of course) prior to positioning changes.

More agressive..maintaining good po nutrition either with milkshakes and protien powder (in food or drinks), a good MVI helps too.

Good incontinance care also. A&D or a zinc oxide....Xenaderm also helps with mild stage 2s

OOOO don't forget the skin prep...it helps toughen the skin.

MacNurse · Jul 5, 2005

OOOO don't forget the skin prep...it helps toughen the skin.

Can you clarify that michelle126? Skin prep and toughening the skin?? :uhoh21:

"Interventions to address shear include moisturizing skin to decrease the surface tension as skin is moved across surfaces; using draw sheets, lift sheets, or transfer aids to assist in moving patients; and maintaining the head of bed at

Friction-reducing interventions include moisturization of the skin to decrease surface tension and providing mobility aids, such as an overhead trapeze, to decrease friction. Transparent adhesive film dressings may also be used to protect elbows and heels by decreasing surface tension.

Interventions to reduce moisture include identifying and addressing the cause(s) of moisture. Identification of causes of urinary or fecal incontinence must occur to assist with management of the incontinence. Urine quickly converts to ammonia after voiding occurs. Liquid stool contains digestive enzymes. Either or both can cause maceration and changes in the skin's protective pH. Either can contribute to impaired skin integrity. Treatment of the underlying cause of the moisture, containment of the moisture, and protection of the skin via skin sealants (eg, Smith & Nephew Skin Prep, 3M Cavilon No Sting), or barrier ointments can prevent painful denudement of the epidermis and further erosion of the skin. Adult briefs, despite being absorptive, can create a humid environment that potentiates changes in the skin's pH and protective environment. Preferred interventions for containment include using a single absorptive underpad or applying a fecal containment device."

From:Pressure Ulcer Prevention and Management: The Current Evidence for Care. AACN Clinical Issues: Advanced Practice in Acute & Critical Care. Wound Care: Heart Failure. 14(4):411-428, November 2003.

and for good measure: http://www.npuap.org./

mebeafrn · Jul 5, 2005

Can you clarify that michelle126? Skin prep and toughening the skin?? :uhoh21:
"Interventions to address shear include moisturizing skin to decrease the surface tension as skin is moved across surfaces; using draw sheets, lift sheets, or transfer aids to assist in moving patients; and maintaining the head of bed at
Friction-reducing interventions include moisturization of the skin to decrease surface tension and providing mobility aids, such as an overhead trapeze, to decrease friction. Transparent adhesive film dressings may also be used to protect elbows and heels by decreasing surface tension.
Interventions to reduce moisture include identifying and addressing the cause(s) of moisture. Identification of causes of urinary or fecal incontinence must occur to assist with management of the incontinence. Urine quickly converts to ammonia after voiding occurs. Liquid stool contains digestive enzymes. Either or both can cause maceration and changes in the skin's protective pH. Either can contribute to impaired skin integrity. Treatment of the underlying cause of the moisture, containment of the moisture, and protection of the skin via skin sealants (eg, Smith & Nephew Skin Prep, 3M Cavilon No Sting), or barrier ointments can prevent painful denudement of the epidermis and further erosion of the skin. Adult briefs, despite being absorptive, can create a humid environment that potentiates changes in the skin's pH and protective environment. Preferred interventions for containment include using a single absorptive underpad or applying a fecal containment device."
From:Pressure Ulcer Prevention and Management: The Current Evidence for Care. AACN Clinical Issues: Advanced Practice in Acute & Critical Care. Wound Care: Heart Failure. 14(4):411-428, November 2003.
and for good measure: http://www.npuap.org./

I thought this was a HOSPICE/PALLITIVE care....why are we quoting acute/critical care,talking curative and interventional vs the reality of COMFORT??????

MacNurse · Jul 5, 2005

Here's my rationale for posting something from a critical care journal.

My posting was intended to bring literature and evidence to support the other posters, and what I found happened to be in a critical care journal.

Even if the person is palliative as nurses we still need to prevent pressure sores (let's face it they're usually painful, and probably the last thing that the patient would need).

The OP said that she was recently diagnosed, so I assumed that she has not being lying in bed for long periods of time, and isn't on death's door, just yet. All the more reason to prevent pressure sores. However, once someone is nearing the end, I would reassess turning them q2h, at that point it might just be too painful and futile.

CoffeeRTC, BSN, RN · Jul 5, 2005

Okay..as far as the skin prep...not sure if toughen the skin is the right words, but it does help prevent decubs. We use it over bony prominences..heels, elbows, ankles, spine, etc...it works and its easy.