pressure ulcer???

i have seen patients coming at the later stage of pressure ulcer. usually those with chronic illness or bed ridden patients. its unlikely to develop 3rd stage pressure ulcer at hospital. if yes your job is it stake or there is something lacking in your care.. usually pressure ulcer occur at home

I have certainly seen stg 3 (and worse) ulcers on debilitated patients in the hospital...where the wound started in the hospital.

Any patient with mobility problems, circulation problems, nutritional problems, etc are at great risk for skin breakdown. Do not be fooled into thinking that we can prevent all pressure ulcers...even in the hospital...we cannot. People who are dying often develop pressure wounds...regardless of where they are being cared for. And if they have a wound when they begin to die the wound will not heal and will very likely advance as the patient continues to decline.

Most of the time, in my experience, these are patients who are severely impaired cognitively and have been receiving intensive care...think people in the ICUs who are intubated or trached with with very poor prognosis and families (or physicians) who are in denial.

It is important, when a patient is admitted into your nursing unit, to carefully document any skin integrity problems present at that time. This comprehensive assessment saves you from being tagged for the development of a serious pressure wound "on your watch" when the wound was present at time of admission.

that is very useful information!! i will try my best!!

I just took care of a 65 year old man with a stage 4 pressure ulcer above one of his buttocks. He had COPD and refused to get out of bed. Instead, he barked orders at us for pain and anxiety meds. He was perfectly capable of moving around but wouldn't!!!!

We have a lot of obese patients on the floor that are very hard to turn and very hard to keep repositioning. Many of them cry (especially the older ones) when you try to turn them because they are in so much pain. Trying to turn them on their sides just access their sacrums is a nightmare!!

don't forget that skin breakdown can occur in MINUTES, not hours, on some patients.

Also, be sure to look at labs and nutrition. A lack of protein, dehydration, total iron binding capacity, INR, and other things can affect healing.

Speaking from a LTC perspective..pressure ulcers can go from a simple red area to an open area in MINUTES in some of our more compromised patients.

We turn and position our patients at least every 2 hrs, we try really hard for every 1 hr but that isn't always do-able. And we do treat the red areas accordingly with the special creams, protective ointments, paddings, etc. But most of our simple red areas on some pts will go to a 2-3 stage simply because of non-compliance with being positioned. Its such a sad thing, we KNOW we can stop the area from getting worse simply by keeping the resident off the area, but they are insistant they want to sit or lay a certain way. and due to patient rights, we cannot force them to be in the position WE want them to be.

I had one resident..obese, diabetic, heart issues..you name it she had it. Started with a simple little blister from her constantly rubbing her foot/heel back and forth. That blister went to a stage 3 in the blink of an eye. All because she would not stop rubbing her foot, we could not restrain that foot, she would not allow nor stay in a position that would deter her from rubbing the foot/heel on a surface. I was begining to believe that the foot would never heel, but finally she started allowing to be positioned so that the foot was protected..and slllooowwwwlllly that foot healed.

Nurses and othe care givers do see when/where the pressure area starts, most times its the residents medical diagnosis and/or non-compliance with care that cause the red area to develop very quickly to a stageable ulcer..its a vicious circle.

I manage a M/S unit and we have not had a unit acquired pressure ulcer in over 18 months. Go to ANCC Pressure Ulcer Training here on the internet and you will not only learn all about staging and prevention you will earn continuing education credit. The trick to pressure ulcers is PREVENTION and education to the patient/family and the staff.