Pressure ulcers

AuntieRN · Oct 21, 2006

They get them from not being repositioned enough, sitting in urine and feces...it does not take long for a pressure ulcer to start and once it does it takes a lot of care and time to heal if it ever heals.

bethg5 · Oct 21, 2006

Also people that cannot afford full-time home care or those who take care of themselves are prone to ulcers. My mom who is 52 has very fragile skin. She is constantly getting skin tears. I recently called her to give her some information on how to care for them and I asked her how some of them are looking. She said one is over 3 weeks old and won't heal. I told her she needed to get it looked at because it could be infected and she said "oh I'm guessing it already is". So even though this isn't a pressure ulcer it informs one that lots of people don't seek care for skin problems. This summer when I visited her I was shocked at how many skin tears she has and she has yet to see a skin care specialist. Our instructor said as bad as they look, people tend to loose the sensation in the area that is infected, so people tend to just ignore them,especially when they are home bound.

suzy253, RN · Oct 21, 2006

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!

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.

Kelly_the_Great · Oct 21, 2006

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 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

Jules A, MSN · Oct 21, 2006

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

I agree, certiainly there can be a component of poor care involved but bedridden patients are nearly impossible to keep free from skin issues, imvho. Look at Christopher Reeves, he certainly had the best care money could buy and he had pressure sores. FWIW when I was on the SCI unit they taught us that repositioning needed to be done q20 minutes!

Kelly_the_Great · Oct 21, 2006

fwiw when i was on the sci unit they taught us that repositioning needed to be done q20 minutes!

wow!!!!!!!

Daytonite, BSN, RN · Oct 21, 2006

poor circulation, as in a petered out cardiovascular system, and dehydration contribute to the underlying cause of many ulcers which can be due to pressure or continued irritation of some sort. let's face it, when people get old, their body systems start to wear out. there are a lot of factors that go into the formation and healing of ulcers. the long term care facilities have gotten very good at learning about and dealing with this problem. nutrition is a big factor. in many ltcs i worked a person with even the smallest bit of skin breakdown was placed on supplemental vitamins and a high protein diet immediately and their hydration status watched like a hawk. if a patient has an underlying disease such as diabetes, their circulation is already compromised as well as their ability to heal and no amount of turning is going to be the complete reason the ulcer gets healed.

here are some links on wound healing and wound care:

http://www2.ncn.com/~bln/skills/nur109/nur109_woundcare_index.htm - wound care. includes links to photos on wound staging, how wounds heal, types of dressings and when to use them and how to assess them + some links to more internet information

http://www.nursing.uiowa.edu/sites/chronicwound/ - chronic wound healing. a tutorial that includes definitions, descriptions of wounds, assessment, debridement, cleansing, maintaining a moist environment, supporting the wound surfaces and nutrition. has photographs to help show and explain concepts. by professor rita frantz at the university of iowa college of nursing. look especially at the section on nutrition.

http://www.worldwidewounds.com/ - world wide wounds. an online resource for dressing materials

and practical wound management information. has links at the bottom of the opening page to acute wounds, dressings and bandages, maggot therapy, miscellaneous, veterinary, diabetic feet, infected wounds, leg ulcers and pressure ulcers.

RGN1 · Oct 21, 2006

When I was a student nurse we had a lady on the medical care of the elderly ward who had cancer, I can't remember where. She would only sit up in bed virtually with her legs crossed because she said lying on her side was too painful. We had her on the most state of the art pressure relieveing bed at the time but despite everything her sacrum broke down. we tried soooooooooooooo hard to try and get her to change positions but she just wouldn't. she ended up with a pressure sore so deep that to clean it you literally had to reach right up inside with your hand beyond your wrist!!

I was really distressed to see this but at the same time it wasn't the nurses fault. In those days we had plenty of staff & things were done as they should be. It was just she wouldn't move! It was awful & 17 odd years later I still remember it vividly!

Altra, BSN, RN · Oct 22, 2006

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

:yeahthat: Sad but true ... alert & oriented individuals who are grossly overweight plus have vascular issues & diabetes (and it's rare when those 3 don't go together) will, sooner or later, have skin breakdown. You do what you can.

Marie_LPN, RN, LPN, RN · Oct 22, 2006

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.

BoonersmomRN · Oct 22, 2006

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.