Question

National Patient Safety Goals Effective January 1, 2015

Goal 14

Prevent health care-associated pressure ulcers (decubitus ulcers)

Pressure ulcers are also called pressure ulcers or bedsores. Its classification ranged from reddening of the skin to the presence of cave-in injuries and muscle or bone injuries (stage IV) (1). Pressure ulcers are injuries caused by pressure, friction or shear, or by a combination of these 3 types of forces, which affect the skin and subsequent tissues. Although skin, fat, and muscle tissue can withstand significant pressures for short periods of time, prolonged exposure to a certain amount of pressure slightly greater than capillary compression pressure (32 mmHg) can cause skin necrosis and ulceration (2, 3 ). As little as two hours of uninterrupted depression can cause irreversible changes (2, 3).

Identify a bedside nursing scenario where this goal could prevent an error and/or pt injury (be specific).

Answer 1

A Pressure ulcer is an impairment of skin integrity.Apressure ulcer can occur in anwhere on the body;tissue damage results when the skin and underlying tissue are compressed between a bony prominence and an external surface for an extended period of time.

Risk factors

1)Skin pressure

2)Skin sheraing and frictioN

3)Immobility

4)Malnutrition

5)Incontinence

6)Decreased sensory perception

How to prevent?

Avoid direct massage to a reddened skin area because massage can damage the capillary beds and cause tissue necrosis.

1)Identtify clients at risk for developing a pressure ulcer.

2)Institute measures to prevent pressure ulcers such as appropriate positioning,using pressuer relief devices,ensuring adequate nutrition,and developing a plan for skin cleansing and care.

3)Perform frequent skin assessment and monitor for an alteration in skin integrity.

4)Keep the clients skin dry and sheets wrinkle free;If the client is incontinent,check the client frequently and change pads or any items placed under the client immediately after they are soiled.

5)Use creams and lotions to lubricate the skin a barrier protection ointment for the incontinent client.

6)Turn and reposition the immobile client evey two hours or more frequently if necessary;provide active and passive range of motion exercise at leat every eight hours.

7)If pressure ulcer is present,record the location and size of the wound(Length,Width,Depth) monitor and record the type and amount of exudates and assess for undermiining and tunneling.

8)Serosanguineous exudate(blood-tinged amber fluid)is expected for the first 48 hours;purilant exodates indicate colonization of the wound with bacteria.

9)Use agency protocols for skin assessement and management of a wound.

10)Treatment may include wound dressing and debridement

11)Other treatment may include electrical stimulation to the wound area

Vacuum assisted wound closure,hyper baric oxygen therapy,use of topical growth factors are included in the management of pressure ulcer.