Pressure Ulcer Essay
Pressure ulcers are “ischemic wounds in the skin and underlying tissues caused by long-standing pressure force over an external bone or cartilaginous surface” (Guillén-Solà 2013). Pressure ulcers are a challenging part of the healthcare system due to prolong patient hospitalization and a reduction in the patient’s quality of life, since many patients that are in the hospital are there for either chronic conditions or intensive surgery, which may require an extensive and long term stay. Moreover, “95% of pressure ulcers are avoidable”, which suggests that pressure ulcers may be caused by “poor quality care assistance”, rather than only caused by a patient’s prolonged hospitalization (Guillén-Solà 2013). Pressure ulcers are not just a challenge
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to the health care profession, but they are also costly: “they represent about 5% of overall annual health expenses…stages I and II pressure ulcers have a combined prevalence of 65%” (Guillén-Solà 2013). According to mainstream clinical guidelines, stage II pressure ulcers are usually treated by applying either polyurethane or hydrocolloid dressings.
Hydrocolloid dressings “can provide moist wound healing in the case of pressure sores and can promote angiogenesis and fibrinolysis” (Hoffman 1996). The promotion of angiogenesis and fibrinolysis speeds up the healing of pressure ulcers, which allows for the patient’s quality of care to improve. There was a study into the performance of hydrocolloid dressings and hydrocolloid gel which found that the time between dressing changes was longer than with other treatment options, and the “combination was effective in debriding sloughy wounds and some patients thought the gel reduced their pain” (Hoffman 1996). Originally, hydrocolloid dressings were developed to function as part of the “stomal flange” in diabetic foot ulcers; however, because of the hydrocolloid dressing success in protecting patient’s skin, the dressings were introduced gradually into other areas of wound care. Hydrocolloid dressings contain “wafers of gel-forming polymers, such as gelatin, pectin, and cellulose agents, within a flexible water-resistant outer layer…the wafers absorb wound exudate, forming a gel and creating a moist healing
environment” (Hoffman 2016). There are many benefits of hydrocolloid dressings since they are “occlusive, retain wound exudate and promote a moist environment”, thus creating an environment that is optimal for wound healing (Hoffman 2016). The dressings also help to promote autolytic wound debridement by removing necrotic tissue, which can be a barrier to wound healing, from the wound bed; “wet or moist wound environments promote re-epithelialization, reduce inflammatory reactions, and decrease scar formation” (Hoffman 2016). Hydrocolloid dressings “aid wound healing by retaining growth factors in the exudate, promoting granulation tissue formation and epithelialization” (Hoffman 2016). In addition, hydrocolloid dressings promote a low pH, which reduces the chance of bacteria proliferating inside of the wound bed, but even though these dressings have many benefits, they are contraindicated for patients suffering from already infected ulcers. Another advantage of nurses using hydrocolloid dressings is that they are self-adherent and easy to apply: “they can be left intact up to 7 days, depending on the amount of wound exudate…the need for less frequent dressing changes can reduce disruption of healing, improve patient compliance, and decrease cost” (Hoffman 2016). Even though hydrocolloid dressings are significantly more expensive than traditional wound dressings, such as wet-to-dry gauze, they require fewer dressing changes, fewer supplies, and less professional time, so they are a lot more cost efficient than just the regular wet-to-dry dressings. Moreover, hydrocolloid dressings “cost about the same as advanced wound healing modalities, such as negative pressure wound therapy” (Hoffman 2016). A patient’s pain level and the quality of a patient’s wound care go hand in hand. Some health practitioners may give pain management a low priority when dealing with patients that have chronic wounds, this may be due to the healthcare provider’s preoccupation with treating the wound, lack of time, or even inexperience with how to properly deal with severe wounds. The physician’s inexperience may be due to many mistaken beliefs, such as believing that “pain is harmless and an unavoidable consequence of having a wound, that the patient is exaggerating the pain, or that if the patient does not complain that he or she is not in pain” (Hofman 2006). Additionally, health-care professionals with insufficient knowledge of the physiology of pain are going to be less likely able to address the problem at hand: “Education about the mechanisms of pain, the psychosocial and physical impact of pain on patients with wounds and how to assess and treat pain should be a mandatory part of the training for any clinician dealing with patients with chronic wounds” (Hofman 2016). The nurse or the physician that is handling a patient’s case with a chronic wound, such as a pressure ulcer, needs to identify the etiology of the pain that the patient is suffering from to efficiently and effectively deal with their problem. Likewise, patients with leg ulcers are frequently suffering from many other comorbidities, such as patients that have diabetes mellitus and an ulcer, may have an impact on their pain because there is so much more going on with them, which causes much more stress on their already injured body. The nurse must make a very detailed assessment of the patient’s medical and social history, as well as an in-depth assessment of the wound and the patient’s surrounding skin, is essential to identify the possible causes of the pain. The key to managing patients who suffer from painful wounds is to carefully create a detailed assessment of both their level of pain and the possible causes of their pain because the patient will not be able to fully heal if they are not somewhat comfortable, since they will be focusing on the pain rather than trying to get better. The nurse needs to have an understanding of administering the patient an appropriate analgesia for their pain, be knowledgeable of potential side-effects that may come from the administer pain medication, as well as being able to make an informed dressing choice, such as using a hydrocolloid dressing to speed up the healing process of the patient’s wound and to prevent the development of necrotic tissue inside of the wound bed. Nurses deal with pressure ulcers and deep wounds every day, which is why understanding which dressing and what pain medications to give to a patient to allow for their bodies to heal faster is vital knowledge that a nurse will need to know. Nurses do not want to cause undo harm to their patients or take advantage of their patients in any way, shape, or form, so by advocating for the patients that are under their care to have the best type of dressing for their wound is part of what good nursing is about: having a good understanding of these different factors enables health-care providers and nurses to plan more appropriate care and management for their patients.
to the health care profession, but they are also costly: “they represent about 5% of overall annual health expenses…stages I and II pressure ulcers have a combined prevalence of 65%” (Guillén-Solà 2013). According to mainstream clinical guidelines, stage II pressure ulcers are usually treated by applying either polyurethane or hydrocolloid dressings.
Hydrocolloid dressings “can provide moist wound healing in the case of pressure sores and can promote angiogenesis and fibrinolysis” (Hoffman 1996). The promotion of angiogenesis and fibrinolysis speeds up the healing of pressure ulcers, which allows for the patient’s quality of care to improve. There was a study into the performance of hydrocolloid dressings and hydrocolloid gel which found that the time between dressing changes was longer than with other treatment options, and the “combination was effective in debriding sloughy wounds and some patients thought the gel reduced their pain” (Hoffman 1996). Originally, hydrocolloid dressings were developed to function as part of the “stomal flange” in diabetic foot ulcers; however, because of the hydrocolloid dressing success in protecting patient’s skin, the dressings were introduced gradually into other areas of wound care. Hydrocolloid dressings contain “wafers of gel-forming polymers, such as gelatin, pectin, and cellulose agents, within a flexible water-resistant outer layer…the wafers absorb wound exudate, forming a gel and creating a moist healing
environment” (Hoffman 2016). There are many benefits of hydrocolloid dressings since they are “occlusive, retain wound exudate and promote a moist environment”, thus creating an environment that is optimal for wound healing (Hoffman 2016). The dressings also help to promote autolytic wound debridement by removing necrotic tissue, which can be a barrier to wound healing, from the wound bed; “wet or moist wound environments promote re-epithelialization, reduce inflammatory reactions, and decrease scar formation” (Hoffman 2016). Hydrocolloid dressings “aid wound healing by retaining growth factors in the exudate, promoting granulation tissue formation and epithelialization” (Hoffman 2016). In addition, hydrocolloid dressings promote a low pH, which reduces the chance of bacteria proliferating inside of the wound bed, but even though these dressings have many benefits, they are contraindicated for patients suffering from already infected ulcers. Another advantage of nurses using hydrocolloid dressings is that they are self-adherent and easy to apply: “they can be left intact up to 7 days, depending on the amount of wound exudate…the need for less frequent dressing changes can reduce disruption of healing, improve patient compliance, and decrease cost” (Hoffman 2016). Even though hydrocolloid dressings are significantly more expensive than traditional wound dressings, such as wet-to-dry gauze, they require fewer dressing changes, fewer supplies, and less professional time, so they are a lot more cost efficient than just the regular wet-to-dry dressings. Moreover, hydrocolloid dressings “cost about the same as advanced wound healing modalities, such as negative pressure wound therapy” (Hoffman 2016). A patient’s pain level and the quality of a patient’s wound care go hand in hand. Some health practitioners may give pain management a low priority when dealing with patients that have chronic wounds, this may be due to the healthcare provider’s preoccupation with treating the wound, lack of time, or even inexperience with how to properly deal with severe wounds. The physician’s inexperience may be due to many mistaken beliefs, such as believing that “pain is harmless and an unavoidable consequence of having a wound, that the patient is exaggerating the pain, or that if the patient does not complain that he or she is not in pain” (Hofman 2006). Additionally, health-care professionals with insufficient knowledge of the physiology of pain are going to be less likely able to address the problem at hand: “Education about the mechanisms of pain, the psychosocial and physical impact of pain on patients with wounds and how to assess and treat pain should be a mandatory part of the training for any clinician dealing with patients with chronic wounds” (Hofman 2016). The nurse or the physician that is handling a patient’s case with a chronic wound, such as a pressure ulcer, needs to identify the etiology of the pain that the patient is suffering from to efficiently and effectively deal with their problem. Likewise, patients with leg ulcers are frequently suffering from many other comorbidities, such as patients that have diabetes mellitus and an ulcer, may have an impact on their pain because there is so much more going on with them, which causes much more stress on their already injured body. The nurse must make a very detailed assessment of the patient’s medical and social history, as well as an in-depth assessment of the wound and the patient’s surrounding skin, is essential to identify the possible causes of the pain. The key to managing patients who suffer from painful wounds is to carefully create a detailed assessment of both their level of pain and the possible causes of their pain because the patient will not be able to fully heal if they are not somewhat comfortable, since they will be focusing on the pain rather than trying to get better. The nurse needs to have an understanding of administering the patient an appropriate analgesia for their pain, be knowledgeable of potential side-effects that may come from the administer pain medication, as well as being able to make an informed dressing choice, such as using a hydrocolloid dressing to speed up the healing process of the patient’s wound and to prevent the development of necrotic tissue inside of the wound bed. Nurses deal with pressure ulcers and deep wounds every day, which is why understanding which dressing and what pain medications to give to a patient to allow for their bodies to heal faster is vital knowledge that a nurse will need to know. Nurses do not want to cause undo harm to their patients or take advantage of their patients in any way, shape, or form, so by advocating for the patients that are under their care to have the best type of dressing for their wound is part of what good nursing is about: having a good understanding of these different factors enables health-care providers and nurses to plan more appropriate care and management for their patients.