Nursing Care for Bed Sore and Treatment

Nursing Care for Bed Sore Introduction

Pressure ulcers, also known as bedsores or decubitus ulcers, represent a significant health issue affecting a large number of individuals across various healthcare settings. These ulcers develop when prolonged pressure on the skin reduces blood flow to specific areas, leading to tissue damage and necrosis. This comprehensive overview delves into the etiology, health issues, prevention strategies, and treatment of pressure ulcers, highlighting the essential role of nursing care in managing and preventing these debilitating conditions.

Pressure Ulcers as a Health Issue

Pressure ulcers remain a pervasive health problem in healthcare systems worldwide. The prevalence of pressure ulcers varies considerably depending on the healthcare setting. It is estimated that approximately 1 million adults develop pressure ulcers annually. Incidence rates vary significantly: hospitals report rates ranging from 0.4% to 38%, skilled nursing facilities from 2.2% to 23.9%, and home health agencies from 0% to 17% (Cuddigan, Ayello, Sussman, & Baranoski, 2001).

The financial burden of treating pressure ulcers is substantial. The annual cost is estimated at $1.335 billion, with individual treatment costs ranging from $1,190 to $10,185 or more (Kerstein et al., 2001). This high cost underscores the importance of effective prevention and management strategies to reduce the incidence and severity of pressure ulcers.

Etiology of Pressure Ulcers

The development of pressure ulcers results from prolonged pressure that disrupts blood flow to the skin and underlying tissues. This pressure can cause capillary collapse, leading to tissue ischemia and necrosis. While the exact amount of pressure and duration required to cause tissue damage can vary, research indicates that capillary pressure in the range of 20 mm Hg to 40 mm Hg, with 32 mm Hg as an average, is sufficient to impair blood flow and initiate ulcer formation.

Several factors contribute to the development of pressure ulcers, including immobility, poor nutrition, moisture, and friction. For instance, individuals who are bedridden or use wheelchairs are at higher risk due to the constant pressure on specific body areas. Additionally, conditions such as diabetes and vascular diseases can exacerbate the risk by impairing blood circulation and wound healing.

Health Issues of Pressure Ulcers

Pressure ulcers pose significant health risks and complications. These include:

1. Infection: Pressure ulcers can become infected, leading to severe complications such as cellulitis, osteomyelitis, and sepsis. Infection increases the complexity of treatment and can significantly impact patient outcomes.
2. Pain and Discomfort: Pressure ulcers can be extremely painful, affecting the patient’s quality of life and overall well-being. Chronic pain from pressure ulcers can contribute to decreased mobility and further complications.
3. Functional Impairment: Severe pressure ulcers can result in functional impairments, making it challenging for individuals to perform daily activities. This can affect their independence and overall quality of life.
4. Psychological Impact: The presence of pressure ulcers can lead to psychological distress, including anxiety and depression. The chronic nature of these wounds and the associated pain and discomfort can significantly affect mental health.
5. Increased Healthcare Costs: The treatment of pressure ulcers involves substantial healthcare resources. The costs associated with wound care, antibiotics, and additional medical interventions add to the financial burden on both healthcare systems and patients.
6. Litigation and Quality of Care: The development of pressure ulcers is often considered a marker of inadequate care. Increased litigation related to pressure ulcers highlights the need for improved quality of care and effective prevention strategies.

Ulcer Preventive Nursing Care

Effective prevention of pressure ulcers is a critical aspect of nursing care. Key strategies include:

1. Risk Assessment: Identifying patients at high risk for pressure ulcer development is essential. Several tools are available to assess risk, including the Braden Scale and the Norton Scale. The Braden Scale, for example, assesses factors such as sensory perception, moisture, activity, mobility, nutrition, and friction/shear. This tool has good sensitivity (83%-100%) but lower positive predictive value (approximately 40%) (Bergstrom, Braden, Laguzza, & Holzman, 1987).
2. Repositioning: Regularly repositioning patients to relieve pressure on vulnerable areas is crucial. This includes repositioning every two hours for bedridden patients and every 15 minutes for those in wheelchairs.
3. Support Surfaces: The use of specialized support surfaces, such as pressure-relieving mattresses and cushions, can reduce the risk of pressure ulcers. These surfaces help distribute pressure more evenly and reduce the likelihood of tissue damage.
4. Skin Care: Maintaining skin integrity through proper hygiene and moisture management is essential. Keeping the skin clean and dry helps prevent moisture-related skin damage and ulcer development.
5. Nutrition: Adequate nutrition plays a vital role in skin health and wound healing. Ensuring that patients receive a balanced diet with sufficient protein, vitamins, and minerals supports overall skin integrity and reduces ulcer risk.
6. Education and Training: Providing education and training for healthcare staff and caregivers on pressure ulcer prevention and management enhances their ability to implement effective prevention strategies and care practices.

Pressure Measuring Tools

The effectiveness of pressure ulcer prediction tools varies across different populations. While tools like the Braden Scale and the Norton Scale are widely used, their validity in non-White populations has been questioned. For instance, studies have shown that the Braden Scale demonstrates good sensitivity (91%) and specificity (62%) in Chinese populations (Pang & Wong, 1998). However, there is a need for further research to validate these tools across diverse populations and ensure their accuracy in predicting pressure ulcer risk.

Nursing Guidelines for Pressure Ulcers

Guidelines for pressure ulcer prevention have been established to provide clinicians with evidence-based practices. The Agency for Health Care Policy and Research (now the Agency for Health Care Research and Quality) developed guidelines that include:

1. Risk Assessment: Conducting thorough risk assessments upon patient admission and regularly thereafter to identify those at risk for pressure ulcers.
2. Repositioning and Mobilization: Implementing strategies for regular repositioning and mobilization to alleviate pressure on vulnerable areas.
3. Use of Support Surfaces: Employing pressure-relieving mattresses and cushions to reduce pressure on at-risk areas.
4. Skin Care and Nutrition: Ensuring proper skin care and nutritional support to maintain skin integrity and promote healing.
5. Education and Training: Providing ongoing education and training for healthcare staff to enhance their knowledge and skills in pressure ulcer prevention and management.

Studies have shown that adhering to these guidelines can significantly reduce pressure ulcer incidence. For example, Gunningberg et al. (2001) found a reduction in pressure ulcer rates among patients with hip fractures by implementing systematic risk assessment, accurate staging, and the use of pressure-reducing mattresses.

Objective of Ulcer Treatment

The primary objectives of pressure ulcer treatment are to promote healing, alleviate pain, and prevent complications. Key components of effective treatment include:

1. Wound Assessment: Regularly assessing the pressure ulcer to determine its stage, size, and condition. This information guides the choice of appropriate treatment modalities.
2. Debridement: Removing necrotic tissue from the wound bed to facilitate healing and reduce the risk of infection. Methods of debridement include surgical, mechanical, enzymatic, and autolytic techniques.
3. Dressings: Utilizing appropriate dressings to maintain a moist wound environment, which promotes healing and reduces pain. Modern wound dressings, such as hydrocolloids, hydrogels, and foam dressings, are often preferred over traditional gauze due to their superior healing properties and reduced caregiver time (Bolton, van Rijswick, & Shaffer, 1997).
4. Pain Management: Addressing pain through pharmacological and non-pharmacological methods to improve patient comfort and quality of life.
5. Nutritional Support: Ensuring adequate nutritional intake to support wound healing and overall health. Nutritional interventions may include dietary modifications and supplementation.
6. Monitoring and Evaluation: Continuously monitoring the progress of wound healing and adjusting treatment plans as needed to achieve optimal outcomes.

Nurse researchers have contributed to the development of tools and protocols for pressure ulcer treatment. For example, the Pressure Sore Status Tool (PSST) was developed to objectively assess ulcer healing and has demonstrated good content validity and interrater reliability (Bates-Jensen, Vredevoe, & Brecht, 1992).

Conclusion

Pressure ulcers represent a significant health issue with substantial impacts on patients, healthcare systems, and costs. Effective management requires a multifaceted approach, including prevention strategies, accurate risk assessment, and appropriate treatment modalities. Nursing care plays a crucial role in addressing pressure ulcers through risk assessment, prevention, and treatment. Continued research and the development of evidence-based practices are essential to improving outcomes for individuals at risk of or affected by pressure ulcers. By focusing on these strategies and leveraging advances in nursing research, healthcare professionals can enhance the quality of care and reduce the burden of pressure ulcers on patients and the healthcare system.