Free Essay: Prevention and Management of Pressure Ulcers

Prevention and management of ulcers encompass a thorough assessment to determine individuals who are at risk of getting sores like the elderly, the immobile persons, and the ones with a spinal injury. Past studies show that assessments are conducted by pressure parts risk scores like the Braden, and Water low scales to forecast the risk of pressure ulcers (Tran, McLaughlin, Li, Phillips, 2016). After assessments, relevant strategies are put in place to prevent the risk. Past research suggests that potential management choices include silicone dressings, debridement, physical therapy, and antimicrobials (Moore & Webster, 2018). Positioning, repositioning, and support materials are also used. The objective of this study was to establish the prevention and management strategies of pressure ulcers. This paper focuses on summarizing five evidence-based research studies on the prevention and management of pressure ulcers in a reference matrix and creating the literature synthesis.

Database Search and Keywords

In searching the data in the databases, there was first the identification of the keywords and then formatting the words to be used. After formatting, the search was carried out with the application of filters and limits in the specific databases to refine the search. The search results were then reviewed. The databases used include CINAHL, PubMed, and Cochrane Library.

The keywords included pressure ulcers, incidence, management, prevention, wound care, and bedsores. Pressure ulcers are injuries caused on the skin due to prolonged pressure. They mostly develop on the bony areas such as the hips, ankles, and tail bones (Tran, McLaughlin, Li, Phillips, 2016). The search of the keyword led to relevant results that were related to the condition. Incidence refers to the measure of the probability of the occurrence of the condition within a given number of people. The search showed the rate of new cases of the condition and the people at risk. It also led to prevention strategies.

To further filter the search results, the "management" word was used. Management refers to the strategies of treating the condition. It led to relevant results on how to treat and handle the condition in patients. Prevention means the strategies of protecting a population from pressure ulcers. Wound care refers to the various ways of treating an injury ranging from assessment to treatment. Bedsores are similar to pressure ulcers but were used to ensure relevant results from the condition were found (Moore & Webster, 2018). The keywords led to relevant and accurate results of the research topics. It also limited the number of results as the results from searching pressure ulcers were many.

Challenges in the Search

Some keywords, to some point, led to a shallow search. When the keyword was typed in the search database, the results that came up were not relevant as they were only related to the specific keyword. There was, therefore, a need to type in more words related to pressure ulcers. The synonyms could not show up after the entry of the keywords, thus leading to missing out on some relevant information. Pressure ulcers condition has other synonyms which led to an omission of other sources that would have resulted in more accurate sources. Filtering the relevant data was also a challenge as the entry of the keywords led to the display of a lot of studies that were irrelevant to the study.

Reference Matrix
This section will organize the information from the searches for several studies in a matrix format.
Author/ Authors Problem Statements Method/ Design of the Study Findings Analysis of Findings Categories/ Themes

(Tran, McLaughlin, Li, Phillips, 2016). To evaluate the innovations of the prevention of pressure ulcers. Meta-analysis of studies 353 articles.

• 1. 70% suggested the use of risk assessment scales for risk identification.
• 2. 80 % suggested the use of alternative support surfaces than mattresses
• 3. 65 % showed the use of effective repositioning
• 4. 80% suggested making the patient active to prevent the condition.

• 1. Using risk assessment scales
• 2. Use of alternative support surfaces
• 3. Effectively repositioning the patient.
• 4. Patient participation
  
  1. Risk assessment scales
• 2. Patient participation
• 3. Support surfaces
• 4. Patient repositioning

(Moore & Webster, 2018). To evaluate the effect of dressings and topical agents on pressure ulcer prevention on people at risk. Systematic reviews. Selection criteria - Randomized controlled trials Participants-3629

• 1. Pressure ulcers incidences were lower with fatty acids than the used control compounds.
• 2. Silicone dressings reduced the rate of occurrence of pressure ulcers.
• 3. Other dressings reported no difference in prevention.

• 1. Foam and Silicone dressings and creams reduce the risk of developing pressure ulcers.
• 2. Products with fatty acids prevent the ulcers

Use of silicone and foam dressings and fatty acid products. Tayyib & Coyer, 2016) To best evidence regarding the prevention strategies of hospital-acquired pressure ulcers. A meta-analysis of randomized control trials. Comparative reviews in 25 studies

• 1.95 % of the studies showed a significant effect of silicone foam dressing.
• 2. 60% showed the effectiveness of nutrition
• 3. 70 % showed the effectiveness of positioning and repositioning the schedule
• 4. 30 % showed education to patients.

• 1. Silicone foam dressing has the most positive outcome.
• 2. Nutrition is also effective.
• 3. Positioning and repositioning the patient is effective.

• 1. Silicone foam dressing
• 2. Nutrition
• 3. Repositioning and positioning schedule.

(McInnes et al., 2016) To establish whether the pressure-relieving support surfaces reduce the risk of pressure ulcers A meta-analysis of 59 randomized control trials.

• 1. 95 % showed that foam mattresses reduce the incidence in patients at risk.
• 2. 60 % of those who used standard mattresses developed the condition.
• 3. 30 % showed that medical sheepskins helped in preventing.

• 1. People at risk should use higher specification foam mattresses compared to standard mattresses.
• 2. Medication-grade sheepskins reduce the risk.

• 1. Use of higher specification foam mattresses.
• 2. Use of medicated sheepskins

(Norman et al., 2016)

Effects of antibiotics and antiseptics on infected and uninfected ulcers A meta-analysis of studies from randomized control trials. Systematic reviews.12 trials with 576 participants.

• 1. 50% of the trials reported positive outcomes from the use of antimicrobial agents.
• 2.Controls with no antimicrobial agents reported no improvement
• 3. 90% reported healing from antiseptic agents.

• 1. Antibiotics are effective in healing ulcers.
• 2. Antiseptics result in a positive outcome in pressure ulcer patients.

• 1. The use of antibiotics
• 2. The use of antiseptics.

Conclusion One

The five references address the prevention and management strategies of pressure ulcers. The studies that involve prevention strategies suggest that assessment is important in identifying the individuals at risk of the condition. Those at risk include the elderly, immobile people, and those with the spinal cord injury. The studies suggest that pressure scales such as the water-low scales and the Braden scale help in predicting the risk (Tran, McLaughlin, Li, Phillips, 2016). When individuals are assessed, the prevention strategies, such as patient mobility, physical therapy, the use of support surfaces and patient positioning, and repositioning are applied. There is consistency in the sources in the approach to pressure ulcers prevention strategies.

Conclusion Two

All the studies regarding the management of pressure ulcers suggest the use of various treatment options with evidence to support the claims. From the sources, the treatment options include mobilizing the patients, positioning and repositioning the patient. There is also evidence about the use of support surfaces in combination with other wound management methods (McInnes et al., 2016). There is also proven used of silicone foam dressings and products with fatty acids (Moore & Webster, 2018). Moreover, the studies indicate the use of higher specification mattresses and medicated sheepskins.

Conclusion Three

There is a need for proper assessment of patients in intensive care units. The elderly and those who are immobile should also be regularly assessed as they are at risk of developing bedsores. In addition to the other management options, medical practitioners should use antibiotics to manage the condition. Evidence also shows the effectiveness of antiseptics in treating pressure ulcers (Norman et al., 2016). Furthermore, nutrition is important in managing pressure ulcers. However, the studies show that the nutrition strategy should be used alongside the wound treatment options to ensure that the wound heals.

Conclusion

The prevention and management of pressure ulcers require an assessment to determine those at risk. The injuries are also assessed to determine the treatment management options for different people. There are various deterrence and management options. In managing the condition, medical practitioners should use antibiotics, antiseptics, and support surfaces, and make sure they mobilize the patient. They should also position and reposition the patients and those at risk to prevent pressure from being exerted in the body tissues. However, there is a need for guidance and validation of the approaches used in the treatment and management of pressure ulcers to ensure that the best evidence supports the strategies adopted

References

McInnes, E., Jammali-Blasi, A., & Bell-Syer, S. E. M, Dumville, JC, Middleton, V., & Cullum, N.(2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, 9. Retrieved from doi: 10.1002/14651858.CD001735.pub5.

Moore, Z. E. & Webster, J. (2018). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, (12). Retrieved from https://doi.org/10.1002/14651858.CD009362.pub3

Norman, G., Dumville, J. C., Moore, Z. E., Tanner, J., Christie, J., & Goto, S. (2016). Antibiotics and antiseptics for pressure ulcers. Cochrane Database of Systematic Reviews, (4). Retrieved from doi: 10.1002/14651858.CD011586.pub2

Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: a systematic review. Worldviews on EvidenceBased Nursing, 13(6), 432-444. Retrieved from doi: 10.1111/wvn.12177

Tran, J. P., McLaughlin, J. M., Li, R. T., & Phillips, L. G. (2016). Prevention of pressure ulcers in the acute care setting: innovations and technologies. Plastic and reconstructive surgery, 138(3S), 232S-240S. Retrieved from doi: 10.1097/PRS.0000000000002644