Question

Mabel is a 76-year-old female in a skilled nursing facility who receives 12 medications per day, is continent, and has had a recent significant weight loss. Long-term care residents with limited mobility, polypharmacy (more than 8 medications), and bowel and bladder incontinence have increased risk for developing pressure ulcers. An accurate medical history is vital to understanding the physiology of wound healing. The diagnosis and medical history help the assessor determine a realistic wound goal: to heal it, keep it from progressing when healing is not an option, or expect it to worsen. A review of the physician-completed history/physical or the nursing assessment can point to risk factors that can interfere with wound healing. Examples include information related to tissue oxygen perfusion, edema, bacterial bioburden, central circulatory dysfunction such as congestive heart failure, chronic obstructive pulmonary disease, and chronic illness, including diabetes, renal insufficiency, and malignancy. The presence of inflammatory or autoimmune disorders also adversely affects wound healing.

1. What are some risk factors associated with developing pressure ulcers? Name at least five.
2. What nutrition recommendations would you provide in the prevention and treatment of pressure ulcers?
3. What are some non-nutrition recommendations you would provide in the prevention and treatment of pressure ulcers? Name three.

Answer 1

Answer 1

The following risks factors for pressure ulcer (Bed Sores)

•Poor mobility or immobility: Patients who are bedridden and are not able to independently change position while lying on bed are more risk prone to develop pressure ulcers, it is due to pressure exerted over bony prominences of the dependent psrt which results in reduced blood flow to the tissues & subsequent hypoxia leads to tissue death and ulcers.

•Compromised blood flow: Whenever there is reduced flow of blood to the tissues there is increased risk of pressure ulcer development. Some common reasons of reduction in blood flow are

i) peripheral arterial disease (PAD)

ii) venous insufficiency

iii) shock etc

•Neuropathy or compromised sensation: Clearly if a person cannot feel pain or pressure, he/she is at higher risk of developing a pressure ulcer. Patients who are most prone that fall into this category are:-

i) patients with spinal cord damage

ii) stroke

iii) neuropathy

iv)other conditions that compromise one’s ability to perceive pain and/or pressure.

Pain: Pain might restrict patients from moving freely, though they are feeling the unpleasant effect due to pressure. Heavy pain medication may sedate the patients to a point where they don’t change positions while lying as often as they should have been .

Age: During the old age, patients are at higher risk of developing pressure ulcers it is due to the inability of the patient to move/change position independently. It can also occur in very young infants as they are unable to change position by themselves, elderly may be similarly unable to change position while lying on bed due to other health problems which are limiting their movements.

Answer 2

Deficiency of micro and macro nutrients in body may delay the wound healing.Nutrients that plays the important role in wound healing are protein, vitamin C and zinc . Early identification of wound in patients is very crucial for the prevention and treatment of pressure sore.

It is necessary to provide adequate and balanced diet to meet the patients nutritional requirements & thus prevent depletion and exhaustion of fats and protein stores

Hyperglycaemia with sepsis & poorly controlled blood sugars is main reason for increase in incidence of infection, this leads to delayed wound healing . Monitoring glucose levels and taking measures to treat hyperglycaemia by dietary means along with medical intervention are essential for pressure ulcer management.

Answer 3

Non nutritional recommendation to prevent pressure ulcers are:-

•Constantly change the position of bed ridden patient through out the day during constant time interval, as lying in one position may lead to ischemic damage to the dependent tissues

• providing soft and comfortable bed/ Cushing material for bed ridden patient to further prevent tissue damage

• Dressing of pressure ulcer wounds on daily basis without use of skin invasive , disinfectants eg hydrogen peroxide etc