Pressure Ulcer Management Reflection

Pressure Ulcer Management Reflection

Since the beginning of my project, pressure wound prevention interventions and evaluation, I have learned a lot of new things that I plan to use in the future during my practice. From my research, I have learned that pressure ulcers are caused by repeated and prolonged periods of shearing pressure and friction of the skin covering bony prominences. Apart from these extrinsic factors, intrinsic factors like decreased blood flow, decreased skin fragility, decreased muscle volume, spinal cord injuries, nutritional deficiencies, and moisture caused by urinary and fecal incontinence are associated with pressure ulcer development (Zaidi & Sharma, 2022). As part of my project, I learned that bedridden and elderly patients are the most prone to developing pressure ulcers. The buttock and hip region are the most vulnerable locations of the body where pressure ulcers develop. Notably, females are more vulnerable than men (Zaidi & Sharma, 2022).

While carrying out this project, I investigated the interventions nurses can employ to improve patient outcomes by preventing the emergence of pressure areas, interventions that they can employ, and assessment aspects that they can look at to see if the interventions are working. Pressure ulcer prevention helps in avoiding complications that can occur, especially stage III and IV ulcers. These complications include necrotizing fasciitis, septicemia, cellulitis, gas gangrene, and osteomyelitis (Zaidi & Sharma, 2022). Through this project, I learned that pressure ulcers can be prevented by doing manual positioning, giving sufficient nutrition, using support surfaces, and performing skin care.

Manual positioning is also referred to as mechanical loading and is one of the nursing interventions that can help prevent pressure wounds. I have learned that mechanical load reduction is key in pressure wound prevention, which involves turning and repositioning the patient in intervals (Al Aboud & Manna, 2022). At the project’s beginning, I was unaware of the standard degree, direction, and time interval that a patient should be turned and repositioned. However, when working on this project, I learned that the patient should be ideally turned in a lateral direction while the degree of prepositioning should not exceed 30o. It was fascinating to learn that a patient should be turned within 2 hours on a standard mattress but 6 hours on a viscoelastic foam mattress as it was new to me (Al Aboud & Manna, 2022).

Proper nutrition is the other intervention that nurses can use to prevent pressure ulcers. It was interesting to note that both forms of malnutrition, undernutrition and overnutrition, are risk factors for pressure ulcers. A point I took to heart is that supplementation can be used in nutrition deficiency, but over-supplementation in the absence of deficiencies is useless (Al Aboud & Manna, 2022). The last intervention that I came across was the use of support surfaces. Support surfaces help with the distribution of pressure and aim at getting the best pressure redistribution. I appreciated the different support surfaces and the respective types of patients that use the surfaces. Air, water, foam, and gel overlays are used for low-risk patients, while moderate to high-risk patients use low-air-loss mattresses. Those at high risk use electric and silicone-coated beads. I keenly noted that using any support surfaces still requires turning and repositioning (Al Aboud & Manna, 2022).

My project also focused on nursing evaluation criteria that would help nurses determine if the interventions are working. The evaluation criteria include monitoring pressure wound incidence rate, nutrition, and wound status (Al Aboud & Manna, 2022). It was helpful to learn about the specific characteristics that suggest that the interventions are working and those that show that they are not working. For instance, an increased number of wounds and patients with wounds shows that the interventions are not working, while a reduced number of wounds indicates interventions are working. Under wound status, I always thought of only assessing the wound’s size, color, and location. However, through the project, we also need to look at the exudate and pain (Al Aboud & Manna, 2022). Consequently, I strongly believe this project has adequately prepared me to prevent pressure ulcers in my future practice.

References

Al Aboud, A. M., & Manna, B. (2022). Wound Pressure Injury Management. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532897/#:~:text=Pressure%20ulcers%20are%20caused%20by

Zaidi, S. R. H., & Sharma, S. (2022, August 9). Pressure Ulcer. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553107/

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Reflection paper for this semesters QI proposal- Hospital acquired pressure wounds and how to prevent them.

Recall what you have learned from developing your QI proposal this quarter.
Reflect on what you learned from this evidence-based process that is new?
How can you use this in the future to promote better patient outcomes.