Pressure Ulcers in Bedridden Patients

The focus population is the bedridden patients in the emergency room. Bedridden patients spend most of their time in bed and deal with various issues brought on by inactivity; as a result of inactivity, the recovery process is prolonged (Cardoso et al., 2022). Pressure ulcers are common problems that bedridden patients face. These are complicated chronic wounds that cause tissue injury. The significant characteristics of bedridden patients with these wounds are mostly elderly, poor care dependency, impairment caused by immobility, risk of having skin conditions, and time of the applied pressure (Mamom & Daovisan, 2022). The pressure ulcer problem facing bedridden patients, supported by evidence-based articles, is discussed below.

First, according to research, the most fundamental way of pressure ulcer prevention is by manually changing the patient’s position regularly. In previous studies, medical mattresses were developed to prevent pressure ulcers, including electric and non-electric powered, constant, and alternating pressure devices, rotating beds, limb protectors, and cushions (Mamom & Daovisan, 2022). However, no medical mattresses were found to be effective in preventing pressure ulcers for bedridden patients. Nevertheless, the positioning change of the pressure-relieving support surface efficiently prevented pressure ulcer development. Medical professionals recommend that patients turn in intervals of two to six hours. Constant turning of patients has been found to reduce the risk of developing pressure ulcers (Mamom & Daovisan, 2022).

Clinical guidelines recommend that healthcare professionals use prepositioning angles of 0^o to 45^o. However, the most effective angle still needs to be clarified. The study aimed to create a side-lying lateral position for bedridden patients to help prevent pressure ulcers. It was found that patient repositioning at 30^o reduced the contact pressure between the surface of the support and the patient. These findings show that 30^o is the optimal angle to help prevent bed sores (Mamom & Daovisan, 2022).

Additionally, the malnutrition state of patients has been associated with the development of pressure ulcers. Malnutrition is a nutrition state that can be subacute or acute, in which a number of degrees of over- or undernutrition and inflammation process result in an alteration of body function and composition (Munoz et al., 2020). In previous research, nutritional supplements were not confirmed to prevent the risk of developing pressure ulcers. However, nutritional deficiency has been associated with increasing the occurrence of pressure ulcers. Nutrition plays an important function in promoting skin integrity and tissue repair support in case of pressure injuries. Bedridden patients are at risk of developing pressure ulcers; they must meet all nutrition requirements (Munoz et al., 2020).

According to research, 76% of 2,425 patients who participated in the study were malnourished. Both undernutrition and overnutrition have been associated with pressure injuries. Undernutrition is the decreased intake of proteins, vitamins, calories, and minerals. As a result, undesired and unplanned weight loss, dehydration, calorie-protein malnutrition, decreased Basal Metabolic Rate (BMI), and decreased muscle mass develops. These symptoms are also linked to pressure injuries (Munoz et al., 2020).

On the other hand, overnutrition is a type of malnutrition where the quantity of nutrients taken surpasses the quantity needed to facilitate growth, metabolism, and development. In obese individuals, common conditions are present, including skin infection, pressure sores, venous ulcers, and dehiscence (Munoz et al., 2020). These comorbidities are a result of ischemia and hypoperfusion in subcutaneous adipose tissue. In addition, hypervascularity leads to the development of pressure injuries in obese patients. Furthermore, decreased movement and difficulty in self-positioning put obese patients at a greater risk of developing pressure ulcers. Skin folds in obese patients attract microorganisms contributing to tissue and infectious injury. Implementing evidence-based nutrition to bedridden patients who present with malnutrition is crucial, for they are at a greater risk of developing pressure injuries (Munoz et al., 2020).

Lastly, there have been queries on the most effective way to prevent pressure ulcers. Preventing pressure ulcers in bedridden patients is more important than treating the wound (Gaspar et al., 2019). A study investigated various ways of preventing pressure ulcers to determine the most appropriate by using the array of incidences. According to the study, several techniques can be used to prevent pressure ulcers. First, support surfaces were found to be effective in reducing pressure ulcers. Educating healthcare staff on how to conduct pressure ulcer prevention has been proven to help reduce the incidence of pressure ulcers. Multiple intervention initiatives have been helpful because they have a positive and better patient outcome than individual interventions (Gaspar et al., 2019).

Risk-assessment tools have helped identify if there is a risk of developing pressure ulcers and which risk factors can lead to pressure ulceration. As stated earlier, early mobilization and repositioning to reduce the duration and amount of pressure over susceptible body areas, such as bone prominences, is also an effective way to prevent pressure ulcers (Gaspar et al., 2019). A reminder system has helped fill the gap between the recommended practice and day-to-day repetitive care. Skin integrity maintenance using silicone-based dermal creams has also been associated with decreased pressure sores occurrence. Lastly, prophylactic dressings have been found to add benefits in preventing pressure ulcers. These dressings help redistribute the weight and protect the skin from friction and shear forces (Gaspar et al., 2019). Conclusively, emergency room bedridden patients are highly susceptible to pressure ulcers, making them vulnerable to severe complications. Evidence-based measures are important in managing and preventing pressure ulcers effectively. Various interventions to prevent pressure ulcers are discussed above in support of scholarly sources.

References

Cardoso, R., Parola, V., Neves, H., Bernardes, R. A., Duque, F. M., Mendes, C. A., Pimentel, M., Caetano, P., Petronilho, F., Albuquerque, C., Sousa, L. B., Malça, C., Durães, R., Xavier, W., Parreira, P., Apóstolo, J., & Cruz, A. (2022). Physical Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review. International Journal of Environmental Research and Public Health, 19(11), 6420. https://doi.org/10.3390/ijerph19116420

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcer prevention: a systematic review. International Wound Journal, 16(5), 1087–1102. https://doi.org/10.1111/iwj.13147

Mamom, J., & Daovisan, H. (2022). Repositioning mattress: how a lateral tilt position reshapes the prevention of pressure ulcers in bedridden patients. Journal of Medical Engineering & Technology, 46(8), 1–12. https://doi.org/10.1080/03091902.2022.2094007

Munoz, N., Posthauer, M. E., Cereda, E., Schols, J. M. G. A., & Haesler, E. (2020). The Role of Nutrition for Pressure Injury Prevention and Healing. Advances in Skin & Wound Care, 33(3), 123–136. https://doi.org/10.1097/

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Question

Identify a problem or concern from your selected population. Write a 1-3 page description of your problem and support the need to address this in your population with 3 evidence-based articles. Include the title and reference page.