Management of a Pressure Sore

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Case study; Management of a Pressure Sore

This essay analyses the assessment tools used and care given to a patient with a grade 2 pressure ulcer on the lower part of the sacrum, and at potential risk of further skin breakdown. The essay begins with an overview of what pressure ulcers are and the prevalence and incidence of pressure ulcers. The paper goes on to evaluate the assessment tools used and the care plan that was implemented for the patient , the essay then discusses the impact of the pressure ulcer on the patient and his wife and concludes with a reflection on the validity and reliability of the assessment tools used. The name of the patient has been changed to maintain confidentiality. Pressure ulcers also known as debucutis ulcers, are an area of localized injury to the skin and underlying tissue, they are caused when the affected area of skin is placed under too much pressure, shear or friction or a combination of these. (Wright et al 2007). When sustained pressure is placed on a particular part of the body the blood supply to that part of the body is interrupted. Blood contains oxygen and other nutrients that are essential to help keep tissue healthy and without a constant blood supply, tissue damage occurs and the tissue will eventually die. The lack of blood supply means that the skin no longer receives infection-fighting white blood cells resulting in the development of a pressure ulcer. Pressure ulcers can range in severity from areas of discoloured skin to open wounds that expose the underlying bone or muscle. Pressure ulcers are a serious problem in health care systems, they cause pain and suffering and can lead to infection, and if not prevented or managed effectively can result in fatality. (Nazarko 2005). The presence of a pressure ulcer creates a number of significant difficulties, psychologically, physically and clinically, to patients, carers and their families, they are a widespread and often under -estimated health problem in the UK. (RCN, 2005). Current research suggests that prevalence rates in the UK are between 5.1 percent and 32.1 percent across a range of care settings. It is estimated that approximately half a million people in the UK will develop a new pressure ulcer in any given year. This is usually people with an underlying health condition. The most consistently associated factors contributing to pressure ulcer development include inactivity, restricted mobility, sensory impairment, incontinence and nutritional status. (Russell 2000). The groups identified as most at risk of pressure ulcers include those who are seriously ill, neurologically compromised, have impaired mobility or who are immobile, those who suffer from impaired nutrition, obesity and older people. (NICE, 2005)

The financial cost to the NHS is considered to be substantial, recent financial estimates put the total cost of pressure ulcer care in the UK between 1999 and 2000 as £1.4 to 2.1 billion (Dougherty et al 2008).

The causes of pressure ulcers are split into two groups, intrinsic- that which is within the body and cannot be influenced and extrinsic- that which is external to the body and can be influenced. Intrinsic factors include; disease, medication. malnutrition, age, dehydration/fluid status, lack of mobility, incontinence, skin condition, weight. Extrinsic causes are; pressure, shearing forces, friction, moisture. (Waterlow, 2011)

Mr Elliot is a 77 year old man who has advanced stage Alzheimer’s disease and double incontinence. He has a grade 2 pressure ulcer on his sacrum. The ulcer is superficial and presents as a blister, with whitening of the skin, whereas before it was red. The area around the wound is red and irritated and the skin also appears cracked and broken (EPUAP 2009).

Informal and formal assessments were adopted to fully ascertain Mr Elliot’s level of risk of pressure ulcers. The assessments are also integral in planning care for management of his current pressure ulcer and any...
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