Concepts[ edit ] In many cases, terms such as disease, disorder, morbidity, sickness and illness are used interchangeably. Disease The term disease broadly refers to any condition that impairs the normal functioning of the body.
Author Information Courtney H. Preventing pressure ulcers has been a nursing concern for many years. Although the prevention of pressure ulcers is a multidisciplinary responsibility, nurses play a major role. Inthe U. Although the AHRQ document was published 15 years ago, it still serves as the foundation for providing preventive pressure ulcer care and a model for other pressure ulcer guidelines developed afterward.
Nurses are encouraged to review these comprehensive guidelines. The document identifies specific processes e. Research also suggests that when the health care providers are functioning as a team, the incidence rates of pressure ulcers can decrease. Incidence, Mortality, and Costs The incidence rates of pressure ulcers vary greatly with the health care settings.
For patients in the hospital, they can occur within the first 2 weeks. Several studies noted mortality rates as high as 60 percent for older persons with pressure ulcers within 1 year of hospital discharge.
Thus, the development of pressure ulcers can be a predictor of mortality. Studies further suggested that the development of skin breakdown postsurgery can lead elders to have major functional impairment post surgical procedure. It has been estimated that the cost of treating pressure ulcers is 2.
Etiology Pressure ulcers develop when capillaries supplying the skin and subcutaneous tissues are compressed enough to impede perfusion, leading ultimately to tissue necrosis. Sincewe have understood that normal blood pressure within capillaries ranges from 20 to 40mm Hg; 32mm Hg is considered the average.
However, capillary blood pressure may be less than 32 mm Hg in critically ill patients due to hemodynamic instability and comorbid conditions; thus, even lower applied pressures may be sufficient to induce ulceration in this group of patients.
Pressure ulcers can develop within 2 to 6 hours. Risk Factors More than risk factors of pressure ulcers have been identified in the literature. Some physiological intrinsic and nonphysiological extrinsic risk factors that may place adults at risk for pressure ulcer development include diabetes mellitus, peripheral vascular disease, cerebral vascular accident, sepsis, and hypotension.
Microcirculation is controlled in part by sympathetic vasoconstrictor impulses from the brain and secretions from localized endothelial cells. Since neural and endothelial control of blood flow is impaired during an illness state, the patient may be more susceptible to ischemic organ damage e.
The few studies that have included sufficient numbers of black people for analysis purposes have found that blacks suffer more severe pressure ulcers than nonblacks.
Due to the number of risk factors identified in the literature, nurses have found the use of risk assessment tools helpful adjuncts to aid in the identification of patients who may be at high risk.
Most health care institutions that use pressure ulcer risk assessment tools use either the Braden Scale or Norton Scale, with the Braden scale being the most widely used in the United States.
The Braden Scale is designed for use with adults and consists of 6 subscales: The scores on this scale range from 6 high risk to 23 low riskwith 18 being the cut score for onset of pressure ulcer risk.
Research has shown that hospital nurses could accurately determine pressure ulcer risk The Braden Scale and Norton Scale have been shown to have good sensitivity 83 percent to percent, and 73 percent to 92 percent, respectively and specificity 64 percent to 77 percent, and 61 percent to 94 percent, respectivelybut have poor positive predictive value around 40 percent and 20 percent, respectively.Also, race, age and family history play a role in your risk for ocular hypertension and glaucoma.
Though anyone can develop high eye pressure, African-Americans, people over age 40, and people with a family history of ocular hypertension or glaucoma are at greater risk. One study examined the efficacy of an intensive pressure ulcer prevention protocol to decrease the incidence of ulcers in a bed long-term care facility.
50 The pressure ulcer prevention protocol consisted of preventive interventions stratified on risk level, with implementation of support surfaces and turning/repositioning residents. The. What is already known about the topic? • Internationally, primary care is delivered by teams of physicians and healthcare professionals.
• Significant differences regarding education, tasks, remuneration and terminology of health professionals in primary care can be observed internationally.
Introduction. The NHS National Institute of Clinical Excellence (NICE) has recently published its clinical guidelines on "Pressure ulcer risk assessment and prevention".Launched throughout the UK in April , these long awaited recommendations have been heralded as "an important tool in the quest to promote evidence based practice".But what are they and how will they influence the provision.
Senate Passes Opioid Package, Final Vote Expected Soon; Innovation Spotlight—Unity Hospital is Championing Healthy Lifestyles of Local Moms and Their Children. Translating pressure ulcer prevention (PUP) evidence-based recommendations into practice remains challenging for a variety of reasons, including the perceived quality, validity, and usability of the research or the guideline itself.