In pressure ulcers

Preliminary Studies Show Drug-laden Bioelastic Disc to Prevent the Tissue Necrosis Resulting in Pressure Ulcer Formation... 

The Preventing Pressure Ulcers in Hospitals Toolkit assists hospital staff in implementing effective pressure ulcer prevention practices through an interdisciplinary approach to care. The toolkit draws on literature on best practices in pressure ulcer prevention and includes both validated and newly developed tools. 

A topical enzyme aids in the removal of dead soft tissues by hastening the reduction of proteins into simpler substances. This is called proteolysis or a proteolytic action. The components of certain types of wounds, namely necrotic (dead) tissues and purulent exudates (pus-containing fluid), prevent proper wound healing. Removal of this type of debris by application of a topical enzyme aids in healing. Examples of conditions that may respond to application of a topical enzyme include second- and third-degree bums, pressure ulcers, and ulcers caused by peripheral vascular disease An example of a topical enzyme is collagenase (Santyl). 

Lipsky BA, Berendt AR, Deery G, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004 39 885-910. Livesley NJ, Chow AW. Pressure ulcers in elderly individuals. Clin Infect Dis 2002 35 1390-1396. 

A pressure sore is also called a decubitus ulcer and bed sore. A classification system for pressure sores is presented in Table 47-5. Many factors are thought to predispose patients to the formation of pressure ulcers paralysis, paresis, immobilization, malnutrition, anemia, infection, and advanced age. Four factors thought to be most critical to their formation are pressure, shearing forces, friction, and moisture however, there is still debate as to the exact pathophysiology of pressure sore formation. The areas of highest pressure are generated over the bony prominences. 

Decreased mobility or immobility and incontinence are risk factors for the development of pressure ulcers. The use of appropriate barrier skin creams may protect against the development of pressure sores, especially in bedridden patients. 

Gl effects Use cautiously in peptic ulcer. Local irritation may occur centrally mediated Gl effects may occur with serum levels greater than 20 mcg/mL. Reduced lower esophageal pressure may cause reflux, aspiration, and worsening of airway obstruction. 

For debridement of necrotic tissue and liquefication of slough in acute and chronic lesions such as pressure ulcers, varicose, diabetic, and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles, and miscellaneous traumatic or infected wounds. Also stimulates vascular bed activity to improve epithelization. 

Effects of histamine on blood pressure and heart rate in humans. Histamine was infused at 40 u g/kg/h for 5 minutes as shown at the top of the panel. (Modified and reproduced, with permission, from Torsoli A, Lucchelli PE, Brimblecombe RW [editors] H-Antagonists H2 Receptor Antagonists in Peptic Ulcer Disease and Progress in Histamine Research. Excerpta Medica, 1980.)... 

In the disillusionment phase, however, depression and hopelessness may become more prominent, as the reality of how life has changed postdisaster becomes ever more apparent. The enormous drain of reserves— physical, financial, and emotional—takes its toll. Adults may experience physical reactions such as headaches, increased blood pressure, ulcers, gastrointestinal problems, and sleep disorders. Emotional reactions may vacillate between emotional numbness and expressions of intense emotion. Anxiety and depression are common emotional reactions, as are anger and frustration— sometimes displaced onto relief workers when anger about the disaster seems less rational. The reconstruction phase gradually becomes more apparent as intense emotions are replaced by a sense of acceptance, increasing independence, and emotional reinvestment in relationships and activities of daily life. 

Film dressings are used in the treatment of a wide range of conditions, including pressure ulcers, burns, abrasions, and donor sites. In a dermabrasion, hemostasis must first be obtained and the margin of the wound dried before the film is applied. In its application for the treatment of burns, careful disinfection must precede the positioning of the film and it is only recommended for application to superficial and clinically clean burns. The use of films is contraindicated for deep burns as they retard the separation of necrotic tissue. 

Hydrocolloids are suitable for desloughing and for light to medium exuding wounds—but are contraindicated if an anaerobic infection is present. They have been used successfully in the treatment of chronic leg ulcers, pressure ulcers, minor burns, granulating wounds, and wounds exhibiting slough or necrotic tissue or wounds with moderate exudate, as well as skin barriers in the management of stoma. 

Used in men with urge, stress, and overflow incontinence and in those with functional impairments Used for overflow incontinence also used in patients who are bed-bound or with significant mobility impairments and severe incontinence, those with terminal illness, and those with sacral pressure ulcers until healing occurs... 

The ganglionic blocking agents are usually used in hypertension, peripheral vascular disease, vasopastic disorders—thereby lowering the blood pressure and increasing the peripheral blood flow. Occasionally these agents are also employed for their interruption of parasympathetic nervous outflow, as is observed in peptic ulcer and intestinal hypermotility. 

In an attempt to reverse the anemia of chronic disease, several patients in the Spinal Cord Injury rehabilitation unit at Parkwood Hospital, St. Joseph s Health Care, London, Canada, were treated with subcutaneous erythropoietin. A retrospective chart audit was conducted to review the effectiveness of 6 weeks of subcutaneous erythropoietin 75IU/kg subcutaneously 3 times weekly in resolving refractory anemia of chronic disease and healing stage IV pressure ulcers [18]. The mean age of the patients was 59, and all had a stage IV pressure ulcer. 

Human recombinant erythropoietin shows promise in resolving the refractory anemia of chronic disease associated with stage IV pressure ulcers, and further study is suggested. The results may also suggest that rHuEPO acts as a growth factor either alone or in conjunction with intrinsic factors in the wound. Studies of its role at the molecular level are indicated. Further studies of the neurotrophic and neuroprotective properties observed in rat models hold promise in the area of spinal cord injury research. 

The elderly client with a fracmred hip in Buck s traction has a stage I pressure ulcer on the lateral ankle over the bony prominence. Which action should the nurse implement ... 

The nurse is applying a DermaDress dressing to a client with a Stage 2 pressure ulcer on the coccyx. Which interventions should the nurse implement Rank in the order of performance. 

Tape should be used to hold the secondary dressing in place or the antimicrobial binding dressing will not remain in the pressure ulcer. 

The nurse does not place clients with Stage 1 pressure ulcers in the prone position (on the stomach). The nurse would turn the client from side to side. 

Biglari, B., Von der Linden, P.H., Simon, A., Aytac, S., Gemer, H.J., Moghaddam, A., 2012. Use of Medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury. Spinal Cord 50 (2), 165—169. 

---