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Pressure Ulcers

  • Ronni ChernoffEmail author
  • Christine Bradway
Chapter

Abstract

Pressure ulcers are common in all healthcare settings and are associated with negative health outcomes as well as significant individual and system-wide financial consequences. Older adults, particularly those with urologic conditions such as urinary and fecal incontinence, are at high risk of developing pressure ulcers and should be the target of thoughtful and systematic risk assessment, prevention, and treatment strategies, including minimizing the causative risk factors described here and maximizing the environment for prevention or healing. The vast majority of ulcers (95 %) develop on the lower body area, the most common being in the pelvic area and lower leg. Multicomponent programs of care that include the patient and lay caregivers working collaboratively with an interprofessional team are essential to achieving positive outcomes. Target areas for prevention include a bed or chair surface that minimizes pressure, reducing exposure to risk factors, avoiding infection, and providing adequate nutrition to maintain tissue integrity and heal wounds.

Keywords

Fecal Incontinence Nursing Home Resident Pressure Ulcer Interprofessional Team Pressure Ulcer Prevention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Parish LC, Witkowski JA, Crissey JT, editors. The decubitus ulcer in clinical practice. Berlin: Springer; 1997.Google Scholar
  2. 2.
    Baumgarten M, Rich SE, Shardell MD, et al. Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc. 2012;60:277–83.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Theisen S, Drabik A, Stock S. Pressure ulcers in older hospitalized patients and its impact on length of stay: a retrospective observational study. J Clin Nurs. 2011;20:1–8.CrossRefGoogle Scholar
  4. 4.
    Kelleher AD, Moorer A, Makic MBF. Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intenstive care unit. J Wound Ostomy Continence Nurs. 2012;39:152–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Delmore B, Leibovits S, Baldock P, et al. Pressure ulcer prevention program: a journey. J Wound Ostomy Continence Nurs. 2011;38:505–13.PubMedCrossRefGoogle Scholar
  6. 6.
    de Souza DMST, de Gouveia Santos VLC. Incidence of pressure ulcers in the institutionalized elderly. J Wound Ostomy Continence Nurs. 2010;37:272–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Kwong EW-Y, Lau AT-Y, Lee RL-P, et al. A pressure ulcer prevention programme specially designed for nursing homes: does it work? J Clin Nurs. 2011;20: 2777–27868.PubMedCrossRefGoogle Scholar
  8. 8.
    Temkin-Greener H, Cai S, Zheng NT, et al. Nursing home work environment and the risk of pressure ulcers and incontinence. Health Serv Res. 2012;47:1179–200.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Pham B, Stern A, Chen W, et al. Preventing pressure ulcers in long-term care: a cost-effectiveness analysis. Arch Intern Med. 2011;171:1839–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Farren M, Martelly-Kebreau Y. OASIS-C importance of accurate pressure ulcer assessment and management in home healthcare: part II. Home Healthc Nurse. 2011;29:599–608.PubMedCrossRefGoogle Scholar
  11. 11.
    Bergquist-Beringer S, Gajewski BJ. Outcome and assessment information set data that predict pressure ulcer development in older adult home health patients. Adv Skin Wound Care. 2011;24:404–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Bergquist-Beringer S, Daley CM. Adapting pressure ulcer prevention for use in home health care. J Wound Ostomy Continence Nurs. 2011;38:145–54.PubMedGoogle Scholar
  13. 13.
    Bruce TA, Shever LL, Tschannen D, et al. Reliability of pressure ulcer staging: a review of the literature and 1 institution’s strategy. Crit Care Nurs Q. 2012;35:85–101.PubMedCrossRefGoogle Scholar
  14. 14.
    National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington, DC: National Pressure Ulcer Advisory Panel; 2009.Google Scholar
  15. 15.
    Kanj LF, Wilking SVB, Phillips TJ. Pressure ulcers. J Am Acad Dermatol. 1998;38:517–38.PubMedCrossRefGoogle Scholar
  16. 16.
    The National Pressure Ulcer Advisory Panel. Pressure ulcers prevalence, cost, risk assessment: consensus development conference statement. Decubitus. 1989;2:24–8.Google Scholar
  17. 17.
    Parish LC, Sibbald RG. 25 years of pressure ulcers and advances in skin and wound care. Adv Skin Wound Care. 2012;25:57–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Guy H. Pressure ulcer risk assessment. Nurs Times. 2012;108(4):16–20.Google Scholar
  19. 19.
    Baumgarten M, Margolis DJ, Locailio AR, et al. Pressure ulcers among elderly patients early in the hospital stay. J Gerontol A Biol Sci Med Sci. 2006;61:749–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Allman RM, Goode PS, Patrick MM, et al. Pressure ulcer risk factors among hospitalized patients with activity limitation. JAMA. 1995;273:865–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Primiano M, Friend M, McClure C, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94:555–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Walton-Geer PS. Prevention of pressure ulcers in the surgical patient. AORN J. 2009;89:538–48.PubMedCrossRefGoogle Scholar
  23. 23.
    Armstrong D, Bortz P. An integrative review of pressure relief in surgical patients. AORN J. 2001;73: 645–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Factora R. Year in review: National Pressure Ulcer Long-Term Care Study. J Am Med Dir Assoc. 2004;5:356–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Suen W, Parker VA, Harney L, et al. Internal medicine interns’ and residents’ pressure ulcer prevention and assessment abilities: results of an exploratory study. Ostomy Wound Manage. 2012;58:28–35.PubMedGoogle Scholar
  26. 26.
    Moore Z, Price P. Nurses’ attitudes, behaviors and perceived barriers towards pressure ulcer prevention. J Clin Nurs. 2004;13:942–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Anthony D, Papanikolaou P, Parboteeah S, et al. Do risk assessment scales for pressure ulcers work? J Tissue Viability. 2010;19:132–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Kottner J, Dassen T, Tannen A. Inter- and intrarater reliability of the Waterlow pressure sore risk scale: a systematic review. Int J Nurs Stud. 2009;46: 369–79.PubMedCrossRefGoogle Scholar
  29. 29.
    Seongsook J, Inhsook J, Younghee L. Validity of pressure ulcer risk assessment scales: Cubbin and Jackson, Braden, and Douglas scale. Int J Nurs Stud. 2004;41:199–204.CrossRefGoogle Scholar
  30. 30.
    Norton D. Research and the problem of pressure sores. Nurs Mirror Midwives J. 1975;140:65–7.PubMedGoogle Scholar
  31. 31.
    Vap PW, Dunaye T. Pressure ulcer risk assessment in long-term care. J Gerontol Nurs. 2000;26:37–45.PubMedGoogle Scholar
  32. 32.
    Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs. 2006;54:94–110.PubMedCrossRefGoogle Scholar
  33. 33.
    Bergstrom N, Braden BJ, Laguzza A, et al. The Braden scale for predicting pressure sore risk. Nurs Res. 1987;36:205–10.PubMedCrossRefGoogle Scholar
  34. 34.
    He W, Liu P, Chen H-L. The Braden scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis. Ostomy Wound Mange. 2012;58:34–40.Google Scholar
  35. 35.
    Soban LM, Hempel S, Munjas BA, et al. Preventing pressure ulcers in hospitals: a systematic review of nurse-focused quality improvement interventions. Jt Comm J Qual Patient Saf. 2011;37:245–52.PubMedGoogle Scholar
  36. 36.
    Braden B, Bergstrom N. A conceptual schema for the study of the etiology of pressure sores. Rehabil Nurs. 1987;12:8–16.PubMedCrossRefGoogle Scholar
  37. 37.
    Apold J, Rydrych MA. Preventing device-related pressure ulcers. Using data to guide statewide change. J Nurs Care Qual. 2012;27:28–34.PubMedCrossRefGoogle Scholar
  38. 38.
    Frantz RA, Gardner S, Specht JK, et al. Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes. Outcomes Manag Nurs Pract. 2001;5:112–20.PubMedGoogle Scholar
  39. 39.
    Lynn J, West J, Hausman S, et al. Collaborative clinical quality improvement for pressure ulcers in nursing homes. J Am Geriatr Soc. 2007;55:1663–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Hill-Brown S. Reduction of pressure ulcer incidence in the home healthcare setting. Home Healthcare Nurse. 2011;29:575–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Jaul E. Assessment and management of pressure ulcers in the elderly: current strategies. Drugs Aging. 2010;27:311–25.PubMedCrossRefGoogle Scholar
  42. 42.
    Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(suppl):42S–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Liang L, Thomas J, Miller M, et al. Nutritional issues in older adults with wounds in a clinical setting. J Multidiscip Healthcare. 2008;1:63–71.Google Scholar
  44. 44.
    Wojcik A, Atkins M, Mager DR. Dietary intake in clients with chronic wounds. Can J Diet Pract Res. 2011;72:77–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Wolfe RR, Miller SL, Miller KB. Optimal protein intake in the elderly. Clin Nutr. 2008;27:675–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Pompeo M. Misconceptions about protein requirements for wound healing: results of a prospective study. Ostomy Wound Manage. 2007;53:30–8.PubMedGoogle Scholar
  47. 47.
    Matthews DE. Proteins and amino acids. In: Shils ME, Shike M, Ross AC, et al., editors. Modern nutrition in health and disease. 10th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006. p. 23–61. Chapter 2.Google Scholar
  48. 48.
    Desneves KJ, Todorovic BE, Cassar A, et al. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomized controlled trial. Clin Nutr. 2005;24:979–87.PubMedCrossRefGoogle Scholar
  49. 49.
    van Anholt RD, Sobotka L, Meijer EP, et al. Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. Nutrition. 2010;26:867–72.PubMedCrossRefGoogle Scholar
  50. 50.
    Collins N. Adding vitamin C to the wound management mix. Adv Skin Wound Care. 2004;17:109–12.PubMedCrossRefGoogle Scholar
  51. 51.
    Gray M. Does oral zinc supplementation promote healing of chronic wounds? J Wound Ostomy Continence Nurs. 2003;30:295–9.PubMedGoogle Scholar
  52. 52.
    Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19:297–303.PubMedCrossRefGoogle Scholar
  53. 53.
    Gray M. Does oral supplementation with vitamins A or E promote healing of chronic wounds? J Wound Ostomy Continence Nurs. 2003;30:290–4.PubMedGoogle Scholar
  54. 54.
    Kalava UR, Cha SS, Takahashi PY. Association between vitamin D and pressure ulcers in older ambulatory adults: results of a matched case-control study. Clin Interv Aging. 2011;6:213–9.PubMedCentralPubMedGoogle Scholar
  55. 55.
    Borkow G, Gabbay J, Zatcoff RC. Could chronic wounds not heal due to too low local copper levels? Med Hypotheses. 2008;70:610–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Stephenson FJ. Simple wound care facilitates full healing in post-earthquake Haiti. J Wound Care. 2011;20:5–10.PubMedGoogle Scholar
  57. 57.
    Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration and health. Nutr Rev. 2010;68:439–58.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Geriatric Research Education and Clinical CenterCentral Arkansas Veterans Healthcare SystemLittle RockUSA
  2. 2.Department of Biobehavioral Health SciencesUniversity of Pennsylvania School of NursingPhiladelphiaUSA

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