Pressure ulcers:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1997
|
| Series: | Clinics in geriatric medicine
13,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | X S., S. 421 - 611 |
Staff View
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| 245 | 1 | 0 | |a Pressure ulcers |c David R. Thomas ... guest ed. |
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CONTENTS
Preface ix
David R. Thomas and Richard M. Allman
Pressure Ulcer Prevalence, Incidence, Risk Factors, and Impact 421
Richard M. Allman
Pressure ulcers are a common problem among older adults in all
health care settings. Prevalence and incidence estimates vary by
setting, ulcer stage, and length of follow up. Risk factors associated
with increased pressure ulcer incidence have been identified. Ac¬
tivity or mobility limitation, incontinence, abnormalities in nutri¬
tional status, and altered consciousness are the most consistently
reported risk factors for pressure ulcers. Pain, infectious compli¬
cations, prolonged and expensive hospitalizations, persistent open
ulcers, and increased risk of death are all associated with the de¬
velopment of pressure ulcers. The tremendous variability in pres¬
sure ulcer prevalence and incidence in health care settings suggests
that opportunities exist to improve outcomes for persons at risk
for and with pressure ulcers.
Strategies for Preventing Pressure Ulcers 437
Nancy I. Bergstrom
The Agency for Health Care Policy and Research supported the
development of guidelines for the prediction and prevention of
pressure ulcers. Based on the best available scientific evidence, the
guidelines recommend that individuals who are bed or chair
bound should be assessed further for risk and receive care accord¬
ing to the risk factors. Appropriate actions include managing tissue
loads, reducing exposure to moisture, managing incontinence, and
assuring adequate nutrition. The guidelines are presented, research
supporting the guidelines is summarized, and relevant articles
published since the release of the guidelines are reviewed.
CLINICS IN GERIATRIC MEDICINE
VOLUME 13 • NUMBER 3 • AUGUST 1997 V
Pressure Ulcer Assessment 455
JoAnn Maklebust
Pressure ulcer assessment requires quantification of multiple pa¬
rameters of the ulcer and periulcer tissue. Clinical assessment
should include ulcer history (including etiology, duration, and
prior treatment), anatomic location, stage, size (including length,
width, and depth measured in centimeters), sinus tracts, under¬
mining, tunneling, exudate or drainage, necrotic tissue (slough and
eschar), presence or absence of granulation tissue, and epitheliali
zation. In addition, the ulcer borders can provide clues to healing
potential. Intact skin surrounding the ulcer should be assessed for
redness, warmth, induration or hardness, swelling, and any obvi¬
ous signs of clinical infection. Pressure ulcer associated pain should
be assessed prior to examination of the ulcer.
Educational Assessment and Teaching of Older Clients
with Pressure Ulcers 483
Elizabeth A. Ayello, Mathy Mezey, and Elaine Jensen Amelia
The importance of education in preventing and treating patients
with pressure ulcers is evident by the inclusion of recommenda¬
tions for educational objectives in the clinical guidelines by the
Agency for Health Care Policy and Research. Both caregiver and
client should be assessed for knowledge of pressure ulcers. Physi¬
cal changes in vision, hearing, and cognition that might affect ed¬
ucating older clients are described. Strategies suitable for teaching
older clients about the prevention and treatment of pressure ulcers
are given.
The Role of Nutrition in Prevention and Healing
of Pressure Ulcers 497
David R. Thomas
Among the many risk factors for pressure ulcers, malnutrition is
potentially reversible. This article examines the relationship of mal¬
nutrition to the prevention and healing of pressure ulcers. Evidence
for nutrition in preventing and healing pressure ulcers is pre¬
sented. Specific nutrients, including some amino acids, vitamins,
and minerals, have been evaluated for their effects on wound heal¬
ing.
Pressure Relieving Strategies for Preventing and Treating
Pressure Sores 513
Robin E. Remsburg and Richard G. Bennett
Pressure relieving strategies remain the foundation for the preven¬
tion and treatment of pressure sores. Although the published lit¬
erature is inadequate, rational treatment decisions can be made if
they are based on an understanding of the mechanisms by which
vi CONTENTS
pressure relief results with a particular device or strategy. This
article reviews the theoretic and practical approaches to managing
tissue loads so that rational choices of the most cost effective strat¬
egies for preventing and treating pressure sores can be made when
caring for patients.
Pressure Ulcers: Local Wound Care 543
Patricia S. Goode and David R. Thomas
Local care of pressure ulcers includes wound cleansing, debride
ment, and dressings. Wound cleansing should remove loose debris
and exudate but should not damage viable tissue. Saline irrigation
is the standard. D6bridement is often necessary for Stage III and
IV pressure ulcers and can be performed autolytically, mechani¬
cally, enzymatically, or sharply. Prompt d6bridement is essential
for infected wounds. Dressings should keep the wound bed con¬
tinuously moist, should not be toxic to granulation tissue, and
should keep the surrounding intact skin dry. Randomized, con¬
trolled clinical trials are necessary to define optimal local wound
care further.
Adjuvant Therapy for Ulcer Care 553
Rita A. Frantz
Adjuvant therapies, specifically electrotherapy, hyperbaric oxygen,
ultrasound, and hydrotherapy, are considered increasingly for use
with conventional local wound care to support healing of pressure
ulcers. This article describes the characteristics of these modalities,
their physiologic effects on the healing process, and the research
to evaluate their efficacy.
Managing Bacterial Colonization and Infection 565
Nancy A. Stotts and Thomas K. Hunt
High levels of contamination are associated with delayed healing
of pressure ulcers, and problems occur when surface contaminants
invade the tissues and produce infection. This article addresses dif¬
ferentiating contamination from infection, identifying infection
when it is present, and treating the patient with a contaminated or
infected pressure ulcer. Systemic support for healing is discussed
with a focus on oxygenation and nutrition. A comprehensive plan
for the concomitant treatment of all factors contributing to pressure
ulcer infection is recommended.
Assessment of Healing 575
Bruce A. Ferrell
Assessment of pressure ulcer healing involves observation during
a complex series of cellular and molecular events that result in
repair and restoration of skin integrity and function. Although the
most important endpoint in healing is complete wound closure, it
CONTENTS Vii
may not be a practical measurement in most settings. Assessment,
therefore, often relies on measurement of partial healing, including
changes in size and other wound characteristics over time. With
no consensus about the best method for measurement of healing,
it is not surprising that rates of healing have been described in only
a few research studies. The establishment of a universal method
for wound healing measurement is needed urgently.
Operative Repair of Pressure Ulcers 587
Zahid Bin Masud Niazi and C. Andrew Salzberg
Surgical management of pressure ulcers ranges from debridement
and advancement flap closure for simple ulcers to sensate flaps,
expanded flaps, free tissue transfers, and fillet flaps for more com¬
plex ulcers and defects. Some pressure ulcers recur following sur¬
gery or conservative treatment, and the surgical options for man¬
agement of these difficult recurrent ulcers are limited. The geriatric
population offers an even more difficult problem as patients suffer
invariably from underlying medical and systemic diseases that
may affect surgery or the rehabilitation program.
Quality Assurance Programs for Pressure Ulcers 599
George C. Xakellis, Jr
Traditional medical quality assurance programs are beginning to
incorporate the principles of continuous quality improvement pi¬
oneered by Juran and Deming. Strategies for incorporating these
principles into a long term care facility are described, and two ex¬
amples of successful implementation of continuous quality im¬
provement programs for pressure ulcers are presented.
Index 607
Subscription Information Inside back cover
Viii CONTENTS
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| physical | X S., S. 421 - 611 |
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| publisher | Saunders |
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| series | Clinics in geriatric medicine |
| series2 | Clinics in geriatric medicine |
| spelling | Pressure ulcers David R. Thomas ... guest ed. Philadelphia [u.a.] Saunders 1997 X S., S. 421 - 611 txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 13,3 Escarre - Sujet âgé Bedsores Dekubitus (DE-588)4149036-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Dekubitus (DE-588)4149036-8 s DE-604 Thomas, David R. Sonstige (DE-588)1046358618 oth Clinics in geriatric medicine 13,3 (DE-604)BV000019839 13,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007747717&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pressure ulcers Clinics in geriatric medicine Escarre - Sujet âgé Bedsores Dekubitus (DE-588)4149036-8 gnd |
| subject_GND | (DE-588)4149036-8 (DE-588)4143413-4 |
| title | Pressure ulcers |
| title_auth | Pressure ulcers |
| title_exact_search | Pressure ulcers |
| title_full | Pressure ulcers David R. Thomas ... guest ed. |
| title_fullStr | Pressure ulcers David R. Thomas ... guest ed. |
| title_full_unstemmed | Pressure ulcers David R. Thomas ... guest ed. |
| title_short | Pressure ulcers |
| title_sort | pressure ulcers |
| topic | Escarre - Sujet âgé Bedsores Dekubitus (DE-588)4149036-8 gnd |
| topic_facet | Escarre - Sujet âgé Bedsores Dekubitus Aufsatzsammlung |
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