Pressure ulcers are a major challenge facing healthcare professionals in their practice. The treatment of patients with ulcers pressure should include the following elements:
- Consider the patient as a whole - Make a special emphasis on prevention. - To achieve maximum involvement of the patient and his family in the planning and implementation of care - Develop clinical practice guidelines on pressure ulcers at the local level with the involvement of community care, specialized care and health and social care - Configure framework of evidence-based clinical practice - make decisions based on the dimension of cost / benefit - Constantly evaluate clinical practice and incorporate professional activities research.
ASSESSMENT: This is the starting point and basis of treatment planning and evaluation of results. A proper assessment is also essential in communication between caregivers. The assessment should be made in the context of patient health, both physical and psychosocial. Initial assessment
· : complete medical history and physical examination with particular attention to: Risk factors (immobility, incontinence, nutrition, level of consciousness ...); diseases interfere with the healing of the UP (vascular disorders, respiratory , metabolic, immunologic, neoplasms, psychosis, depression ...); elderly snuff, alcohol, hygiene, drugs. Complications (pain, anemia, infection ...)
- Nutritional assessment: the goal is to ensure adequate nutrients to promote healing. Using a simple method of screening for nutritional deficiencies (calories, protein, serum albumin, minerals, vitamins, water intake. Reassess periodically.
- Rating psicosocial.Valorar capacity, ability and motivation of the patient to participate in their treatment program. This information is critical to the care plan is adequate to establish the individual
· rating environment: The objective is to create an environment conducive to compliance with the treatment plan. Identify the primary caregiver. Assess skills, availability, knowledge and resources around the caregiver (family, informal caregivers).
· rating injury: should be described by unified parameters to facilitate communication between professionals and to check the progress. It is very important to the assessment and registration of the same week. Whenever there is deterioration of the patient or the wound should be reassessed treatment plan. The assessment should include:
- Location of the injury. - Staging. - Dimensions. - Existence of fistula formation or excavations. - Type of tissue present in the bed: necrotic, slough, granulation. - State of surrounding skin: full, torn, macerated, eczematization, cellulite ... - Discharge of UP: poor, profuse, purulent, hemorrhagic, serous. - Pain. - Clinical signs of local infection: purulent discharge, odor, swollen edges, fever. - Seniority. - Course-evolution
PRESSURE RELIEF ON THE TISSUES. The objective is to improve the viability of soft tissue and promote healing of the injury by placing UP optimal conditions for healing (forces of pressure, temperature and humidity). Each performance will be directed to reduce pressure, friction and shear, which may be obtained by positioning techniques (in bed or sitting) and an appropriate choice of surfaces.
· positioning techniques: Sitting - If the UP is located on the seating surface, to avoid this position. Exceptionally, helping to support surfaces to ensure the pressure relief be allowed for limited periods.
If there is no injury on the seating surface: changes in position schedules, facilitating the exchange for support of their weight every 15 minutes with postural change or conducting drives. Bedridden
: - Do not put on the UP. - If it is not possible because the patient's condition or the number of injuries: increasing the frequency of changes. . Can be useful surfaces. In both: - Never use float type devices. - Always make a written individualized program. - Involve the caregiver. In high-risk patients make more frequent changes.
· Support Surfaces: Consider the choice the patient's clinical condition, the characteristics of the institution or level of care and characteristics of the surface. His choice is based on the ability to counteract the elements and forces that may increase the risk of injury or increase them, as well as its ease of use, maintenance, cost, comfort, and patient preferences. - Your job is important in the prevention and adjuvant treatment. Never replace repositioning.
- If a PU does not cure the whole plan should be reassessed before replacing the surface. Can act at two levels: - Areas to reduce pressure: the values \u200b\u200bof pressure reduction are not necessarily below that prevent capillary closure. - Pressure-relieving surfaces: the values \u200b\u200bof pressure reduction in the soft tissues are below capillary occlusion pressure, also eliminates friction and shear.
Guidelines for the use of support surfaces: Surfaces Using reduction or pressure relief patient's specific needs.
- Using static area if the individual changes can take place.
- Using dynamic surface if you can not bear them.
- It is recommended that those responsible for resource management were available for some of these areas, the benefits to be derived. Its allocation should depend on social circumstances and the patient's risk, so we suggest the systematic use of risk assessment scale. Requirements for support surfaces: - To be effective in reducing or relieving pressure. - To increase the bearing surface - To facilitate the evaporation of moisture. - What causes low heat to the patient. - To reduce shear forces. - Have good value for money. - What is management and maintenance. - It is compatible with needs of cardio-pulmonary resuscitation if required.
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