PRESSURE ULCERS

From the beginning of my studies and practises I've been interested in and worried about pressure ulcers, I think this common affection have too little attention.

Pressure ulcers are skin lesions that appear as a result of a continuous skin pressure over a hard surface and independent of the position. The most important factor is prolonged pressure over certain skin area. There are many state to evaluate ulcers:

• State I: epidermis is intact, affected area shows an erythema that not disappear.
• State II: sore with graze. Red-coloured area.
• State III: loose of skin thickness, lesion or subcutaneous tissues necrosis
• State IV: Apo neurosis, support tissues, muscle and bones harm.

During my practices I saw that when sores appear, it's so difficult to heal them, I think prevention is so important, because it's easier and less costly make simple steps to avoid ulcers. Often making simple position changes during patient disease will help to prevent them, change patient position every two or three hours will be enough. There are more steps to check:

• Inspect skin at least once per day checking bone protuberance and wet areas, specially perspiration and incontinence areas.
• Keep skin hydration and maintain good hygiene.
• Use of neutral soaps.
• Dry the skin without rubbing.
• Often Apply moisturising cream.
• Protein diet support.

All of this steps are easy to apply in contrast of necessary cures when sore appears. We must know that it's nurse's role.

Besides postural changes there exists some devices to minimize pressure over skin areas like cushions, air cushions, special-fibered cushions, duvets..

It's important to highlight that to heal a sore is necessary treat the main disease such breathing, circulatory and metabolic disorders.

Regarding ulcer treatment, I saw many differences between one professionals and other, that question attract me and make me think about. As a future nurse, I'm still thinking which is the best way to treat sores. Which is the best treatment?, surgical debridement or enzymatic treatment?, during my practices I saw nurses applying the two methods without any rule, and cases in that the doctor gave a warning to the nurse to apply surgical debridement instead enzymatic.

Once during practises I were surprised when a nurse put a silver dressing over the sore, the sore was not infected, but nurse says 'That feel good to the patient'

I understand that it's difficult to standardize and setup a guideline over sore treatment, but I think that is necessary more collaboration and agreements between all nurses to setup basic rules about sores healing keeping in mind that prevention is more important than healing. I think giving nurses and patient good education about that will contribute avoid sores. It's nurses work.

  

I try to find out information how to resolve my doubts in pubmed, among all I like to highlight two texts that have attract me, in the first one it shows how can be the treatment modified by patient features and types of ulcers, the second one is a review of the different types of cares. I put below some bibliography if you like to go in depth.

Declaración de Rio de Janeiro sobre la prevención de las Úlceras por Presión

Consulted bibliography :

Levine SM, Sinno S, Levine JP, Saadeh PB. Current thoughts for the prevention and treatment of pressure ulcers: using the evidence to determine fact or fiction. Ann Surg. 2013 Apr

Greer N, Foman N, Dorrian J, Fitzgerald P, MacDonald R, Rutks I, Wilt T. Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs; 2012 Nov.