Negative Pressure Wound Therapy: A Case Study

The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.

A common health concern seen in the elderly, especially those within institutions, are pressure ulcers. A pressure ulcer is defined as a localized injury to the skin or underlying tissue that occurs when something keeps rubbing or pressing against the skin. Pressure on the skin causes a decrease of blood flow to that area and as a result, an ulcer may form because of the skin dying due to the lack of blood in that region. They generally occur over bony prominences such as, the buttock, elbow, hip, heel, back of the head and ankles. An ulcer has a greater chance of forming if the person uses a wheelchair or stays in bed for a long period of

I have significantly developed my skill in wound care assessment and dressing, in developing this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer assessment it provides a basis for deciding the effectiveness of the current treatment.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

Pressure ulcers are a widespread and often underestimated health problem in the UK. They occur in 4-10% of patients admitted to hospital (Ward et al, 2010).

In order to facilitate understanding of process data and outcome data, this essay will focus on the context of hospital-acquired pressure injury (PI). PI, also referred to as decubitus ulcers, bed sores or pressure sores, is defined as soft-tissue ischaemic necrosis localised in an area caused by prolonged pressure higher than the capillary pressure with or without skin tear or breach, related to posture over a bony prominence. The aetiology of pressure ulcers include: (1) pressure – weight of the skin against contact area; (2) shearing; (3) friction; (4) moisture; (5) position of the patient; (6)immobility; (7) neurological factors; (7) metabolic and nutritional factors; (9) oedema; and (10) age. PIs affects not only in infirmed older people,

This qualitative study by Gorecki, Nixon, Madill, Firth, and Brown (2012) was conducted to ascertain the health-related quality of life (HRQL) as an important and relevant outcome in patients suffering pressure ulceration and the various factors that affect it. Pressure ulcers (PUs) are areas of necrosis and ulceration where tissues are compressed between bony prominences and hard surfaces.

Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure

Pressure ulcers are; damage to the skin or underlying structures from either inadequate perfusion or tissue compression. (Taber’s Cyclopedic Medical Dictionary, 2009, p. 1889). Those at an increased risk for pressure ulcer formation: older adults, persons with spinal cord injury, surgical patients, obese patients, underweight patients, children and patients at end of life. (Ruth & Nix, 2012, p. 125). The Braden Scale, is a tool used to help identify a patient’s risk of developing a pressure ulcer.

Pressure ulcers are defined by the National Pressure Ulcer Advisory Panel (NPUAP) as a site of “injury to the skin and/or underlying tissue usually over a boney prominence, as a result of pressure, or pressure in combination with shear and/or Friction” (NPUAP, 2017). A Hospital Acquired Pressure Ulcer (HAPU) is a pressure ulcer that was obtained while at the hospital. These can change the patients plan of care and can lead to pain, loss of function, extended hospital stays and increased cost. HAPU is considered a medical error so there for Medicare is no longer reimbursed for stage II to IV HAPU unless they were determined to have been present at admission or within 2 days after admission (Kandilov, Coomer, &

Pressure ulcers are localized wounds to the skin that are also known as decubitus ulcers, or are known by the colloquial term “bed sores.” They are common occurrences in healthcare that result from injuries to the skin and the tissues beneath it when the patient remains in one position for long periods of time. Pressure ulcers are typically located over an area with a bony prominence that then causes pressure on the skin. Pressure ulcers are especially common in individuals in extended care facilities, but can occur even in an acute setting. Pressure ulcers, in fact, can develop in just 24 hours, although they may not be apparent to healthcare providers until up to 7 days later (Truong, Grigson, Patel, & Liu, 2016).

Healing of pressure sores have also improved through the application of ultrasound at a low intensity (Williams, 1968). There have however been reports suggesting that ultrasound can increase the size of ulcers following treatment as the intensity was excessively higher than required, contradicting William’s theory (Harvey and Elphick, 1969). It has been suggested that the application of ultrasound at a low dose can increase degranulation of mast cells and the release of histamine accelerating the acute inflammation phase. It can also reduce the amount of fluid being released from the capillaries following injury and collagen synthesis can be increased during the repair process (Denegar, Saliba and Saliba, 2006). If there is more exposure than required it can result in a breakdown of tissues and can increase the acute inflammatory response for a longer period of time, resulting in the patient suffering with their injury longer than the average healing time. Baker and Robertson (2001) came to the conclusion that therapeutic ultrasound may not be more effective than placebo ultrasound for pain, musculoskeletal disorders or soft tissue healing. However many researchers and practitioners continue to believe that ultrasound has many beneficial effects and from their books and journals evidence can be found to further their theories. The author has also come to the conclusion that when applied correctly ultrasound can treat a range of

Pressure Injuries—often referred to as pressure sores, bed sores, pressure ulcers or decubitus ulcers—are the injuries, sores, inflammation or ulcers in the skin over a bony prominence due to constant pressure or friction. The common sites for pressure injuries are sacrum, heels, elbows, ankles, hip, knees, occipital bones and shoulder blades (Harris, Nagy &Vardaxis, 2010, p.1404). A shearing force or a frequent pressure on a bony prominence tends to block the blood supply which leads to ischemia or cell death. Elderly, incontinent, wheelchair or bed-bound individuals are prone to pressure sores. However, it also depends on the individual’s skin integrity and weight (Brown & Edwards, 2012, p. 239). The pressure injury can affect any person of any age. Therefore, every patient requires an assessment for risks regardless of gender, age or weight. A pressure injury can develop with both the high pressure for short duration and low