PIC0 for Pressure Ulcers Literature Review

Pressure ulcers are caused by factors such as unrelieved pressure and shearing forces on the surfaces of the body. The condition can be prevented and treated if it is diagnosed early enough in a patient. However, if it advances, it can be deadly. The condition poses a numerous challenge to medical practitioners in the developed world since it causes substantive iatrogenic deaths.

There are four main stages of pressure ulcer which range from stage I to stage IV. Stage I is superficial and is visually similar to a condition known as reactive hyperemia witnessed after the skin has been exposed to prolonged application of pressure. Stage II becomes evident when damage to the epidermis extends to the dermis thereby forming a blister. Stage III is extending to the subcutaneous tissue which has poor blood supply hence its inability to heal faster. Stage IV pressure ulcers can extend to the muscles and bones. It is the deepest stage of pressure ulcer. This study seeks to come up with a nursing problem (pressure ulcers), identify its possible solution and conduct a review of related literature to pressure ulcers. This will enable the researcher to come up with the possible solutions to the problem. In conducting the review, five main scholarly sources will be used. The study will then analyze and critically appraise the evidence based on the literature to support the solution to the problem.

Hew de Laat and Van Achterberg (2005, p. 466) study intended at describing the current scientific evidence surrounding diagnosis and pain treatment, the malodor of the wound and fluids that ooze from the pressure ulcers. The study similarly intended at making recommendations to be used in the nursing practice informed by the findings. The objectives and methods involved systematic search of literature to attain current knowledge in relation to pain diagnosis, wound malodor and exudates from individuals suffering from pressure ulcers and ways used to mitigate such problems. The search strategies used in searching related publications was based on key words pressure ulcers combined with pain and exudates were Medline, CINAHL, and Cochrane. Distinction was created between opinionated, contemplative or journalistic scientific publications through filtration of the publication.

Terms used in filtration included randomized controlled trial, controlled clinical trials and clinical trials among others. The review entailed issues related to pain, wound and exudates. Studies were integrated in the review only if they touched on patients with pressure ulcers. Intervention studies were only allowed on condition that they relieved pain. Publications that did not touch on patient oriented research were not used in the review as well as those dealing with patients with non-chronic wounds. The first author on basis of inclusion and exclusion criteria screened the abstracts of all the publications. In case of doubts, the whole article had to be retrieved. If there were still doubts, on the whole article, one of the authors was consulted to decide on the inclusion and exclusion criteria to be used. A total of 13 publications were selected. The publications zeroed on pressure ulcer patients. One publication could however not be found. Three pertinent guidelines were proposed as sure ways of treating pressure ulcers.

Reliable rating scales were also used to diagnose pain. This was achieved by using McGill Pain Questionnaire (MPQ), The Visual Analogue Scale (VAS) used in measuring pain intensity and the Faces Rating Scale (FRS). Interventions to reduce pain included use of benzydamine gel to wounds occasioned by pressure ulcers. Due to lack of available scales for conducting evaluation of wound malodor, patients were subjectively judged. Some other studies classified the level of malodor as strong, moderate, slight or absent. This classification has however not been put into operation. Wound malodor was treated by regular cleansing of wound using tap water or by recommendation of a regime of antibiotics. Availability or unavailability of wound exudates was determined through observation.

Pieper, Langemo and Cuddigan (2009, p. 76) posit that patients with pressure ulcers undergo excruciating pain. These scholars define pain as an unpleasant sensory and emotional experience that results from tissue damage. Pressure ulcers pain therefore have to be assessed and treated regardless of the age of the patient or their status of health due to its far reaching physical and psychosocial ramifications to the patient, their family members and nurses. This study identified 32 grants in a bid to examine pressure ulcer research funding. Aspects of assessment of pressure ulcers, its prevention and treatment, quality of care were put into perspective. Only one grant focused on pain associated with pressure ulcers. It was noted that despite the fact that pressure ulcers pain was underrepresented compared with other funded projects, clinicians and nurses are urged to assess pain and treatment of pressure ulcers basing on the research evidence.

Research findings were summarized based on tools used to assess pain, the medications given to pressure ulcer patients, the care given to the wound occasioned by the pressure ulcer and the kind of food patients with pressure ulcers take. The study inferred that pressure ulcers can be caused by tissue trauma from sustained loads, inflammation or damage to the nerve endings. The skin has a rich supply of sensory nerves than any other organ in the human body. As pressure ulcers continue damaging the skin, nociceptive nerve terminals are affected resulting into acute or chronic inflammation. The resultant effect is damage to nerve terminals. Regeneration of the peripheral nerves force nociceptive nerves to send immature sprouts of nerve tissue hypersensitive to noxious and non-noxious stimulus.

The study performed literature searches using PubMed and the Cumulative Index in Nursing and Allied Health Literature between 1992 and 2008. Phrases used in the search were pressure ulcers pain. Only English language was used. Human research was used in the study. A total of 15 papers were identified four of which captured topical medication treatment. The other eleven covered varying aspects of measuring pain. The most prominent sign of the existence and intensity of pain was the patient self-report. Pain rating scales used included the MPQ, FRS, and VAS. MPQ was basically used because of its ability to describe pain qualities. In addition, it gave a quantitative measure of pain. In addition, it was used to categorize pressure ulcer into stages from stage I to stage IV.

Catania et al (2007, p. 45) regrets that despite the technological and preventive advances, pressure ulcers incidence in acute care facilities has remained high. This called for establishment of pressure ulcer prevention protocol interventions. As a result, risks and nutritional status of the patients were assessed. Skin care, referrals and documentations of the patients were conducted. Intervention measures considered included development of PUPPI (pressure ulcers prevention protocol intervention. Evidence based guideline for pressure ulcer prevention and skin care was the benchmark used for all activities.

The World Health Organization analgesic dosing ladder has to be used to systematically manage the pain. The WHO ladder integrates many categories of systemic medication to manage pain. These include opioids, adjuvants, and NSAIDS.

Hydrocolloid dressings can be used in treatment of wounds that result from pressure ulcers. This method is much better than topical dressing since less pain is felt when dressing the wound. In addition, Hydrocolloid dressing removal during subsequent dressing does not cause much pain compared to other dressing removal methods.

Sorting out incidence and prevalence helps in determining the rate at which the condition occurs. Incidence means the number of new cases that have been identified while prevalence refers to all case both the existing and new ones.

One of the guidelines that should be considered includes developing a repositioning schedule. In addition, clinicians should ensure that patients lay in specialized beds. The patients should not lay on the side which has pressure ulcer. This helps in reducing pain associated with pressure ulcers.

Laying the patients on specialized beds other than the normal hospital beds also aids in reducing pain. However, this should depend on assessment of the physician.

Continuous patient’s assessment should be conducted to minimize risk of patient developing pressure ulcers.

Search of databases for evidence based guidelines for treatment of pressure ulcers was done between 2004 and 2006 by use of electronic and online data sources (Whitney, 2006. p.43). PubMed, EMBASE and Cochrane data base reviewed to ascertain if they had any data relating to treatment of pressure ulcers. The project intended to come up with a comprehensive evidence based guideline for treatment of pressure ulcer and show case these guidelines in a clear and simple format made to enhance health care provider’s decisions in managing pressure ulcers. This study’s published guidelines were founded on clinical human studies. In addition, well controlled animal studies with proof of principle to corroborate laboratory results by clinical series were considered.

Strength of evidence formed the basis for classifying pressure ulcers into level one, two, or three. Current evidence and expert opinion came up with guideline one which encompassed establishment of repositioning schedule to avoid positioning of patients suffering from pressure ulcer. Pressure ulcer origin was associated with soft tissue compression on bony prominence. This study associated delayed healing of pressure ulcers and therefore repositioning of patients reduces their chances of getting pressure ulcers. However, the study does not give an exact turning interval hence the need for empirical derivation of turning interval. Other intervention included having the head of the bed at low elevation. Patients with large stage 3 or 4 pressure ulcers a specialized bed is recommended especially bed with low air loss or those that have been air fluidized. These type of beds minimize the amount of pressure that is exerted on the wound even if the patient lies with the side having pressure ulcers.

Reference list

Catania, K. (2007). The Pressure Ulcer Prevention Protocol Interventions. AJN, Nursing 107(4): 44-52.

Hew de Laat, E., Reimer, W.J.S., & van Achterberg, T. (2005). Pressure ulcers: diagnostics and interventions aimed at wound-related Complaints: a review of the literature, Journal of Clinical Nursing 14: 464–472.

Pieper, B., Langemo, D., & Cuddigan, J. (2009). Pressure Ulcer Pain: A Systematic Literature Review and National Pressure Ulcer Advisory Panel White Paper. Scottsdale Wound Management Guide 55(2).

Whitney et al. (2006). Guidelines for the treatment of pressure ulcers. Wound Rep Reg 14: 663–679.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with Online Academic Experts
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 20k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
Economics
Nice work
Customer 453185, May 21st, 2022
Emergency Management
Overall, I think it's a great service. I have yet to submit the assignment, so I don't know what kind of grade I'll get. But customer service was excellent. Reviews were made and the assignment proofed for satisfaction.
Customer 453015, December 15th, 2021
Other
I am beyond eager to write this review for this writer. I received a grade of "Mastered"upon first submission on this assignment. I will shout to the rooftops ENCOURAGING you to hire him. I have used other writers but NONE have delivered such awesome work as this writer and NONE of their prices can compare to his. He does not try to "break the bank" and he works hard; it shows in the final paper and the grade. He is simply,THE BEST HERE!!
Customer 452995, November 16th, 2021
Psychology
Thank you!
Customer 452545, February 6th, 2021
Psychology
Came in as promissed. Good paper.
Customer 453027, January 6th, 2022
Management
It's the second time I use this service and it does not let me down. Work quality is so good for its price!
Customer 452985, December 3rd, 2021
Human Resources Management (HRM)
My son and I have been sick for two weeks, of course at the end of my semester. I am so grateful that myhomeworkgeeks were able to help! Both papers got A's and I couldn't be more thrilled! Thank you so much and don't forget to tip your writer!
Customer 453077, February 22nd, 2022
Nursing
Paper much better compared to the one prior revision request. References need to be no more than the past 5 years.
Customer 452547, July 20th, 2021
Business Studies
Amazing!
Customer 452985, November 11th, 2021
Business Studies
First of all, the writer made sure that he completely understood my assignment and all the guidelines before he began writing. My paper was finished very fast and well before the specified deadline. I thought it was written excellently. He definitely completely grasped the topic. Overall, he is a great writer and I couldn't have asked for better.
Customer 452441, November 29th, 2021
Literature
Thank you!
Customer 453145, April 19th, 2022
Nursing
The writer was timely and proficient. I had to ask for a revision, but I got it back quickly with no other issues. Would use this essay writing service again
Customer 452441, November 14th, 2021
11,595
Customer reviews in total
96%
Current satisfaction rate
3 pages
Average paper length
37%
Customers referred by a friend
OUR GIFT TO YOU
15% OFF your first order
Use a coupon FIRST15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat
Live ChatWhatsApp