Model essay 1: Nursing experience of pressure ulcer Abstract Pressure, scissors, friction and humidity are the main factors of pressure ulcer. Pressure sore, also known as bedsore, refers to the pathological changes caused by ischemia and hypoxia caused by local tissue compression. The pathophysiological mechanism of pressure sore is that the local tissue is compressed for a long time, and the blood circulation is partially or completely interrupted, which causes local tissue microcirculation disorder, reduced nutrient supply, and chronic accumulation of metabolites, leading to tissue damage. The occurrence of pressure ulcers is common in patients with long-term bed rest, malignant tumors and chronic diseases in the elderly after operation, and can also be seen in patients with long-term limited sitting position. The occurrence of pressure ulcers is a long-term and gradual process. At present, the nursing viewpoint holds that the key to improve pressure ulcers is to control local tissue compression, which is also a difficult problem in nursing work.
Pressure sore; Nursing; nutrition
1 Factors of pressure sore formation
The pressure of 1 is the vertical force on the receiving surface, which is the main treatment factor and related to the duration. Ulcers form faster under high pressure than under low pressure. When the pressure exceeds the average capillary pressure of 4.7Kpa, the skin blood flow will stop, because the accumulated lymphatic stasis and anaerobic metabolic waste are easy to cause tissue necrosis, and the diffusion pressure is from shallow to deep, mostly concentrated in the protruding parts of deep bones, and atrophy, emaciation scars and infected tissues increase the sensitivity to pressure.
Internal dampness can be caused by incontinence and sweating. , resulting in soft skin foam, easy to be injured by shear friction. Urinary incontinence is more dangerous because more bacteria and antibiotics are more dangerous than urinary incontinence. The infection caused by soaking this pollutant makes the situation worse. Smoking is an important risk factor for stress ulcer. Now, after smokers quit smoking, the risk of stress ulcer is obviously reduced, and the influence of adverse reactions can be partially reversed. Cognitive impairment is also an important risk factor for pressure ulcers, and the risk of pressure ulcers in unconscious state is significantly higher than that in semi-conscious state. Brain alarm level, history of cerebrovascular accident and Alzheimer's disease are the risk factors of pressure ulcer.
2 measures to prevent pressure ulcers
1 prevention of pressure ulcers should be evaluated first, at the time of admission, regularly or at any time after admission, and other high-risk patients should be emphasized. Medical resources can benefit from rational distribution and utilization.
Turn over and posture, intermittent decompression are the key to effectively prevent pressure ulcers. It is suggested that compared with the horizontal position, patients who lean 30 degrees and support this position with pillows can always avoid their bone protrusion and disperse the pressure.
3. Protect the patient's skin. Studies have shown that massage does not help prevent pressure ulcers. This is a normal protective reaction, because soft tissues turn red under pressure. Generally, the pressure will subside after 30-40 minutes, and no protective film for pressure sores and some massage oil will be formed to prevent pressure sores and improve nutrition. Malnutrition is one of the internal causes of pressure ulcers, and it is also directly affected by the healing factors of pressure ulcers. Patients with high risk of pressure ulcers should cooperate with dieticians to adjust their diet structure and give them high sugar, high protein and appropriate amount.
Encourage patients to exercise and health education, avoid using restrictive diet as much as possible, help patients to do all joint activities, and promote early getting out of bed. The main complication of pressure sore is infection. Due to the loss of skin barrier function, feces are often polluted, and the infection rate is very high, including cysts, suppurative infections, suppurative infections and so on. Hospitalization conditions The mortality rate of bedsore infection complications is as high as 50%, which is the direct cause of death of 7%-8% patients with spinal cord injury. The mortality rate of pressure ulcers in elderly patients is 23%-37%. Compared with the elderly without pressure ulcers, the mortality rate of the elderly with pressure ulcers has increased by four times, and if the pressure ulcers do not heal, the mortality rate has increased by six times.
3 Treatment and nursing
3. 1 dressing change nursing
When dealing with pressure sore wounds, we should strictly follow the principle of sterility to avoid iatrogenic pollution. First, you can clean the wound with normal saline or ethacridine lactate solution, and then gently wipe it with sterile gauze to clean the residual liquid medicine and exudate; A small amount of debridement glue can be applied to the wound surface; Covering with sterile gauze, sticking, or topical Cornwall plaster. Change dressing 1 time /2 ~ 3 days. If the pressure sore is serious and exudation is more, the dressing change time can be shortened. It is worth noting that every time the dressing is changed, the secretions and liquefaction of the wound surface should be completely removed. The application of drugs The effect of local use of antibiotics on wounds is inaccurate. It is recommended not to abuse it under any circumstances, even if it is used carefully, it should be limited in time. According to recent research, iodine can promote the growth of tissues, relieve the pain of ulcer, eliminate pus and stimulate granulation.
3.2 Local decompression
Because the key inducement of pressure sore lies in the long-term oppression of local tissue, local decompression protection is the key to relieve pressure sore. For long-term bedridden patients, nurses and their families should help them turn over regularly, 1 time/1 ~ 2 hours. Air cushion can be used to protect the patient's compressed part, and air cushion bed can be used if conditions permit. If these items are not available, you can also consider using temporary substitutes such as soft pillows and sponge quilts.
3.3 diet care
Intensive malnutrition will affect wound healing. Although malnutrition and dehydration will not cause pressure ulcers, they will make the skin lose vitality, reduce skin elasticity and increase the risk of pressure ulcers. The same weight loss and muscle reduce the natural buffering effect between the patient's skin and bones, and increase the susceptibility to pressure injury. Adequate intake of protein can prevent compressive injury. Vitamins and minerals are very important in the construction of new tissues and the healing of injured tissues. Due to the reduced activity, age and basic diseases of patients with pressure ulcers, patients often have loss of appetite and insufficient long-term nutritional intake, which is also the reason why pressure ulcers have not healed for a long time. Therefore, we advocate that patients eat more foods rich in protein and collagen, and increase the intake of vitamins and minerals. These nutrients are an important material basis for promoting body repair.
3.4 wound care
Treatment of pressure ulcers should be based on local treatment, supplemented by systemic treatment, and comprehensive nursing measures should be taken. According to the actual situation, superficial ulcers can be treated by any method, and deep ulcers should be used with caution. Treatment and Protection of Wound Nursing Before the wound of pressure ulcer, the size, location, stage and appearance of ulcer should be checked first, and mechanical debridement, chemical debridement or self-melting debridement should be adopted according to the wound condition. Washing the wound with warm salt water can remove necrotic tissue and foreign bodies, thus reducing infection and promoting healing. It is very important to protect the wound when the wound is covered with granulation tissue and the infection is limited, and the epithelium around the wound grows to the edge of granulation. Keeping moist is beneficial to the vigorous growth of granulation tissue. Wet saline gauze, hydrogel and polyethylene film can be used to provide a moist environment. Pay attention to keep the sheets flat and clean, and avoid the folds of the sheets rubbing against the skin; In addition, the dirt on the sheets should be cleaned up in time, including food residue, urine, feces and so on. , in order to reduce the adverse stimulation to the skin. When helping the patient turn over or carry the patient, don't drag the patient's body level on the bed, otherwise the pressure sore itself may be aggravated due to the friction between the sheets and the skin.
3.5 Psychological nursing
Patients who stay in bed for a long time often have certain unhealthy psychological characteristics, and are prone to depression and depression, which has a negative impact on treatment. Nurses should patiently enlighten patients, encourage them to receive treatment with an optimistic attitude, cooperate with the guidance of medical staff, and strengthen their daily care for pressure ulcers. When necessary, patients who have been successfully treated can be invited to speak freely to enhance their confidence in treatment. Because the recovery of pressure ulcers is a long-term process, apart from systematic and scientific nursing by nurses, family members should take care of patients more carefully. Explain the common sense, treatment and nursing measures of pressure sore and matters needing attention in daily home care to patients' families, so as to improve their nursing awareness and operation level. In addition, follow-up work should be done in a planned way to reduce the occurrence of pressure ulcers.
refer to
Zhao Youjuan, Zhang Tian, Ren Xiaoying, Wang Guilan. Related research on compression site injury of patients undergoing long-term surgery [J]. Journal of Nursing Science, No.22, 2004.
[2] Wu Lianhong. Observation on therapeutic effect of foam dressing on pressure sore [J]. Anhui Medicine, 20 1 19.
[3] Yang Xu. New progress in prevention and care of pressure ulcers [J]. ordinary care, 33 (2008).
Objective: To analyze the clinical effect of comprehensive nursing intervention mode for pressure ulcers in critically ill patients and summarize the preventive measures. Methods: 49 critically ill patients from 20 12 to 20 13 and 12 were selected as research objects and randomly divided into intervention group and control group. The intervention group adopted comprehensive nursing intervention mode, while the control group adopted conventional nursing mode. The nursing effects of the two groups before and after nursing were compared. Results: Through the comprehensive nursing mode, none of the patients in the intervention group developed pressure ulcers, while 14 patients in the control group developed pressure ulcers, and the incidence of pressure ulcers was 58.33%. After nursing, the scores of depression and anxiety in the intervention group were lower than those in the control group, and the difference between the two groups was statistically significant, that is, P < 0.05. Conclusion: The effect of comprehensive nursing intervention mode on pressure ulcers in critically ill patients is remarkable, which can reduce the incidence of pressure ulcers and improve patients' bad mood.
Keywords comprehensive nursing intervention; Critically ill patients; Pressure sore
Pressure ulcers are also called pressure ulcers and bedsores. The main reason is that the patient's local limbs and tissues have been oppressed for a long time, which affects blood circulation, leading to continuous hypoxia and ischemia of subcutaneous tissue and local skin, and finally tissue ulceration and necrosis. Patients with severe illness will also endanger their lives and health [1]. The author analyzes the implementation of comprehensive nursing mode for critically ill patients, and the detailed report is as follows.
1 data and methods
Basic information of 1. 1
49 critically ill patients from 20 12 to 20 13 12 were selected as the research objects and randomly divided into intervention group and control group. There were 24 patients in the intervention group, including male patients 13 and female patients 1 1 case. The youngest patient was 5 1 year, and the oldest patient was 83, with an average age (6 1.8? 3.5 years old. There were 25 cases in the control group, including 65438 03 males and 65438 02 females. The youngest patient was 50 years old and the oldest patient was 84, with an average age of 62.4? 3.3 years old. There was no statistical significance between the two groups, that is, P & gt0.05.
1.2 nursing methods
The control group adopted routine nursing mode, such as observing patients' basic vital signs, taking care of patients' daily life and guiding patients to take medicine. The intervention group adopted comprehensive nursing intervention mode, which mainly included: (1) skin care; Because the skin of critically ill patients is emaciated or edema, the skin condition is poor. Nurses can choose an air cushion bed and apply foam to the prominent parts of patients to ensure that they turn over more than twice every hour and get proper massage. (2) Life nursing; Keep the patient's skin dry and clean every day, and change clothes, sheets and quilts for the patient regularly. Scrub the patient's skin with warm water every day, massage the compressed skin and relieve local blood circulation. For patients who use drainage tube, nursing staff need to clean the drainage tube regularly to avoid infection. (3) nutritional support; For elderly patients, insufficient nutrition intake leads to emaciation and prone to pressure ulcers. Nurses can make a corresponding diet table according to patients' own conditions, and take the form of eating less and eating more meals to ensure patients' reasonable intake of fat, protein, sugar and trace elements. (4) Psychological nursing; Pressure ulcer is a common complication of critically ill patients, and it is also a difficult point to carry out nursing work. Because of long-term bed rest, patients lose confidence in treatment, which leads to a decline in quality of life and an increase in economic burden. Nurses need to communicate with patients actively and enthusiastically, and explain the harm, forming factors and preventive measures of pressure ulcers to patients. For patients who can't communicate, you can use gestures and handwriting boards. Help patients rebuild their confidence in overcoming diseases.
1.3 observation index
All patients were assessed for their negative emotions according to self-rating anxiety scale and self-rating depression scale, with the full score of 100. The higher the score, the more serious the anxiety and depression.
Statistical analysis of 1.4
SPSS2 1.0 was used for statistical soft analysis, chi-square test was used for counting and t test was used for measuring data, P
Two results
There was no statistical difference in negative emotions between the intervention group and the control group before nursing, that is, P & gt0.05. Among them, the degree of anxiety and depression in the intervention group with comprehensive nursing intervention mode was lower than that before nursing, and the difference before and after nursing was statistically significant, that is, P < 0.05. The scores of anxiety and depression in the control group after nursing were also lower than those before nursing, but there was no significant difference before and after nursing, that is, P & gt0.05. The detailed results are shown in table 1.
Number of cases in this group: depression and anxiety.
Before nursing, after nursing, after nursing and after nursing.
Intervention group 24 59.62? 6.84 42. 19? 2.68 57.46? 6.53 4 1.35? 3.2 1
Control group 25 58.45438+0? 6. 15 52. 14? 5.32 57.39? 6.42 52.69? 5.36
Table 1 Compare the negative emotions of the two groups.
3 discussion
Because of the poor skin elasticity, less subcutaneous fat and insufficient nutrient intake of critically ill patients who have been in bed for a long time, it is more difficult to care for their skin. Moreover, pressure ulcers are prone to occur, and the clinical manifestations of pressure ulcers are numbness, erythema, ulceration, ulcer and necrosis. In addition to comprehensive nursing intervention, our hospital should also set up a pressure sore nursing team to prevent the occurrence of pressure sores in critically ill patients. The main members are 1 nurse, 1 skin nurse and 4 responsible team leaders. Responsible for observing and tracking patients and guiding nursing staff to carry out the clinical treatment of pressure ulcers. Put a sign on the bedside of patients to prevent pressure ulcers, so as to improve the attention of nurses and patients. Strengthen the nursing staff's handover system. Nurses in two shifts need to observe the patient's skin together and report any skin abnormality immediately.
At the same time, when nursing critically ill patients, it is necessary to prevent patients from lung infection, strengthen the number of patients turning over, buckle their backs and help patients expectorate. For patients with weak system, sputum expectoration machine can be used. In order to keep the patient's respiratory tract unobstructed, sputum aspiration can be performed when necessary. Nurses care for patients' oral cavity more than twice a day to avoid oral parasite infection. Patients should be encouraged to drink plenty of water and keep the respiratory tract unblocked.
In a word, comprehensive nursing intervention and corresponding preventive measures for critically ill patients can effectively reduce the incidence of pressure ulcers and improve patients' bad mood.
References:
[1] Tang Yulin, Huang Mei, Yang Wenqun. Prevention and nursing of pressure ulcers in critically ill patients [J]. Modern Medicine and Health, 2012,28 (2): 266-267.
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