Model essay on nursing of pressure sore 1: formation and nursing of acute pressure sore
Pressure ulcer is a kind of pressure ulcer, which causes blood circulation disorder, tissue nutrition and hypoxia, and then makes skin and subcutaneous tissue lose normal function and tissue damage and necrosis [1]. Pressure ulcer itself is not a disease, most of them are accompanied by other diseases, mainly because they are not well cared for during illness. It has been reported [2] that the incidence of pressure ulcers in hospitalized patients is1%~1%,while the incidence of pressure ulcers in surgical patients is as high as 4.7% ~ 66.9%. Due to some non-artificial and artificial factors in the operation process, patients are more prone to acute pressure ulcers and increase pain. From 20 10-0 1, 94 cases were operated for more than 6 hours after operation, the risk score of pressure ulcer and related factors were analyzed, and corresponding nursing measures were put forward. The report is as follows.
Clinical data of 1
On the day of operation, the visiting nurse scored the patients according to Waterlow pressure sore risk score. Scores of 10 ~ 15 are classified as dangerous, 15 ~ 20 as highly dangerous, and scores above 20 as very dangerous. The higher the score, the greater the possibility of pressure ulcers. Collection of operation time > postoperative records: 6 hours after operation, 94 cases, including 565,438 0 males and 43 females. The age ranged from 6 to 81year, with an average of (54.7? 1 1.5) years old. At the beginning and end of the operation, the visiting nurse conducted a comprehensive examination of the patient's skin, focusing on the prone parts of acute pressure ulcers: supine position, occipital protuberance, scapula, elbow, spinal protuberance, heel and sacrococcygeal region; Lateral position, auricle, acromion, hip, greater trochanter, knee and ankle; Prone position, forehead, cheeks, female breasts, sternum, rib protrusion, anterior superior iliac spine, male genitals, anterior knees and toes. If you find that the skin is under pressure, make a record carefully. Actively prevent the occurrence of intraoperative pressure ulcers and deal with them in time according to high-risk factors.
Two results
During the operation, there were 3 cases of acute pressure sore, 3 cases of craniotomy/kloc-0, and several blisters appeared on the scapula. 1 case is a patient with lumbar spondylolisthesis treated by internal fixation through orthopedic posterior approach, and the breast appeared 5cm after operation. 4cm ulceration, 1 case of posterior cervical spinal canal enlargement, during which a cluster of blisters appeared on the left knee. After effective and scientific nursing, the wound healed well.
3 discussion
3. 1 Causes of pressure ulcers
The occurrence of acute pressure sore during operation is closely related to the operation time, anesthesia state, temperature, humidity and the patient's own situation. The main causes of pressure ulcers are local skin compression and ischemia. The operation time is prolonged, the skin is compressed, the tissue is in a state of hypoperfusion and ischemia and hypoxia for a long time, and the incidence of pressure ulcers is higher. Surgery patients are under anesthesia, and more than half of them will suffer from hypoxemia during anesthesia. Because the blood vessels below the anesthesia block plane relax, the blood flow slows down, and accordingly the skin tissue at the blood supply site is ischemic and hypoxic. Furthermore, patients will temporarily lose their response to discomfort in some parts of the body during anesthesia, and can't adjust their posture in time to reduce the occurrence of oppression. These factors aggravate the hypoxia of skin tissue and lead to the occurrence of acute pressure ulcers [4]. Temperature change and moist stimulation are also related factors to the occurrence of acute pressure ulcers during operation. It has been reported that the risk of patients with pressure ulcers will increase by five times in humid environment [5]. When the humidity is too high, too much liquid on the skin will change the surface pH value, lose the protective oil, increase the friction between the skin and the sheets, and increase the risk of skin damage; When the patient's body temperature drops, the peripheral blood volume decreases, and the pressure blood supply further decreases, further increasing the risk of pressure ulcers. In addition to the above external factors, the patient's own situation is also an important factor affecting the occurrence of pressure ulcers. Generally speaking, due to the weakening of vascular elasticity and the decline of peripheral circulation function, the elderly are more prone to skin ischemia and hypoxia after local compression, forming pressure ulcers; Nutritional status is also an influencing factor. Extremely thin patients with thin subcutaneous adipose tissue are prone to pressure ulcers. In addition, it has been reported that patients whose serum protein level is lower than normal are more prone to acute pressure ulcers during operation, and the risk of pressure ulcers increases by 3 times with the decrease of serum protein 1g [6]; The incidence of pressure ulcers in patients with hypoproteinemia, diabetes and rheumatic diseases is also high.
3.2 Nursing countermeasures
First of all, a scientific evaluation system needs to be established. Prevention is the key to nursing acute pressure ulcers during operation. Nurses should master the commonly used evaluation scales such as Braden, Nortor, Wa-terlow, Douglus and Gasnell, scientifically evaluate the risk of pressure ulcers before operation, and formulate corresponding individualized nursing plans according to different risk levels. For example, for patients who are older, have a long operation time, and have cardiovascular and metabolic diseases, they can prevent the use of posture pads or soft pillows in advance. Secondly, do a good job in intraoperative nursing. To assist patients to put a reasonable posture, mechanical factors should be fully considered, natural physiological bending should be maintained, the operating field should be fully exposed, the respiratory and circulatory functions of patients should not be affected, and tissue overstretching should be avoided. We can put good quality body pads such as sponge pads or gel pads in the parts prone to pressure ulcers. Carefully observe the patient's skin condition, such as whether it is wet, cyanosis, pallor, edema, etc., and inform the doctor to take corresponding measures. If the operation permits, massage the compressed parts regularly, and focus on nursing the parts prone to pressure ulcers. External use of saifurun (fatty acid peroxide ester) and other drugs can improve local blood circulation, improve ischemia and hypoxia, and form a lipid protective film locally; Massage is also an effective way to prevent the formation of pressure ulcers. The research shows that [7] when the operation time exceeds 1 hour, decompression massage can reduce local pressure and promote local blood circulation. Control the temperature and humidity of the operating room, keep the operation sheet clean and dry, and deal with the exudate and washing liquid in the operation in time. Finally, do a good job in postoperative care. After the operation, we should first carefully check whether there are blisters, ulcers and so on. In the compressed parts, timely treatment of pressure ulcers and careful records; Change clean and dry sheets for patients in time to keep their skin in good condition; Pay attention to the patient's condition, timely infusion and blood transfusion to avoid acute pressure ulcers caused by insufficient microcirculation.
4 abstract
It is not difficult to prevent the occurrence of pressure ulcers during operation, which has a lot to do with the careful work of nursing staff. This work requires our nurses to attach great importance to it before, during and after operation, formulate a scientific and programmed nursing plan, carefully observe and solve problems in time, which can effectively prevent the occurrence of pressure ulcers. The incidence of pressure sore during operation is an important index to evaluate the nursing quality in operating room. Efforts should be made to do a good job in all aspects related to the operation, so that patients can survive the operation safely, reduce the occurrence of acute pressure ulcers during the operation, and promote the early recovery of patients.
Model essay 2: Application of evidence-based nursing in patients with high-risk pressure ulcers in neurology department
abstract
Objective To evaluate the application effect of evidence-based nursing in high-risk patients with pressure ulcer in neurology department. Methods 90 patients with high risk of pressure ulcer in neurology department were randomly divided into control group and experimental group, with 45 cases in each group. The control group was given basic nursing, while the experimental group was given evidence-based nursing. The incidence of pressure ulcers and sleep quality scores of the two groups were observed. Results The incidence of pressure sore and the score of sleep quality in the experimental group were lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Evidence-based nursing for high-risk patients with pressure ulcers in neurology department can effectively reduce the incidence of pressure ulcers and improve the sleep quality of patients, which can be popularized and applied in clinic.
Evidence-based nursing; Department of neurology; Pressure sore; High risk patients
Neurology is two independent disciplines and does not belong to the concept of internal medicine. It mainly treats inflammatory brain diseases, cerebrovascular diseases, myelitis, nervous system diseases and other diseases [1]. Patients in neurology department are prone to pressure ulcers during hospitalization. Pressure ulcer refers to the disorder of blood circulation caused by long-term compression of local tissues, leading to hypoxia and ischemia, and finally leading to local tissue necrosis, which seriously affects the health of patients [2]. Evidence-based nursing for high-risk patients with pressure ulcers in neurology department can significantly reduce the incidence of pressure ulcers. The specific report is as follows:
1 data and methods
1. 1 general information
90 cases of high-risk patients with pressure ulcer in neurology department from June 20 12 to August 20 14 in our hospital were selected as the observation objects and randomly divided into control group and experimental group, with 45 cases in each group. The ratio of male to female in the control group was 28: 17, with an average age of 60.23? 5. 14) years old, hospitalization time 7 ~ 30 days, average hospitalization time (19.86? 8.67)d； The ratio of male to female in the experimental group was 29: 16, with an average age of 60.56? 5.08) years old, the hospitalization time was 5 ~ 30 days, and the average hospitalization time was (19.72? 7.93. There is no significant difference in general information between the two groups (P & gt0.05), which is comparable.
1.2 method
The control group received basic care, including physical care, diet care and drug care. Evidence-based nursing was carried out in the experimental group, as follows: ① A nursing group was established: one group was composed of/kloc-0 nurses in charge and two nurses, and the members in the group were trained in evidence-based nursing knowledge; ② Question: Find out the causes of pressure ulcers in patients. Neurological patients have poor tissue metabolism, poor mobility, and relatively weak ability to withstand pressure. Due to long-term pressure on local tissues, the friction between the body and the contact surface is large, and pressure ulcers are prone to occur. After finding out the causes of pressure ulcers, this paper puts forward how to prevent pressure ulcers and how to deal with them after they occur. (3) Looking for evidence-based evidence: looking for references and books related to pressure ulcers to verify the causes of pressure ulcers; (4) Evidence-based analysis and evaluation: clinical experience is combined with references and books to evaluate evidence, and the literature and methods used in clinical practice are counted and applied to practical operation; ⑤ Evidence-based application: a. Posture nursing: help patients turn over regularly, adopt a supine posture when turning over, reduce friction, and put a soft pillow with an appropriate height on the patient's back to disperse pressure; B. Nursing care of pressure sore parts: After cleaning the pressure sore-prone parts, apply ointment to form a closed oil film to reduce the friction on the skin; C. Body care: regularly observe the situation of pressure sore prone parts, regularly clean the whole body skin, keep the skin dry, and rub talcum powder on sweaty parts to prevent infection; D diet care: instruct patients to eat high-calorie, high-vitamin and low-fat food, and adopt nasal feeding to absorb nutrient solution for comatose patients.
1.3 observation index
The incidence of pressure ulcers and sleep quality scores of the two groups were observed. The Pittsburgh Sleep Scale was used to score the patients' sleep quality, with a total score of 265,438+0. The higher the score, the worse the sleep quality.
1.4 statistical method
SPSS20.0 statistical software was used for data statistical analysis. Are the measured data average? Standard deviation (x-? S) means t-test; The counting data is expressed by the ratio (%), using? 2 check. P & lt0.05 indicates that the difference is statistically significant.
Two results
The number of pressure ulcers in the control group was 5 cases, accounting for 11.11%,while the number of pressure ulcers in the experimental group was1case, accounting for 2.22%. The score of sleep quality in the control group was (12.56? 2.58), the sleep quality score of patients in the experimental group was (8. 12? 2. 14) points; There were significant differences in the incidence of pressure ulcers and sleep quality scores between the two groups (P
3 discussion
The main causes of pressure ulcers in neurology patients are long-term bed rest, disturbance of consciousness, dyskinesia, limb paralysis, malnutrition, incontinence, lack of protection of compression parts, high friction of compression parts and so on. The clinical symptoms of pressure ulcers are mainly local edema, erythema, blisters and so on. If not treated in time, it will lead to complications such as focal periostitis and osteomyelitis [3], which will aggravate the patient's condition, increase the patient's medical expenses and seriously affect the patient's health and quality of life. Therefore, nursing measures to prevent pressure ulcers and effective treatment after pressure ulcers are particularly important for neurology patients. Traditional routine nursing is limited to nursing patients' problems and symptoms, lacking foresight; Evidence-based nursing refers to a nursing method that combines nursing theory with clinical practice under the guidance of professional knowledge and nursing theory [4]. Evidence-based nursing follows the principles of professional knowledge training, asking questions, looking for evidence, analyzing evidence and applying evidence, so that nurses can think, analyze and solve problems independently when encountering problems, and make nursing work more efficient, scientific, rigorous and professional [5]. Evidence-based nursing can not only improve the work efficiency and quality of nursing staff, but also reduce the medical expenses of patients, provide standardized and economical nursing services for patients, alleviate their pain and have a positive impact on their rehabilitation. The results of this study showed that there were 5 cases of pressure sore in the control group, accounting for 1.11%,and 2.22% in the experimental group. The score of sleep quality in the control group was (12.56? 2.58), the sleep quality score of high-risk patients with pressure ulcers in the experimental group was (8. 12? 2. 14) points; There were significant differences in the incidence of pressure ulcers and sleep quality scores between the two groups (P
refer to
Xiao Min. Application of evidence-based nursing in the prevention of pressure ulcers in elderly patients with severe neurological diseases. Nursing practice and research, 2012,9 (8):17-18.
[2] Li Shujuan. Analysis of nursing countermeasures for preventing pressure ulcers in coma patients in neurology department. Jilin medicine, 2013,34 (3): 558.
[3] Huang Yuhong. Observation on the role of evidence-based nursing in the prevention of pressure ulcers in elderly patients in neurology department. Journal of Mudanjiang Medical College, 2013,34 (6): 92-93.
[4] Li. Application of evidence-based nursing in prevention of pressure ulcers in stroke patients. Qilu Nursing Journal, 20 10, 16(27):89-90.
[5] Han Jie. Application of evidence-based nursing in neurology. Ordinary care, 20 13, 1 1 (5): 394-395.
Model Paper on Nursing of Pressure Ulcer Part III: On Prevention and Nursing of Pressure Ulcer in Critical Patients
Objective: To analyze the clinical effect of comprehensive nursing intervention mode on pressure sore 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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