Assessment of Pressure Ulcers

Pressure ulcers are local injuries to the skin epithelium, the tissue beneath or in some instances both anatomical layers are affected. This occurs most times over bony prominences, secondary to continuous pressure exerted, coupled with a shear. The ulcers are typical in persons unable to reposition themselves for pressure relief on the subject bony prominent regions of the body. Such is evident in the geriatric, malnourished and acutely ill demographic. According to Mortimer (2020), the considerably significant prevalence in long-term care units often fluctuates, ranging from 8% to 53% with the incidence varying from 7% to 71% as of 2018 data. The typical anatomical areas wherein pressure sores are a common occurrence are the sacrum and heels, with a grade 1 or 2 majorities. Still, an increase in age is directly proportional to the incidence and prevalence of pressure ulcers (Mortimer, 2020). Demographic shifts and the projected increase in the geriatric population is suggestive of a potential rise in the prevalence and incidence of pressure sores, except if preventive interventions are employed, and to do this. A comprehensive assessment would be ideal to appreciate the surrounding dynamics.

Assessment of established pressure sores includes a comprehensive medical evaluation of the subject patient. An extensive patient history captures the start and duration of the ulcers, prior wound care approaches, risk factors and a detailed listing of health concerns and pharmacological (Friedman, Bowden & Jones, 2003). Other variables like mental health, conduct and cognition, social and economic factors, and reach to caregiving services are pivotal in the preliminary assessment and may impact the treatment protocols (Baker, Kesler & Guidotti, 2020). The existence of a pressure ulcer could be indicative of the patient lacking proper support, in this case, the victim may require intensive support systems or the caregiving team need more training, respite, or aids with lifting and shifting the patient. Patient with engagement or sensory impairments are more prone to acquiring these sores, given their impairments or may convey their discomfort in atypical ways.

The essence of a comprehensive occupational and environmental health history cannot be stressed more. Work impacts the health of all persons, whether through injury or via the effects of acute or chronic conditions which might predispose a victim to develop pressure ulcers (Baker, Kesler & Guidotti, 2020). Furthermore, with industrial advancements and the institution of various chemicals and other toxic items into the environmental space, it is essential for the health practitioner to factor in both occupational and environmental exposures when sourcing for a medical history of pressure ulcers.

Air and water pollution, food contamination, released from neighbouring industries or waste disposal sites, and environmental hazards within the housing setup, are among the top expressed concerns by patients, the surrounding community, and public health experts.  In taking a comprehensive occupational and environmental health history on pressure ulcers, one is mandated to address these queries or concerns related to the environment and work, as they could be contributory to the development of the sores (Baker, Kesler & Guidotti, 2020). This would be critical in evaluating pressure ulcers patients, more so in the initial hospital visits and for those expressing new-onset symptoms, from hard metal poising that could impair the neural functioning, incapacitating ambulatory motor movements to predispose the patients to pressure ulcers (Cogan et al., 2017). In this case, I would be asking questions on the community, housing status, hobbies, occupation, distinctive attributes, diet and drugs, as a practical starting point. Some of the mentioned questions might appear irrelevant, but then the essence of being comprehensive is to rule out any other indirect factors that could be the trigger to the pressure ulcers. In this case and as a health practitioner, I should understand the direct and indirect effects of given environmental exposures on the patients and the similarities and distinctions between occupational and environmental health.

Being able to understand the probable contribution of occupational exposures to the patient’s illness, another model would be to visit the workplace; however, time interests may limit those patients for whom such approaches may be accorded to (Cogan et al., 2017). In this case, i would first seek consent to reach out to the workplace and move forward to find workplace access through reaching out to the employer’s health and safety oversight authority, or in smaller setups, the manager. Pressure ulcers patients have workplace predispositions like; uninterrupted sit-downs for long hours, working gear –tight and clunky shoes were applying unfettered heel pressure, also tight and uncomfortable clothing applying excessive pressure on bony prominences. Asking such questions would be integral in gaining more information on the probable causes.

In the process of taking the patient history, it is essential to remember that there may have been an inspection conducted by the oversight Occupational Safety and Health Administration that may come in handy for assessment. In this case, a referral could be precisely active should I suspect probable violations of the stipulated standards of workplace activity.

Friedman Family Assessment

The Friedman Family Assessment tool, coupled with health knowledge and relevant history taking frameworks, enables the health practitioner to dive into the domain of assessing the family health (Friedman, Bowden & Jones, 2003). In doing so, collaborate with the family as a client in crafting the family health maintenance and facilitation approaches for the pressure ulcers patient. In this case, the Friedman assessment tool was opted for based on clinical exposure, as it fits with the established nursing philosophies in our setup. This model features closed-ended questions based on the FSO structures. This assessment is based on a structured evaluation of the surrounding family factors focused on addressing contributing variables that can be attributed to the development of pressure ulcers (Friedman, Bowden & Jones, 2003).  The Friedman assessment model examines the various family elements employing a quantitative paradigm of research.

The pressure of a pressure ulcer could be indicative of the patient lacking proper family support; in this case, the victim may require intensive support systems involving the family, or the caregiving team need more training, respite, or aids with lifting and shifting the patient (Jiang et al., 2020). The structured questions in the Friedman model would aid in the collection of rich data on the pressure ulcers factors by the patient’s family, pertinent to the initial perceptions held by the families. In doing so, offer guidance on therapeutic interventions based on the formalized Friedman Family Assessment framework. (Friedman, Bowden & Jones, 2003)

Risk assessment

According to Mortimer (2020), applying the pressure sores risk assessment models is an element of the assessment approach employed in identifying persons at risk of acquiring a pressure ulcer. Several international pressure ulcer prevention models have recommended risk assessment tools, but it remains a concern, whether a risk assessment is of considerable difference in patient outcomes. Herein, I would appreciate the ideal roll and critical questions to be answered and to ask the patient in recognising the pressure ulcers dynamics. Given the several risk factors pointed out in medical literature, nurses have found assessment tools crucial in instituting additional aids in the identification of patients at risk of pressure ulcers. In my assessment I would use the Braden scale, structured for usage on patients and features six subsets; sensory perception, moisture, activity, mobility, nutrition, friction and shear (Mortimer, 2020). According to the model, the overall grading ranges from; 6-(high risk), to 23-(low risk), and, with 18, set as the benchmark score for pressure sore risk.

Health Risks

There are several identified risk factors for pressure ulcers, with some physiological and non-physiological. These involve diabetes, peripheral vascular diseases, septicemia, CVA and low blood pressure (Mortimer, 2020). Besides, there are additional factors, mostly intrinsic and are; being over 70years, tobacco use, urinary and faecal incontinence, malnourished persons, immobility, cancer disease, prior history of pressure sores and the white race. However, medical research has disputed the white race for being a predisposing factor for pressure sores, as the considerably small account of nonwhite victims would make someone question this conclusion. Some researchers have pointed out that the black race is prone to more severe sores as compared to other races.

In conclusion, it has been debated that pressure ulcers risk assessment is primarily not an interventional measure, instead of an antecedent to the generation of an ideal plan of care to curb or minimize the impact of the highlighted predisposing variables. Should risk assessment be practical, then a drop in the prevalence and incidence of pressure sores should succeed. Assumingly, such implies that the risk assessment is succeeded by ideal risk intervention and that these measures are present and practical; however, from this paper, it appears not the case.

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