Pressure ulcers are avoidable
in 95% of cases. A nurse has an important function in preventing them and in
their correct treatment.
Many years ago I was at a
nursing home in a small town and I saw for the first time a pressure ulcer in a
patient. What I was surprised of, apart from the size of it, covering the
entire back, was how the nurse was spreading honey all over the ulcer to heal
it.
In our practice as future
nurses we see the use of techniques that are not correct because they are not
based on scientific evidence.
I’m going to make a
reflection on the mistakes we that tend to make when we don’t follow the
scientific evidence.
The most usual mistakes in
prevention:
- Not using the
Norton scale à You must use the Norton scale for assessing the
risk of pressure ulcers.
- Applying
alcohol on the skin àYou must not apply it, because it produces dryness.
- Massaging red
areas and bony prominences à Don’t do it. AGHO should be applied in areas exposed to
friction, pressure or shear.
- Not to do
postural changes à postural changes must be scheduled, programmed and
individualized and wehave to teach the patient or caregiver to do them.
- Raise the bed
30 ° à It must not be done.
- Use floats as
a seating surfaces à Don’t do it, because pressure is concentrated on
the body area in contact with the float and produces a compressive effect.
- Bandages on
the heels à foam heels are more effective than padded
bandages.
- Carelessness on the sterility of productsàWe must maintain sterilit.
Most common mistakes in
treatment:
- Changes on treatment
before 8-10 days à We must keep it a minimum of 8-10 days to make
sure it is useful.
- Dry cure à Moist wound healing provides the level of
temperature and humidity suitable for biological remediation and a
semipermeable barrier that prevents the evaporation of excess moisture and acts
as a wall to bacteria.
- Cleaning wound bed with antiseptic products à It must not be done. These are inactivated by
contact with organic matter. They can irritate the granulation tissue. They
need a minimum operation time. And the residual effect is short-lived.
- Touching wound
bed when we dry the ulcer à Do not touch, dry surrounding skin only.
·
Debridement:
o
Mixing
collagenase + silver à silver is inactivated. Correct choice: collagenase
+ hydrogel.
o
Debridement on
the heel à It’s not necessary, there is risk of
osteomyelitis.
·
In
Infection:
o
Using
antibiotic ointments à Antibiotic treatment must be oral. Use silver
dressings.
o
Improper
dressing Size à it must be put on the wound and about 2-3 cm of
healthy skin.
o
Placing gauze under
dressings à it difficults the exudate management and can it adhere.
o
Placing
adhesive dressings after applying hyper-oxygenated fatty acids à they don’t
adhere properly.
o
Putting
silicone net dressing with healing
dressings for moist evironment so that the injury doesn’t stick à It only increases costs.
o
Setting cures
regardless of wounds evolution à We should Schedule
them depending on the state of the wound.
o
Not recording
properlythe size of the lesions à We don’t have
objective data of the lesion evolution.
o Not thinking about an extra protein intakeà It should be
administrated if there is no contraindication to have a protein diet with
supplements of vitamin C.
