Measures to prevent pressure ulcers
Attention should be paid to comprehensive prevention combining local nursing with patients' general situation.
1. Body position
(1) Body position change: relieving local oppression and preventing pressure ulcers are the main principles and the premise of treating pressure ulcers. On the surface, turning over is the simplest and most effective way to relieve stress, but in essence it is the main measure to make up for the imbalance of physiological reflex activities. Although various cushions, mattresses and straps have been continuously improved, good results have been achieved in the application of various turn-over beds, air-cushion beds or sand beds. But the most basic, simple and effective preventive measures are that nurses or their families help patients turn over, or patients change their positions regularly. Generally, supine position and lateral position are used alternately, and the interval is no more than 2 hours.
(2) Angle of lateral position: According to the mechanics principle, it is suggested that clinical nurses can reduce local pressure by changing the contact angle between human body and bed, and at the same time, they can also use soft mattress to change the stress area to reduce local pressure, so as to achieve the purpose of preventing pressure ulcers. When the human body forms a 90-degree angle with the bed, the contact part bears the greatest pressure. When the human body makes an angle of 30 with the bed, the local pressure is 65438+ 0/2 of the body weight.
Use decompression articles
Reduce the pressure on the prone parts of pressure ulcers, otherwise any treatment will be of no help. When people lie on their backs, sacrococcygeal region is the main compression point to support the weight of buttocks. Place a cotton pad or other elastic and soft objects at the back of the sacrococcygeal region, which can be used to cushion the compression of gravity on the sacrum. Patients who are too emaciated, no matter what posture, have more carina parts than normal people, and are prone to multiple pressure ulcers. In order to avoid pressure on many parts of the body, you can use an air cushion bed or an air cushion chair to massage the prominent parts of the bones through regular inflation and deflation.
3. Reduce friction and shear force
(1) Pay attention to raising the angle of the bedside: when the bedside is raised by 30, shearing force and sacrum compression will occur. Therefore, it is necessary to try to avoid the head of the bed from rising above this height. When it is necessary to raise, you can put a cotton pad on the sacrum, and replace the sacrum with rich subcutaneous fat in the buttocks to bear the body weight.
(2) No massage: Massage has been used for a long time, but its reliability was doubted in the late 1970s. Too much massage is harmful to the tissue. After massage 1min, there may be problems such as increased pulse, decreased venous oxygen content and decreased skin humidity. Autopsy proved that all the massaged tissues were impregnated and denatured, and there was no massage and no tearing. If the skin continues to be red, it means that there is a large area of circulatory disorder in the subcutaneous tissue. Rubbing hard will aggravate the injury and make it worse, so massage is forbidden in the red part.
Protect skin
(1) Scrub the compressed parts every morning and evening, keep the skin clean and dry, and change the wet sheets and clothes for patients in time.
(2) Check the whole body skin 1 time at least every day, especially the parts prone to pressure ulcers. Acute patients can be treated by doctors, nurses and their families.
(3) If it is urinary incontinence, the patient should be given bladder training or other behavioral therapy to reduce the occurrence of urinary incontinence; If it is fecal incontinence, the primary cause must be determined and eliminated.
(4) The application of new dressings, such as skin protective film, transparent film and thin hydrocolloid dressing, can prevent pressure sores.
Strengthen nutrition
A good diet is an important condition for improving patients' nutrition and promoting comprehensive healing, including regulating gastrointestinal function, giving a diet with high protein, high calorie and high vitamins, and carefully regulating patients' appetite. When necessary, enteral route (via nasogastric tube, nasojejunum tube, gastrostomy or jejunostomy) can be combined with parenteral route (via peripheral vein or central vein) to supplement nutrition, and different methods can be selected according to patients' different conditions to restore the internal environment balance as soon as possible.
6. Health education
It is very important to give patients detailed psychological care and explain various risk factors of pressure ulcers for preventing or reducing the occurrence of pressure ulcers. Patiently educating patients to adopt various methods to change their behavior, popularizing knowledge of pressure ulcer prevention and doing a good job of follow-up in a planned way can reduce the recurrence of pressure ulcers.