Pressure ulcers are caused by long-term pressure on local tissues of the body, obstruction of blood circulation, and inability to properly supply the nutrients required by the skin and subcutaneous tissue, causing the local tissues to lose their normal functions and form ulcers and necrosis.
1. Prevention of pressure ulcers
Pressure ulcers have long been a hot topic in hospital nursing work. It is a stubborn disease that needs to be overcome in nursing work. Pressure ulcers not only cause pain and even death to patients, but they can also prolong hospitalization. Post-operative patients, long-term bedridden patients, elderly patients, low-protein patients, emaciated patients, obese patients, paralyzed patients, and patients with incontinence are the main groups of people who develop pressure ulcers.
Prevention is an important means to avoid pressure ulcers. Use effective protective measures, formulate a diet plan, and provide health education. "Seven diligences" are very important to prevent pressure ulcers, that is, frequent observation, frequent turning, frequent tidying up, frequent scrubbing, frequent massage, frequent shift handover and frequent replacement.
1. Avoid long-term compression of local tissues
(1) Encourage and assist bedridden patients to frequently change their lying positions, usually turning over every 2 hours, and the interval can be shortened if necessary. The patient should be lifted when turning over, taking care to avoid dragging, pulling, pushing, etc.
(2) Use soft pillows or sponge cushions in the patient's body gaps, and use air cushion pressure, water pressure, etc. to reduce the pressure on the bone protrusion. Loop-shaped pads that can cause ulcers, such as rubber balloons and cotton pads, should not be used.
(3) For patients using plaster, splint, or traction fixation, check whether the pad is flat and in the appropriate position. You should also observe local and extremity skin color changes at any time.
2. Avoid irritation from local physical and chemical factors
(1) Keep the skin clean and dry
(2) Incontinence and sweating
< p> (3) The bed should be made frequently and bed clothes should be changed in time.Avoid moisture, friction, irritation such as urination and defecation, and patients with excessive secretions should be scrubbed in time; patients should not be allowed to lie directly on rubber sheets (or plastic sheets), and it is strictly forbidden to use damaged bedpans.
3. Promote local blood circulation. Check the compressed areas frequently and massage them regularly with 50% ethanol or safflower alcohol.
(1) Manual massage
1) Full back massage: Assist the patient to lie prone or sideways, expose and observe the back and buttocks, and scrub with hot water first. Use 50% ethanol for full back massage. Starting from the patient's sacrococcygeal area, massage the hands downward along both sides of the spine up to the back of the shoulders in a circular motion, back to the coccyx. Repeat this several times.
2) Local massage: Use 50% ethanol to massage the thenar area of ??the palm of your hand close to the patient's skin in a circular motion. The pressure is from light to heavy, and then from heavy to light, for 3 to 5 minutes each time.
(2) Massage with electric massager:
4. Improve nutritional status: If the condition permits, the patient should be given a high-protein, high-vitamin diet, and at the same time, appropriate mineral supplements, such as oral zinc sulfate To enhance the body's resistance and tissue repair capabilities, it can also promote the healing of chronic ulcers.
5. Encourage patients to move
Based on the patient's condition, encourage the patient to get out of bed as soon as possible. Through appropriate limb and muscle activities, the body's blood circulation can be promoted and local tissue ischemia and Hypoxia prevents the occurrence of pressure ulcers.
6. Health education
Inform patients and their families of the dangers of pressure ulcers, and provide them with some knowledge and methods to prevent pressure ulcers, and then work together with patients and their families Effectively prevent the occurrence of pressure ulcers.
2. Care of pressure ulcers
Pressure ulcers are not only complications of certain acute and chronic diseases, long-term bed rest, or inconvenience in local limb movement, but also reflect the overall condition of the patient. At the same time, the condition also reflects the quality of nursing to some extent. Therefore, nursing methods are particularly important.
1. Congestion and rosy period Nursing points: During this period, the cause of the disease should be removed in time and various preventive measures should be taken to prevent the development of pressure ulcers. When massaging the local area, use the pulp of your thumb to make a circular motion, massaging from the area near the pressure sore outward. Infrared irradiation can also be used.
2. Inflammatory infiltration stage. Nursing points: During this stage, the skin should be protected to avoid infection. In addition to strengthening decompression measures, local infrared irradiation can be used. Small unbroken blisters can be bandaged with a thick layer of talcum powder to reduce friction, prevent rupture and infection, and allow them to absorb on their own. Use a sterile syringe to extract the fluid from the large blister, apply disinfectant and then wrap it with a sterile dressing.
3. Ulcer stage Nursing points: In addition to systemic and local measures, surgical dressing changes should be performed according to the wound condition. When the wound is infected, the principle of local treatment is to relieve pressure, clean the wound, remove decay, promote new growth, and promote healing. This period can also be supplemented by infrared irradiation to dry the sore surface and facilitate tissue repair.
4. Psychological care
Patients who are bedridden for a long time and cannot get out of bed and have poor blood circulation are more likely to develop pressure ulcers. These patients generally cannot take care of themselves. Considering that they will harm their families, Unsatisfactory living and working conditions in the future will inevitably make these patients discouraged, disappointed, lonely, depressed, and even desperate. They will lose confidence in treating and overcoming the disease. Some patients may even engage in extreme behaviors such as suicide. In response to these situations, nurses should also consider the patient's psychological needs when taking care of the patient's body, consider the patient's financial status, family support, etc., take measures to solve the patient's actual difficulties, help the patient establish a belief in fighting the disease, and cooperate with effective treatment and care measures to promote patient recovery.