Pressure Ulcers

By Lauren Lazarevski RN, BSN, CWOCN

As I contemplate the current conversation around ventilators, I am encouraged to refresh my knowledge about mucosal pressure injuries. Pressure injuries on the mucous membranes present and are staged differently from cutaneous pressure ulcers, and they are usually attributed to a medical device or tube. Nasogastric or orogastric tubes, oxygen cannulas or masks, endotracheal tubes, and urinary and fecal containment devices pose a risk of causing local ischemia to tissue in the nose, mouth, genitals, or rectum, respectively. Once a mucosal injury occurs, the patient is at increased risk of other problems, including pain, infection (especially if injury occurs to the urinary tract), and even malnutrition, if pain from oral wounds makes it difficult to eat and drink. These hospital-acquired pressure injuries contribute to the physical burden on the patient, as well as the financial burden on the hospital because they do count as a nosocomial—and usually, preventable—ulcer.

By the WoundSource Editors

COVID-19: The name of the disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The abbreviation COVID-19 is short for coronavirus disease 2019.

Fit test: A 15- to 20-minute testing of the seal between the respirator's facepiece and your face. After passing a fit test with a respirator, you must use the exact same make, model, style, and size respirator on the job.

Liquid sealant: Liquid skin sealants are designed to protect vulnerable areas from the effects of skin injury. They form a transparent protective coating on the skin. Indicated for use on stage 1 pressure injuries and low-exudating stage 2 pressure ulcers, pressure points and bony prominences, and under adhesive products to protect the skin.

By Holly M. Hovan MSN, RN-BC, APRN, CWOCN-AP

With National Nurses Week approaching, we will once again be seeing the work of Florence Nightingale highlighted, along with the concepts and values that have built the nursing profession. As we've heard many times, nursing is an art and a science. The basic foundations and concepts of nursing are built from evidence, books, and what we learn in school from our teachers, professors, and clinical instructors. The science behind nursing is important—there are formulas, math, research, memorizations, and concepts that must come from a book. However, there is also a huge piece of nursing that comes from our hearts. Nursing is caring, compassion, kindness, and wanting what is best for someone else. Nursing is wanting to help our patients and our peers. Being a nurse is a calling and a passion, and that piece can't always be learned... it starts in our hearts, and it shows in our practice.

By Kara S. Couch, MS, CRNP, CWCN-AP

Hospital-acquired pressure ulcers (HAPUs) pose a challenge for acute and post-acute care environments and are listed as hospital-acquired conditions (HACs) by the Centers for Medicare & Medicaid Services (CMS). Other HACs include central line–associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Although CLABSIs and CAUTIs have seen a decrease in prevalence over the past decade, the HAPU is the only HAC that has not. In my recent WoundSource webinar, I discussed the topic of building a pressure ulcer prevention program within hospitals. The webinar is still available for viewing on WoundSource.com.

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.

By the WoundSource Editors

Pressure injuries represent a great challenge in patient care, as well as a significant burden on the health care system. This burden is likely to continue to increase as a result of the growing geriatric population, along with the increasing rates of obesity, diabetes, and cardiovascular disease. Recent estimates in the United States show annual costs of pressure injury treatment to be approximately $9.1 to $11.6 billion. In addition to cost, these localized injuries to the skin are often very painful for patients, particularly as the injuries become more severe.

By the WoundSource Editors

Pressure injuries require complex care. They can be incredibly painful for patients, and they represent an enormous financial burden on the health care system. Nationally, pressure ulcers cost between approximately $9.1 and $11.6 billion annually to treat. A subset of these patients includes those who are particularly prone to developing pressure ulcers as a result of comorbid conditions. This subset includes patients who may have cognitive disabilities, those who have a spinal injury or have undergone an amputation, and bariatric patients.

By the WoundSource Editors

Pressure injuries are a significant risk for patients and pose a tremendous clinical challenge to medical providers. Serious pressure injuries can present a substantial threat to patients' survival when comorbidities are present, and even less serious pressure injuries can negatively affect a patient's comfort and well-being. Although some pressure injuries are unavoidable, best practices in patient skin care can greatly reduce the risk in many circumstances, with some research demonstrating that up to 95% of pressure injuries are preventable.

By the WoundSource Editors

With aging populations facing increasingly complex comorbid medical conditions coupled with polypharmacy and multidrug-resistant organisms, wound healing can often feel like an uphill, never-ending battle. There are often elements that cannot be allayed, and some factors will always be outside the control of the patient and the practitioner. Barriers that can be eliminated should be, but sometimes compliance is a concern.

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

Worldwide Pressure Ulcer/Injury Prevention & Awareness Day is November 21st. This day is considered pretty much a holiday at my home. I have Stop Pressure Ulcer tee shirts, and I order a cake or STOP sign cookies every year from the bakery in memory of my mother. To some it might sound crazy, but my life was strongly impacted forever in 1996 after my mother passed away in my arms at only 47 years old because of complications of diabetes and what was called at that time "multiple decubitus." The image and smell will never leave my mind. It changed my life forever as a daughter, a caregiver, and later as a wound nurse. I needed more answers to heal my heart. How could my mother acquire such horrible wounds while at the hospital to get better? My mind was twirling nonstop with the 5Ws. Who, what, when, where, why? So, then it began. I wanted to learn everything I could. This ended up being sort of my therapy, which transitioned into my passion and purpose.