Posted at 11.26.2018
Caring for Pressure Sores in Elderly People with Circulatory Problems from Long-Term Diabetes, in Medical Homes
Pressure sores are tears or ulcerations in your skin, that occur typically in the low half of your body over 'bony prominences' that support the weight of your body during lying, position, and sitting. The most frequent areas that older people are inclined to growing pressure sores are the heel, lower legs and foot, and lower back. Nearly all pressure sores appear in people aged 70 or over through age-related health insurance and lifestyle factors from the elderly.
a) What physical care and attention needs do such seniors generally have?
Damage to your skin leading to pressure sores can cause wounds of varying degrees of severeness, which have the actual to become contaminated. Physical care and attention through wound treatment is thus essential and so effective co-working with medical personnel colleagues like the community nurses will be very very important to nursing home to manage. Recommended medications to counteract attacks and topical ointment locations in order to aid therapeutic are all area of the care regimen for people that have existing pressure sores. Also within wound treatment, dressings and bandages will need to be changed according to the patients worry plan to be able to minimize potential for infection.
Physical care regimens for elderly patients in assisted living facilities residential health care can also require taking actions in order to minimize the chance from stresses, as well as assisting residents in wound treatment as outlined above. As diabetes will often incur the indicator of more frequent dependence on urination, incontinence may be particularly problematic as dampness in clothing, or in bed sheets etc, is likely to cause skin discomfort and thus escalates the risk from pressure sore. Physical treatment thus must involve regular toilet sessions, changes to sanitary health products like pads, and changing foundation clothes when necessary. Staying away from plastic foundation padding is also preferable as plastic will capture dampness between the skin and the plastic material therefore could increase discomfort.
Foot health care is an essential physical need that older diabetic patients will most likely require improve. Because of changes to your body's circulatory system and minimizing ability of the skin to repair and renew itself (turnover of epidermis can reduce by 50% in more mature years), once trivial feet problems like in-grown toe-nails or blisters can result in infections and potentially gangrene (occasionally requiring amputation). Ensuring patients / residents are putting on well fitted footwear and this toe-nails are maintained short should be completed by personnel. This risk from pressure sores is also increased by the reduction in sensitivity that aged-skin possesses - older patients simply might not exactly be able to feel that skin area ulcers or pressure sores are growing until they are really well advanced, therefore more difficult to treat, and for the body to heal. Therefore regular assessments and skin evaluation in risk areas on the body including the feet should make up an important area of the care program for older patients, who might not exactly have the ability to do these investigations themselves, or who might not exactly have enough skin sensitivity to understand these problems as they arise.
b) Why do such elderly people develop foundation sores?
Pressure sores (also called bed sores) should come about through changes in your skin associated with ageing, greatly restricted movement, and when there the body has circulatory problems and the health benefits associated with poor blood flow. Those older patients with diabetes especially, will most likely experience circulatory problems, that happen to be then compounded by the restricted movement and general reduction in mobility involved within the aging process, which places repeated or long term pressure on certain factors of your skin causing deterioration that your body is unable to cope with.
Elderly patients generally are susceptible to skin surface damage and pressure sores through the changes with their skin that make it thinner (dermal width can lower by 20%) and weaker as they get older. These processes include the 'reduction of subcutaneous cells, diminished pain notion, reduced cell mediated immunity, slowed wound recovery, and the improved hurdle properties of aged skin. These natural changes to your skin possess the medical implications that your body's local inflammatory responses will diminish which slows the healing process, and sensory damage in the skin may follow. These are particular factors that expose older people to pressure sores.
In conjunction to the risk from age-related skin area changes, the lot of elderly patients who have diabetes means that compromised circulatory systems can put people at even higher risk. This happens because diabetes affects the body's capacity to effectively control blood vessels as the high levels of glucose that remain in the blood commence to harm the blood vessels, and it is this process that starts to inhibit circulation of blood around the body. Over time, poor flow can have the effect where limb extremities start to suffer and can learn to change in the feeling they arouse - a sense that is specially common is tingling in the low legs and feet. A big change in feeling especially within the legs can be indicative of worsening circulation which can have serious implications when a pressure sore occurs. Poor blood circulation compromises the healing process meaning it requires longer for wounds to mend, and leave people more susceptible to developing attacks and probably gangrene. Change in experience is also often coupled with sensory loss, whereby people may struggle to feel when they have a pressure sore, therefore wounds may be still left untreated for quite a while if not regularly checked out by do it yourself or others.
The restricted motion which many elderly people in care and attention homes experience also puts them at risk. Prolonged sitting down or lying for folks who've difficulty walking or who are bed-bound are the ones that are in the best risk group. Hip-fractures, neurological disease paralysis from conditions such as stroke are common within elderly populations and so should be supervised accordingly. Strokes tend to be problems for people that have diabetes due to the damage that high degrees of glucose causes to blood vessels, which can eventually begin to exert on the arteries, so elderly diabetics may undergo immobilization and feeling loss caused by both strokes and poorer standard blood flow from the diabetes.
c) Describe one Clinical Skill necessary to meet the relevant physical care need(s) of the patients. Describe how this skill would be employed.
Devising a repositioning (regular turning) schedule may help to alleviate the strain on certain specific areas of your skin for people that have restricted ability to move or with standard immobilization. As mentioned previously, elderly diabetic patients will probably suffer poor blood circulation which can result in change in pores and skin sensation and finally sensory loss over some regions of skin. Through this process people may stay or rest for a lot longer periods of time, or be unable to move at all; so increasing the stress placed on set areas of skin - younger parents for occasion typically switch their body weight every 15 minutes, even whilst asleep.
Physical care should thus include examining the repositioning needs of individual patients or residents - some documents discuss a 2-hour turning routine as a bench draw. The time needed between activities and making of the body may however be greater for those at higher risk of pressure sores, such as though who've severe mobility limitation or immobilization; those people who have existing wounds, those on sedating medications (and for that reason may reduce their moves regarding to when on medication and when not. Also factors like whether special mattresses or support areas are being used will have an impact on the rate of which people should be repositioned. Skin inspection should also determine the repositioning needs of individual patient needs.
Physical care routines should therefore apply repositioning by alternating residents / patients between sitting, standing, lying; especially whether people can engage in physical activities during the day. Short walks, motivating movements or moving residents between different rooms within domestic care and attention (such as between communal lounges, gardens conservatories etc) where possible provides health advantages as well as minimizing rest from pressure sores by moving body weight through movements and activity. For those with severe immobilisation or those who find themselves bed bound, rotating bodyweight for lying on back again to sitting in bed etc should be retained along with regular small shifts in body activity (adjusting cushion position, angle of which resting). Written repositioning schedules are also good practice in places of residence (such as assisted living facilities) where multiple caring staff will be making use of the making and repositioning of the individual - this will ensure that the devised timetable of movements is adopted.
d) Supporting literature
Pandya, N. (2003) 'Diabetes management in long-term-care' Caring for the Ages
Vol. 4 No. 2 p21-24
Richens, Y. Stephens F. Bick, D. Morrell, C. Loftus-Hills, A. Duff, L. (2003) 'Pressure ulcer risk examination and reduction: Improving practice, improving treatment' Clinical practice Guidelines, Royal University of Nursing.
Vohra, R. & McCollum, C (1994) 'Fortnightly Review: Pressure Sores' English Medical Journal Vol. 309 p853 - 857
Zulkowski, K (2003) 'Guarding your patient's aging skin' Nursing
Nuffield Institute for Health & NHS Centre for reviews and dissemination (1995) 'The reduction and treatment of pressure sores: How useful will be the measures for rating peoples risk of creating a pressure sore?' Effective Medical Bulletin
www. helptheaged. org. uk
www. nelh. nhs. uk