This document provides guidance on skin and wound care for patients receiving palliative care. It discusses how physiological changes that occur during the dying process can affect the skin. Regular skin assessments are important to document any areas of concern. While preventing pressure ulcers may not always be possible, existing ulcers should be managed through symptom control to improve quality of life. Treatment plans must recognize patients' wishes and goals. The goal in palliative care is often to maintain rather than heal pressure ulcers as death approaches.
This document discusses overlapping chronic pain conditions (COPCs), where many common pain conditions frequently co-occur and overlap. It notes that COPCs are more prevalent in women than men. The failure to account for the heterogeneous and overlapping nature of most chronic pain conditions may result in small treatment effects when administered to general chronic pain populations. It recommends advancing the understanding of COPCs by considering their overlapping nature in clinical trials and pain condition classifications.
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
This document discusses how implementing a person-centered care (PCC) approach could improve dancers' mental health. PCC focuses on knowing the whole person, understanding their context and history, and engaging them as an active partner in treatment decisions. The document outlines that dancers face unique mental health risks like stress, anxiety, depression and eating disorders due to the pressures of their career and need for a supportive environment. It argues that a shift to PCC could help dancers' mental health by reaching a mutual understanding with professionals and considering dancers' priorities and wishes in their specialized care.
Consensus Guidelines For The Management Of Chronic Pelvic PainEliana Cordero
The document provides clinical practice guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC) for the management of chronic pelvic pain (CPP). It includes:
1) An overview of CPP, including its burden and complex multifactorial causes.
2) Recommendations across various areas of CPP management, including general assessment, myofascial pain, medications, imaging, and multidisciplinary care.
3) Evidence and guidelines related to specific sources of CPP, such as endometriosis, adnexal torsion, hysterectomy, and interstitial cystitis.
4) Emphasis on the need for improved education of healthcare professionals and research
This document provides guidelines for the management of cancer pain. It discusses that pain is a common symptom in cancer patients, with a prevalence of over 50% depending on cancer stage. While pain is undertreated in many cancer patients, comprehensive assessment and appropriate treatment including opioids can effectively manage cancer pain. The guidelines cover principles of cancer pain management, diagnosis and assessment of pain, classification of cancer pain, and tools for assessing pain intensity and quality.
This document summarizes research on the relationship between catastrophizing and pain in rheumatic diseases like arthritis and fibromyalgia. It finds that catastrophizing, which includes negatively magnifying and ruminating about pain, is associated with greater reported pain severity, affective distress, tenderness, disability, and worse treatment outcomes. Higher catastrophizing is also related to increased pain sensitivity and central nervous system processing of pain. The mechanisms by which catastrophizing influences pain experience may include reducing active coping and health behaviors, amplifying attention to pain, and sensitizing central pain processing pathways in the brain and spinal cord.
This document outlines the modules in the NURADN6 nursing program. Module 1 focuses on patient safety, including assessing safety risks, fall prevention, restraint use, and emergency procedures. Module 2 covers infection control practices like standard precautions, asepsis, isolation, and hand hygiene. Module 3 is about personal hygiene and bed making. Modules 4-7 address safe patient handling, exercise, vital signs, pain assessment, and nutrition.
This document discusses overlapping chronic pain conditions (COPCs), where many common pain conditions frequently co-occur and overlap. It notes that COPCs are more prevalent in women than men. The failure to account for the heterogeneous and overlapping nature of most chronic pain conditions may result in small treatment effects when administered to general chronic pain populations. It recommends advancing the understanding of COPCs by considering their overlapping nature in clinical trials and pain condition classifications.
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
This document discusses how implementing a person-centered care (PCC) approach could improve dancers' mental health. PCC focuses on knowing the whole person, understanding their context and history, and engaging them as an active partner in treatment decisions. The document outlines that dancers face unique mental health risks like stress, anxiety, depression and eating disorders due to the pressures of their career and need for a supportive environment. It argues that a shift to PCC could help dancers' mental health by reaching a mutual understanding with professionals and considering dancers' priorities and wishes in their specialized care.
Consensus Guidelines For The Management Of Chronic Pelvic PainEliana Cordero
The document provides clinical practice guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC) for the management of chronic pelvic pain (CPP). It includes:
1) An overview of CPP, including its burden and complex multifactorial causes.
2) Recommendations across various areas of CPP management, including general assessment, myofascial pain, medications, imaging, and multidisciplinary care.
3) Evidence and guidelines related to specific sources of CPP, such as endometriosis, adnexal torsion, hysterectomy, and interstitial cystitis.
4) Emphasis on the need for improved education of healthcare professionals and research
This document provides guidelines for the management of cancer pain. It discusses that pain is a common symptom in cancer patients, with a prevalence of over 50% depending on cancer stage. While pain is undertreated in many cancer patients, comprehensive assessment and appropriate treatment including opioids can effectively manage cancer pain. The guidelines cover principles of cancer pain management, diagnosis and assessment of pain, classification of cancer pain, and tools for assessing pain intensity and quality.
This document summarizes research on the relationship between catastrophizing and pain in rheumatic diseases like arthritis and fibromyalgia. It finds that catastrophizing, which includes negatively magnifying and ruminating about pain, is associated with greater reported pain severity, affective distress, tenderness, disability, and worse treatment outcomes. Higher catastrophizing is also related to increased pain sensitivity and central nervous system processing of pain. The mechanisms by which catastrophizing influences pain experience may include reducing active coping and health behaviors, amplifying attention to pain, and sensitizing central pain processing pathways in the brain and spinal cord.
This document outlines the modules in the NURADN6 nursing program. Module 1 focuses on patient safety, including assessing safety risks, fall prevention, restraint use, and emergency procedures. Module 2 covers infection control practices like standard precautions, asepsis, isolation, and hand hygiene. Module 3 is about personal hygiene and bed making. Modules 4-7 address safe patient handling, exercise, vital signs, pain assessment, and nutrition.
Wound healing is a complex process involving three overlapping phases: inflammation, proliferation, and remodeling. During the inflammatory phase, blood vessels are disrupted causing bleeding and a fibrin clot forms. Inflammatory cells are recruited to the wound to remove debris and prevent infection. In the proliferative phase, new tissue such as granulation tissue, blood vessels and epithelium form. Finally, in the remodeling phase, the wound undergoes scarring and strengthening as collagen is remodeled over several months. Factors like infection, smoking, and malnutrition can disturb the healing process, while proper wound care including debridement, dressings and management of bioburden can optimize healing.
The document discusses terminal sedation, which involves deeply sedating a terminally ill patient to relieve suffering until death. There is no consensus on terminology or definitions. While some see it as palliative care, others argue it could be a concealed form of euthanasia. Experts disagree on its acceptability for physical versus mental suffering or patients with different prognoses. Terminal sedation requires careful adherence to principles of double effect and is best seen as a last resort therapy within a comprehensive palliative care plan.
Vortrag von Ulrich Fink und Günter Heimermann,
Diözesanbeauftragter für Ethik im Gesundheitswesen des Erzbistums Köln auf dem Niederrheinischen Pflegekongress 2009 in Krefeld.
This document provides best practice guidelines for identifying, assessing, and managing seven common stoma complications: hernia, laceration, mucocutaneous separation, necrosis, prolapse, retraction, and stenosis. For each complication, definitions, contributing factors, identifying characteristics, assessment parameters, nursing interventions, potential complications, patient education topics, and indications for referral are outlined. The overall purpose is to facilitate proper care of patients experiencing these ostomy issues.
1) The document discusses constipation as a common side effect in cancer patients, especially those treated with opioids, with a prevalence of up to 90%.
2) It provides an assessment approach for constipation involving a thorough history, physical exam, and identification of risk factors to develop an effective bowel care plan.
3) Treatment recommendations include general measures like activity and diet, as well as specific measures like stool softeners, stimulant laxatives, osmotic laxatives, lubricants, and enemas tailored to the individual case.
The document discusses the phases of wound healing: inflammatory, proliferative, and maturation. It describes key events in each phase such as angiogenesis, granulation tissue formation, epithelialization, collagen deposition, and scar remodeling. Growth factors and cytokines that participate in wound healing are also outlined.
Wound healing is a complex, dynamic process involving several phases: inflammatory, proliferative, and remodeling. The inflammatory phase involves hemostasis and inflammation to limit blood loss and seal the wound. The proliferative phase fills the wound gap with granulation tissue through fibroplasia, angiogenesis, and re-epithelialization. The remodeling phase involves regression of vessels and granulation tissue, wound contraction, and collagen remodeling to strengthen the scar. Successful wound healing depends on factors like adequate blood supply, infection control, and avoiding risks such as smoking, which can impair healing.
This document discusses pathophysiology of wound healing and factors affecting it. It begins with an introduction to wound classification and the normal phases of acute wound healing. It then discusses factors that can impair wound healing and cause chronic wounds, such as diabetes, peripheral artery disease, radiation therapy, malnutrition, and infection. Recent developments to expedite healing, such as negative pressure wound therapy, are also covered. NPWT applies subatmospheric pressure to a wound which increases blood flow and stimulates cellular processes to promote granulation tissue growth and accelerate wound closure.
This document outlines the agenda and key points for a "Train the Trainer" seminar. The seminar will cover:
1. Preparation, including understanding adult learning styles, the differences between teachers and instructors, creating checklists and lesson plans, and motivating audiences.
2. Training delivery, including gaining attention, setting aims and objectives, explaining content, facilitating discussions, and demonstrating techniques.
3. Best practices such as using multimedia, facilitating discussions, summarizing, and checking for understanding.
The goal is to equip participants to effectively plan, deliver, and facilitate their own training sessions.
This very short document appears to be in an unfamiliar language and does not provide much contextual information to summarize. It contains a few words that are unclear in meaning along with references to place names that are not well known out of context. The document leaves off with an ambiguous ending of "The end? To be continued".
This document provides teaching techniques to help students improve in three weeks or less. It describes techniques including TPR (total physical response), chanting, Pimsleur, and word recognition. TPR uses physical motions to reinforce vocabulary. Chanting sets lessons to rhythms to engage students. Pimsleur teaches phrases backwards to build fluency. Word recognition links words to pictures to facilitate reading. Combining these evidence-based techniques with repetition in various tones is effective for student growth.
The document provides tips and skills for teachers to improve their classroom performance and effectively communicate ideas to students. It emphasizes the importance of subject matter mastery, developing creative teaching methods, using vocal and physical animation, incorporating humor, role-playing, props, and suspense. Teachers are encouraged to show passion for their subject, understand students, and dedicate themselves to excellence in teaching through enthusiasm, dedication, and unwavering student support.
Train The Trainer Power Point Presentationpreethi_madhan
This document provides guidance on various aspects of designing and delivering effective training, including needs assessment, objectives, content development, delivery methods, and evaluation. It discusses qualities of a good trainer, such as subject matter expertise, presentation skills, and the ability to engage trainees. Key steps in the training process are identified, such as analyzing training needs, designing the content and structure, developing materials, implementing the training, and evaluating outcomes. Factors that influence training design decisions are also addressed, such as the training goals, skills required, and learners' readiness.
TEDx Manchester: AI & The Future of WorkVolker Hirsch
TEDx Manchester talk on artificial intelligence (AI) and how the ascent of AI and robotics impacts our future work environments.
The video of the talk is now also available here: https://youtu.be/dRw4d2Si8LA
How to Become a Thought Leader in Your NicheLeslie Samuel
Are bloggers thought leaders? Here are some tips on how you can become one. Provide great value, put awesome content out there on a regular basis, and help others.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Crit care med give your patient a fast hug (at least) once a daybenylondon
This document introduces the "Fast Hug" mnemonic as a simple strategy to improve quality of care for critically ill patients. The mnemonic stands for Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Checking each component at least once daily can help identify issues, encourage teamwork, and apply evidence-based guidelines. While protocols have limitations, checklists like "Fast Hug" provide a concise approach to consider key aspects of patient care without restricting clinical judgment.
This document provides guidance on preventing and treating pressure ulcers. It begins with the learner objectives and background on skin anatomy. It then discusses early prevention techniques, risk factors, the Braden risk assessment scale, nutrition screening, thorough skin assessment including staging, documentation, and appropriate wound care and support surfaces. The overall message is that diligent skin assessment and individualized prevention plans are necessary to reduce pressure ulcer risk.
Wound healing is a complex process involving three overlapping phases: inflammation, proliferation, and remodeling. During the inflammatory phase, blood vessels are disrupted causing bleeding and a fibrin clot forms. Inflammatory cells are recruited to the wound to remove debris and prevent infection. In the proliferative phase, new tissue such as granulation tissue, blood vessels and epithelium form. Finally, in the remodeling phase, the wound undergoes scarring and strengthening as collagen is remodeled over several months. Factors like infection, smoking, and malnutrition can disturb the healing process, while proper wound care including debridement, dressings and management of bioburden can optimize healing.
The document discusses terminal sedation, which involves deeply sedating a terminally ill patient to relieve suffering until death. There is no consensus on terminology or definitions. While some see it as palliative care, others argue it could be a concealed form of euthanasia. Experts disagree on its acceptability for physical versus mental suffering or patients with different prognoses. Terminal sedation requires careful adherence to principles of double effect and is best seen as a last resort therapy within a comprehensive palliative care plan.
Vortrag von Ulrich Fink und Günter Heimermann,
Diözesanbeauftragter für Ethik im Gesundheitswesen des Erzbistums Köln auf dem Niederrheinischen Pflegekongress 2009 in Krefeld.
This document provides best practice guidelines for identifying, assessing, and managing seven common stoma complications: hernia, laceration, mucocutaneous separation, necrosis, prolapse, retraction, and stenosis. For each complication, definitions, contributing factors, identifying characteristics, assessment parameters, nursing interventions, potential complications, patient education topics, and indications for referral are outlined. The overall purpose is to facilitate proper care of patients experiencing these ostomy issues.
1) The document discusses constipation as a common side effect in cancer patients, especially those treated with opioids, with a prevalence of up to 90%.
2) It provides an assessment approach for constipation involving a thorough history, physical exam, and identification of risk factors to develop an effective bowel care plan.
3) Treatment recommendations include general measures like activity and diet, as well as specific measures like stool softeners, stimulant laxatives, osmotic laxatives, lubricants, and enemas tailored to the individual case.
The document discusses the phases of wound healing: inflammatory, proliferative, and maturation. It describes key events in each phase such as angiogenesis, granulation tissue formation, epithelialization, collagen deposition, and scar remodeling. Growth factors and cytokines that participate in wound healing are also outlined.
Wound healing is a complex, dynamic process involving several phases: inflammatory, proliferative, and remodeling. The inflammatory phase involves hemostasis and inflammation to limit blood loss and seal the wound. The proliferative phase fills the wound gap with granulation tissue through fibroplasia, angiogenesis, and re-epithelialization. The remodeling phase involves regression of vessels and granulation tissue, wound contraction, and collagen remodeling to strengthen the scar. Successful wound healing depends on factors like adequate blood supply, infection control, and avoiding risks such as smoking, which can impair healing.
This document discusses pathophysiology of wound healing and factors affecting it. It begins with an introduction to wound classification and the normal phases of acute wound healing. It then discusses factors that can impair wound healing and cause chronic wounds, such as diabetes, peripheral artery disease, radiation therapy, malnutrition, and infection. Recent developments to expedite healing, such as negative pressure wound therapy, are also covered. NPWT applies subatmospheric pressure to a wound which increases blood flow and stimulates cellular processes to promote granulation tissue growth and accelerate wound closure.
This document outlines the agenda and key points for a "Train the Trainer" seminar. The seminar will cover:
1. Preparation, including understanding adult learning styles, the differences between teachers and instructors, creating checklists and lesson plans, and motivating audiences.
2. Training delivery, including gaining attention, setting aims and objectives, explaining content, facilitating discussions, and demonstrating techniques.
3. Best practices such as using multimedia, facilitating discussions, summarizing, and checking for understanding.
The goal is to equip participants to effectively plan, deliver, and facilitate their own training sessions.
This very short document appears to be in an unfamiliar language and does not provide much contextual information to summarize. It contains a few words that are unclear in meaning along with references to place names that are not well known out of context. The document leaves off with an ambiguous ending of "The end? To be continued".
This document provides teaching techniques to help students improve in three weeks or less. It describes techniques including TPR (total physical response), chanting, Pimsleur, and word recognition. TPR uses physical motions to reinforce vocabulary. Chanting sets lessons to rhythms to engage students. Pimsleur teaches phrases backwards to build fluency. Word recognition links words to pictures to facilitate reading. Combining these evidence-based techniques with repetition in various tones is effective for student growth.
The document provides tips and skills for teachers to improve their classroom performance and effectively communicate ideas to students. It emphasizes the importance of subject matter mastery, developing creative teaching methods, using vocal and physical animation, incorporating humor, role-playing, props, and suspense. Teachers are encouraged to show passion for their subject, understand students, and dedicate themselves to excellence in teaching through enthusiasm, dedication, and unwavering student support.
Train The Trainer Power Point Presentationpreethi_madhan
This document provides guidance on various aspects of designing and delivering effective training, including needs assessment, objectives, content development, delivery methods, and evaluation. It discusses qualities of a good trainer, such as subject matter expertise, presentation skills, and the ability to engage trainees. Key steps in the training process are identified, such as analyzing training needs, designing the content and structure, developing materials, implementing the training, and evaluating outcomes. Factors that influence training design decisions are also addressed, such as the training goals, skills required, and learners' readiness.
TEDx Manchester: AI & The Future of WorkVolker Hirsch
TEDx Manchester talk on artificial intelligence (AI) and how the ascent of AI and robotics impacts our future work environments.
The video of the talk is now also available here: https://youtu.be/dRw4d2Si8LA
How to Become a Thought Leader in Your NicheLeslie Samuel
Are bloggers thought leaders? Here are some tips on how you can become one. Provide great value, put awesome content out there on a regular basis, and help others.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Crit care med give your patient a fast hug (at least) once a daybenylondon
This document introduces the "Fast Hug" mnemonic as a simple strategy to improve quality of care for critically ill patients. The mnemonic stands for Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Checking each component at least once daily can help identify issues, encourage teamwork, and apply evidence-based guidelines. While protocols have limitations, checklists like "Fast Hug" provide a concise approach to consider key aspects of patient care without restricting clinical judgment.
This document provides guidance on preventing and treating pressure ulcers. It begins with the learner objectives and background on skin anatomy. It then discusses early prevention techniques, risk factors, the Braden risk assessment scale, nutrition screening, thorough skin assessment including staging, documentation, and appropriate wound care and support surfaces. The overall message is that diligent skin assessment and individualized prevention plans are necessary to reduce pressure ulcer risk.
Healthcare Problem PresentationBy Vannelyn Oriel1SusanaFurman449
Healthcare Problem Presentation
By: Vannelyn Oriel
1
Problem Definition
In this case, pressure ulcers is the problem that was identified.
Pressure ulcers refer to injuries to the skin and underlying tissue and this is can be attributed to prolonged pressure on the skin.
Today, pressure ulcers is increasingly becoming a major health concern globally.
Healthcare systems worldwide continue to direct resources towards helping patients effectively and efficiently manage pressure ulcers.
Pressure ulcers is becoming a major health concern globally.
It root cause is prolonged pressure on the skin.
It mostly affects patients in hospitals.
Few studies have focused on assessing this healthcare problem.
It is a pattern that I would like to change to improve quality.
2
Pressure Ulcers
According to data from the Agency for Healthcare Research and Quality (AHRQ), more than 2.5 million people in the U.S. develop pressure ulcers annually.
Pressure ulcers especially among patients recovering in hospitals bring pain.
The healthcare problem also leads to increased health care utilization.
There is increase risk for serious infection among patients in hospitals.
Overall, documented cases of pressure ulcers has been on an upward trend globally.
In most cases, pressure ulcers develop among patients who have a specific health condition that limits their ability to change positions.
3
Symptoms and Causes of Pressure Ulcers
There exist various symptoms and causes of pressure ulcers.
The first symptom is unusual changes in a patient’s skin color or texture.
Increased tenderness of skin areas.
Swelling can be observed.
Pus-like draining is another symptom.
Bedsores can be categorized into different stages that cause pressure ulcers.
Common areas for pressure ulcers
Buttocks.
Back of legs, and arms where a patient rests against the chair.
Shoulder and spine.
4
Risk Factors
Immobility for example, assuming a patient in hospital is using a wheelchair, they would apply pressure to specific parts such as buttocks leading to pressure ulcers.
Incontinence where a patient’s skin becomes susceptible due to extended exposure to urine and stool.
Poor diet and nutrition leading to lack of vitamins and minerals that can lead to a healthy skin.
Patients with diabetes also have high risk of experiencing pressure ulcers.
Pressure ulcers if not well managed and treated among patients can lead to complications such as cancer, and bone and joint infections.
5
Description of the Problem
Pressure ulcers is a major health concern in today’s nursing practice.
Despite so, it is largely preventable in nature.
The management of pressure ulcers relies on its severity.
A study by Surg, 2015 established that cleaning of wound, using antibiotics, and undergoing reconstructive surgery were the present treatment options for pressure ulcers (Surg, 2015).
However, there exist newer treatment options such as cell therapy, wound therapy and wound therapy.
...
guidelines for the care of skin in relation to tissue viability 2015 GNEAUPP.
This document provides guidelines for assessing and caring for skin in relation to tissue viability. It outlines how to properly assess skin, including documenting intrinsic and extrinsic factors that may compromise skin health. Regular skin assessment is important to detect any changes or breaks in the skin barrier. Assessing peri-wound skin is also key, as it has a compromised barrier. The guidelines recommend considering various patient-specific factors when assessing skin and providing preventative care and treatment.
The document discusses fever, an overview including:
- Definition of fever as a body temperature above 37.5°C.
- Factors influencing normal body temperature like age, sex, time of day.
- Stages of fever including chill, fever and sweating stages.
- Common causes of fever like infections from bacteria, viruses, parasites.
- Sites to measure temperature including oral, rectal, axillary, ear canal.
- Assessment and management of common fevers is discussed including acute fever, malaria, dengue, chikungunya and typhoid. Non-pharmacological and pharmacological treatment and patient education is also covered.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
This Quick Reference Guide summarizes evidence-based guidelines for the prevention and treatment of pressure ulcers developed by the European Pressure Ulcer Advisory Panel and American National Pressure Ulcer Advisory Panel over 4 years. It provides definitions for pressure ulcers and classifications, as well as recommendations for assessment, wound care, dressings, infection treatment, and other areas. The full Clinical Practice Guideline contains more detailed analysis, research discussion, methodology, and acknowledgments.
This document summarizes expert opinions on the management of CLN2 disease based on a survey of 23 disease experts. It finds that while guidelines do not exist, management strategies are consistent worldwide. A multidisciplinary approach is critical and should include specialists in neurology, palliative care, genetics, physiotherapy, and patient advocacy. Key aspects of management include seizure control using antiepileptic drugs, management of movement disorders, maintaining nutrition, early palliative care involvement, and addressing sleep, pain, and end-of-life issues. The goals of care evolve over the course of the disease from maintaining function to preserving quality of life as symptoms progress.
Project Zero Towards Nursing Never Events - Reduction of Hospital Acquired Pr...Apollo Hospitals
Hospital-acquired pressure ulcers (HAPU) or bedsores e also called pressure sores or pressure ulcers e are
injuries to skin and underlying tissues that result from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks. People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for prolonged periods. Bedsores can develop quickly and are often difficult to treat. Several care strategies can help prevent some bedsores and promote healing.
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation of the joints. It affects around 1% of the adult population globally. The disease is characterized by destruction and proliferation of the synovial membrane that lines the joints, causing pain, swelling, stiffness and limited range of motion. Diagnosis involves assessing symptoms, laboratory tests showing inflammation, and x-rays that can reveal bone erosion over time. Treatment aims to reduce inflammation, slow joint damage, and improve function through medications, exercise, joint protection, and nutritional support. Nursing care focuses on pain management, maintaining mobility and independence with daily activities.
Optimising wellbeing in people living with a woundGNEAUPP.
This document discusses optimizing wellbeing in people living with wounds. It defines wellbeing as having physical, mental, social, and spiritual/cultural components. Living with a wound can negatively impact wellbeing in many ways, such as through physical pain/odor, psychological issues like anxiety/depression, social isolation, and cultural/spiritual conflicts with treatment. The document advocates for a patient-centered approach that considers an individual's overall wellbeing, not just wound healing, and encourages shared decision making between clinicians and patients.
This document discusses the role of medical nutrition therapy in wound healing, specifically for pressure ulcers. It identifies key nutrients needed to support wound repair like protein, calories, vitamins, and minerals. The goals of nutrition intervention for wound healing are to provide adequate nutrients and prevent or promote healing of pressure ulcers. Medical nutrition therapy for wound healing should include increasing energy and protein intake and fluid intake. It also discusses the role of registered dietitian nutritionists in assessing nutritional status, identifying risks, developing nutrition care plans, and monitoring progress.
This document provides a causation evaluation for pressure ulcers that developed in Mitchell Lightfoot during hospitalizations at Local Regional Medical Center and Smith's Center Health and Rehabilitation. It identifies multiple risk factors for pressure ulcer formation in Mr. Lightfoot. There were four deviations from the standard of care at Local Regional Medical Center that led to the development of pressure ulcers. After transferring to Smith's Center, the ulcers deteriorated further due to two deviations from standards of care. Potential defendants are identified as Local Regional Medical Center and Smith's Center. Damages resulting from the deviations included severe pressure ulcers, infections, surgeries, and suffering.
This document discusses the importance and scope of global health initiatives. It covers several key topics, including understanding global health, major global health organizations, managing infectious diseases, immunization programs, maternal and child health, non-communicable diseases, health systems strengthening, health security, environmental health, health equity, the role of technology, public health education, and the future of global health initiatives. The overall message is that global health requires international cooperation to tackle interconnected health issues and improve outcomes worldwide.
Pressure ulcers, also known as decubitus ulcers or bedsores, are localized injuries to the skin and underlying tissue that are usually caused by pressure over bony prominences. They are commonly seen in immobilized or bedridden patients and are associated with increased costs of care and risk of litigation. The Braden Scale is commonly used to assess pressure ulcer risk based on factors like mobility, sensation, moisture, activity, nutrition, and friction/shear. Treatment focuses on pressure redistribution through support surfaces, wound care including debridement and moist dressings, and managing pain and infection. Staging systems classify ulcers by depth of tissue damage from non-blanchable erythema to full thickness tissue loss.
Concept of disease control and concept of disease preventionNithin Mathew
1) Disease control aims to reduce the incidence, duration, and transmission of disease as well as its physical and psychological effects and financial burden on communities. It focuses on primary and secondary prevention.
2) Disease elimination aims to interrupt disease transmission at a regional level, as with measles, polio, and diphtheria. Eradication means terminating all transmission globally, which has only been achieved for smallpox so far.
3) Monitoring involves routine measurement of health status and environments, while surveillance provides continuous scrutiny of disease occurrence and distribution through programs like polio surveillance.
This document describes the development of an evidence-based position statement on medical device-related hospital-acquired pressure ulcers (HAPUs) within a large healthcare system. A task force used the Iowa Model of Evidence-Based Practice to identify device-related HAPUs as an issue, review the literature, and define device-related HAPUs as injuries caused by external medical devices. They developed a position statement to standardize identification and reporting. Implementation involved disseminating the statement to various groups. Initial results showed improved identification and a 33% reduction in overall HAPU rates.
This document discusses a nursing case study that assesses a patient using the Roper-Logan-Tierney model of nursing. The model covers 12 activities of daily living and how they can be influenced by biological, psychological, socio-cultural, environmental, and political-economic factors. The document focuses on assessing one patient admitted to a cardiac ward named Ann and identifies one problem during the assessment and the corresponding nursing care provided.
This document provides guidelines for pressure ulcer risk assessment and prevention. It was developed by the Royal College of Nursing to help reduce pressure ulcer occurrence. The guidelines are intended for use by all healthcare staff, and provide evidence-based recommendations on identifying individuals at risk, using risk assessment scales, recognizing risk factors, skin inspection, pressure redistribution devices, positioning, seating, education and training. They also cover essential care aspects like nutrition, continence and hygiene that can impact pressure ulcer development.
Adapted from the PICOT Questions Template; Ellen Fineout-Overh.docxstandfordabbot
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
Template
for
Asking
PICOT
Questions
INTERVENTION
In
____________________(P),
how
does
____________________
(I)
compared
to
____________________(C)
affect
_____________________(O)
within
___________(T)?
THERAPY
In
__________________(P),
what
is
the
effect
of
__________________(I)
compared
to
_____________
(C)
on
________________(O
within
_____________(T)?
PROGNOSIS/PREDICTION
In
______________
(P),
how
does
___________________
(I)
compared
to
_____________(C)
influence
__________________
(O)
over
_______________
(T)?
DIAGNOSIS
OR
DIAGNOSTIC
TEST
In
___________________(P)
are/is
____________________(I)
compared
with
_______________________(C)
more
accurate
in
diagnosing
_________________(O)?
ETIOLOGY
Are____________________
(P),
who
have
____________________
(I)
compared
with
those
without
____________________(C)
at
____________
risk
for/of
____________________(O)
over
________________(T)?
MEANING
How
do
_______________________
(P)
with
_______________________
(I)
perceive
_______________________
(O)
during
________________(T)?
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
Short
Definitions
of
Different
Types
of
Questions
Intervention/Therapy:
Questions
addressing
the
treatment
of
an
illness
or
disability.
Etiology:
Questions
addressing
the
causes
or
origins
of
disease
(i.e.,
factors
that
produce
or
predispose
toward
a
certain
disease
or
disorder).
Diagnosis:
Questions
addressing
the
act
or
process
of
identifying
or
determining
the
nature
and
cause
of
a
disease
or
injury
through
evaluation.
Prognosis/Prediction:
Questions
addressing
the
prediction
of
the
course
of
a
disease.
Meaning:
Questions
addressing
how
one
experiences
a
phenomenon.
Sample
Questions:
Intervention:
In
African-‐American
female
adolescents
with
hepatitis
B
(P),
how
does
acetaminophen
(I)
compared
to
ibuprofen
(C)
affect
liver
function
(O)?
Therapy:
In
children
with
spastic
cerebral
palsy
(P),
what
is
the
effect
of
splinting
and
casting(I)
compa.
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1. Skin & Wound care for
Patients Receiving Palliative
care
Professor Carol Dealey,
Birmingham, UK
International Pressure Ulcer Guidelines
2. Acknowledgements
Part of this paper is based on the SCALE
Statements and part is based on a joint
paper that I presented with Diane Langemo
at the 11th National NPUAP Conference in
Washington DC in 2009.
International Pressure Ulcer Guidelines
3. “The skin is essentially a window into the health
of the body, and if read correctly, can provide a
great deal of insight into what is happening
inside the body.” (Sibbald et al, 2009)
International Pressure Ulcer Guidelines
4. Palliative Care
It is estimated that about 300 million
individuals, or 3% of the world’s
population need palliative and end-of-
life care each year (Singer & Bowman, 2002).
International Pressure Ulcer Guidelines
5. Guideline Development
Palliative care, according to the World Health
Organization (1989), is focused on managing and
controlling patient’s symptoms while promoting the
best quality-of-life for both the patient and family,
while neither hastening nor prolonging death.
Moderately sufficient informed clinical consensus
exists to support pressure ulcer management in an
individual receiving palliative care, despite the
ethically understandable absence of randomized
controlled trials comparing approaches in human
subjects
International Pressure Ulcer Guidelines
6. SCALE: Skin Changes at Life’s End
A series of consensus
statements developed by
an international panel
Freely available from
www.woundsresearch.com
I include some I think
useful here
International Pressure Ulcer Guidelines
7. Statement 1
Physiological changes that occur as a result
of the dying process may affect the skin and
soft tissues and may manifest as observable
changes in:
skin colour
Skin turgor
Skin integrity
Localised pain
They can be unavoidable despite best
possible care
International Pressure Ulcer Guidelines
8. Statement 4
Skin changes at life’s end are a reflection of
compromised skin:
Reduced soft tissue perfusion
Decreased tolerance to external insults
Impaired removal of metabolic wastes
International Pressure Ulcer Guidelines
9. Statement 7
A total skin assessment should be performed
regularly and document all areas of concern
consistent with the wishes and condition of
the patient.
Although the main concern will be the bony
prominences, other skin damage may be
present such as bruising, mottling of the skin
or skin tears
International Pressure Ulcer Guidelines
10. Moving on to the commonest problem: Pressure Ulcers
International Pressure Ulcer Guidelines
11. The rest of this paper is based on the
International Pressure Ulcer Guidelines
(NPUAP/EPUAP, 2009)
International Pressure Ulcer Guidelines
12. Prevention of Pressure Ulcers
Ideally PU should be prevented in all palliative care
patients, but it must be accepted that it is not always
possible
This section of the presentation identifies specific
prevention guideline statements that should be
utilised when caring for these patients
This is not to say that other statements are not also
important………
International Pressure Ulcer Guidelines
13. Risk Assessment
General Health Status (Strength of Evidence B)
A number of epidemiological studies have used
measures indicating general health status
relevant to the population under study, and
these have emerged in multivariable modelling
as predictive of pressure ulcer development.
Examples include:
number of activity of daily living dependencies
do not resuscitate status
APACHE score
lymphopenia
confusion/mental status
International Pressure Ulcer Guidelines
14. Psychosocial Assessment
Consider the care setting of the patient and the
implications for care delivery
Identify the wishes of the individual and family
members
Identify individual’s problems, not the healthcare
giver’s problems
International Pressure Ulcer Guidelines
15. Repositioning
Repositioning frequency will be influenced by
the individual (SOE = C) and the support
surface in use (SOE = A).
Repositioning frequency will be determined by:
the individual’s tissue tolerance,
their level of activity and mobility,
their general medical condition,
the overall treatment objectives
assessment of the individual’s skin condition.
(SOE = C).
International Pressure Ulcer Guidelines
16. Skin Integrity
Undertake regular skin inspection of the bony
prominences for signs of redness in individuals
identified as being at risk of pressure ulceration.
The frequency of inspection may need to be
increased in response to any deterioration in
overall condition. (SOE = C)
Inspect the skin over bony prominences for early
indications of pressure damage (redness) each
time an immobile individual is turned or
repositioned. Do not turn the individual onto a body
surface that is still reddened from a previous
episode of pressure loading (SOE = C)
International Pressure Ulcer Guidelines
17. Skin Care
Use skin emollients to hydrate dry skin in order to
reduce risk of pressure damage (SOE = B)
A study of risk factors in 286 hospitalised patients
with limited mobility used multivariate analysis to
identify significant factors for pressure damage. They
found dry skin to be a significant and independent
risk factor (Allman et al, 1995). The most appropriate
emollient has yet to be determined.
International Pressure Ulcer Guidelines
18. Nutrition
Provide nutritional support to each individual with both
nutritional risk and pressure ulcer risk, following the
nutritional cycle:
Nutritional assessment
Estimation of nutritional requirements
Compare nutrient intake with estimated
requirements
Identification of a feeding route
Monitoring of nutritional outcome
Reassessment of nutritional status when there is a
change in the individual’s condition.
International Pressure Ulcer Guidelines
19. Reassessment of nutritional status when there is
a change in the individual’s condition.
Individuals may need different forms of nutritional
management during the course of their illness. Furthermore,
this nutritional management needs to be properly managed
and may need to be provided in different settings as their
clinical status changes. Clinical processes can only be
effectively implemented if there is a robust infrastructure.
The clinical team needs to understand the different elements
involved in effective service provision and this also depends
on bringing together many disciplines including catering/food
service, finance and senior management. (Stratton et al.,
2003)
International Pressure Ulcer Guidelines
20. Nutritional management of individuals with
inadequate nutritional intake and pressure ulcer
risk, who are also receiving palliative care or end
of life care, has to take into account their
prognostic profile. Moreover it has to meet
especially the individual’s wishes and preferences.
Family members may also wish to be involved in planning
nutritional management
International Pressure Ulcer Guidelines
21. Individualising Care
Palliative care and end of life care is not a ‘one size
fits all’ system.
It needs to be tailor-made to the individual
Sometimes we have to accept that we will not be
‘permitted’ to provide all the care that we would wish
International Pressure Ulcer Guidelines
22. Pressure Ulcer Treatment
The palliative care individual, with body systems
shutting down, generally lacks the physiological
resources for closure/healing of PU to occur. The
goal may be to maintain or enhance PU status, rather
than healing. As death nears, the skin may be first
organ to be compromised and “fail”, with other
systems following the downward spiral.
International Pressure Ulcer Guidelines
23. Pressure Ulcer Assessment
Regular PU assessment provides information on PU
status & alerts staff to need for treatment change.
Assess location, size, depth, undermining, tunneling,
pain, edema, tissue present (e.g.necrotic, slough,
eschar, granulation, epithelialization), & exudate &
odor.
Wound monitoring is important to continue to meet
goals of comfort & reduction in wound pain &
symptoms such as odor & exudate.
PU may ↓ as death approaches & condition worsens.
As physical condition deteriorates, less frequent
assessment may minimize pain & discomfort.
International Pressure Ulcer Guidelines
24. Pressure Ulcer Management
Set treatment goals consistent with the values and
goals of the individual, while considering the family
input. (SOE = C)
Assess impact of PU on quality of life of patient and
family. (SOE = C)
Set a goal to enhance quality of life, even if the
pressure ulcer cannot/does not lead to
closure/healing. (SOE = C)
International Pressure Ulcer Guidelines
25. Pressure Ulcer Management
The treatment plan will vary according to the specific
requirements of the individual patient.
The next few slides provide some general guidance
which can be adapted to specific patient need
International Pressure Ulcer Guidelines
26. Pressure Ulcer Management –
Dressing Change
Manage the PU and periwound area on a regular
basis. (SOE = C)
Cleanse wound with each dressing change using potable
water, Normal Saline, or a non-cytotoxic cleanser,
minimizing trauma to the wound and to help control odor.
(SOE = B)
Use a dressing that maintains a moist wound healing
environment and is comfortable to the individual. (SOE = B)
Use dressings that can be left in place for longer time
periods to promote comfort related to PU. (SOE = B)
Protect the periwound skin with a skin protectant/barrier or
dressing. (SOE = C)
International Pressure Ulcer Guidelines
27. Pressure Ulcer Management -
Debridement
Debride ulcer of devitalized tissue to control
infection and odor. (SOE = B)
Use conservative, non-surgical (autolytic)
debridement of necrotic tissue as appropriate.
(SOE = B)
Avoid sharp debridement with fragile tissue that
bleeds easily. (SOE = C)
International Pressure Ulcer Guidelines
28. Pressure Ulcer Management -
Infection
Assess PU for signs of infection; ↑pain; friable,
edematous, pale, dusky granulation tissue; foul odor &
wound breakdown; pocketing at base; or delayed
healing. (SOE = B)
Antibiotics may be required to control infection (SOE =
C)
Use an antimicrobial dressing, or a polyurethane
foam or a hydrogel or alginate dressing. (SOE =
B)
Choose a dressing that can absorb the amount of
exudate present, control odor, keep periwound
skin dry, and prevent dessication of ulcer.
(SOE=C)
International Pressure Ulcer Guidelines
29. Pressure Ulcer Management - Odor
Odor results from bacterial overgrowth & necrotic
tissue. Malodorous wounds are often polymicrobic,
with anerobes & aerobes. PU odor can be very
disturbing to patient, contributing to significant
feelings of embarrassment &/or depression, isolation,
& poor QOL.
Assess pt and ulcer, with focus on co-morbid
conditions, nutritional status, cause of ulcer,
presence of necrotic tissue, presence & type of
exudate & odor, psychosocial implications, etc. (SOE
= C)
International Pressure Ulcer Guidelines
30. Pressure Ulcer Management
Control wound odor
Cleanse ulcer & remove devitalized tissue. (SOE=C)
Use metronidazole to effectively control PU odor. (SOE=C)
Use honey to help control odor. (SOE = C)
Use external odor absorbers for the room (e.g. activated
charcoal, kitty litter, vinegar, vanilla, coffee beans, burning
candle, pot pouri). (SOE = C)
International Pressure Ulcer Guidelines
31. Pressure Ulcer Pain Management
Perform a routine PU pain assessment. (SOE = B)
Assess PU procedural & non-procedural pain initially, weekly, &
with each dressing change. (SOE = C)
Provide a systematic treatment for PU pain. (SOE = C)
If consistent with treatment plan, provide opioids &/or non-
steroidal anti-inflammatory drugs 30 min before dressing
change or procedure & afterwards.
International Pressure Ulcer Guidelines
32. Pressure Ulcer Pain Management
Ibuprofen impregnated dressings may help
decrease PU pain in adults.
OTC lidocaine preparations help ↓PU pain.
Diamorhine hydrogel is effective analgesic
treatment for open PU in palliative care
individual.
Provide local topical treatment for PU pain.
Select extended wear time dressings to ↓pain
associated with frequent dressing changes.
International Pressure Ulcer Guidelines
33. Pressure Ulcer Pain Management
Encourage individuals to request a time out during a procedure
that causes pain. (SOE = C)
For a patient with PU pain, music, relaxation, position
changes, meditation, guided imagery, and TENs are
sometimes beneficial . (SOE = C)
Self-hypnosis, healing touch, progressive relaxation, &
electrothermal therapy are reported to be of benefit to treat
chronic neuropathic pain. (SOE = C)
International Pressure Ulcer Guidelines
34. Pressure Ulcer Pain Management
Anxiety is influenced both physiologically and
psychologically. Anxiety can be somewhat
ameliorated by talking with the patient about their PU
related pain, providing a detailed explanation of each
procedure, answering questions, allowing active
participation, pacing the procedure to pt’s preference,
& allowing time outs as needed (Smith et al., 1997)
International Pressure Ulcer Guidelines
35. Conclusions
Pressure ulcers can add to a patient’s burden
and distress at end of life
It is not always possible to prevent PU as the
skin may ‘fail’
Existing PU should be managed by symptom
amelioration to improve QoL
Treatment plans should always recognise the
wishes and goals of the individual and family
members.
International Pressure Ulcer Guidelines
36. In doing so…
We can hope that our patients have a
peaceful and comfortable death
International Pressure Ulcer Guidelines