意大利醫(yī)院是如何預(yù)防褥瘡

1、,,AZIENDA OSPEDALIERA UNIVERSITARIA SENESETRAINING PROGRAM:BUSINESS FACILITATORS PRESSURE INJURIES PREVENTION1° ed. 9 – 16 november 20152° ed. 25 november – 3 december 2015 Pietrelli Carla nu

2、rse,PREVENZIONE LESIONI DA PRESSIONEASPETTO ASSISTENZIALE,Bedsores represent a welfare issue in our society as they commit human and techonologic resources to treat the patient,PRESSURE INJURIES PREVENTIONWELFARE ASPEC

3、T,,Tuscany Guidelines, published in 2005, updated in 2012, underline that “A GOOD PREVENTION HAS AN IMPORTANT ROLE IN THE PREVENTION OF PRESSURE INJURIES”,GUIDE LINES,,According to Professional Profile, the nurse is “res

4、ponsible for general nursery assistance”. He/she has an important role of prevention and care... in a team work.,,INITIAL CLINICAL EVALUATION is fundamental. It is managed by the nurse, he/she is responsible to fill the

5、nursing checklists (business form, risk survey forms...),CLINICAL EVALUATION,VALUTAZIONE CLINICA,WHEN?Patient's admittance in the Operative UnitDuring hygienical daily caresEverytime the patient's general con

6、ditions change,CLINICAL EVALUATION,VALUTAZIONE CLINICA,WHO?The nurse is resposible for the patientThe nurse assistant during daily hygienical caresThe nurse and the nurse assistant when the patient's conditions ch

7、angePatient's care giver,CLINICAL EVALUATION,,The attention should be focused on identifying and treating the pathologies, such as vascular diseases, diabetes, immunodeficiency, malnutrition, tumors, psychosis, ecc.

8、.. which may cause the onset of ulcers,CLINICAL EVALUATION,,bedridden patients or on chair, unable to move, should be evaluated in relation with other factors:,CLINICAL EVALUATION,,Movement autonomyIncontinance Nutriti

9、onConsciousness levelPain General conditions,VALUTAZIONE CLINICA,CLINICAL EVALUATION,AMENTE,Risk evaluation should always take into consideration clinical judgementNOT RELY ONLY ON identification of risk factors,C

10、LINICAL EVALUATION,VALUTAZIONE CLINICA,The nurse is resposible for nursing check. He/she identify patient's needs through the use of EVALUATION SCALES: BARTHEL scale (functional state) BRADEN scale (risk of pressur

11、e ulcer) MUST scale (nutritional risk) VAS scale (pain risk),CLINICAL EVALUATION,Patients exposed to risk,Identifying and recognizing patients at risk is essential to prevent:Patients with movement problem: neurologic

12、al diseases, stroke, dementia (癡呆癥), brain traumaUnderweight patientsOverweight patients,patients exposed to risk,Other factors:malnutrition ...nutritional evaluationPoor hygieneDehydration,SKIN AREAS AT RISK,Sacru

13、mHeels Iliac crestMalleolousElbow Occipital bone 枕骨,SKIN AREAS AT RISK,,SKIN AREAS AT RISK,,,,Where does prevention start?,Persona all'inizio di un viaggioHa davanti molte strade Dove vadoDa dove inizio,CARE

14、of HEALTY SKIN,Sistematic cutaneous inspectionAccurate skin hygieneMinimize the enviromental factorsUrinary-fecal incontinance 糞便尿失禁Minimize damage caused by shear and friction forces,Cutaneous inspection,It is impor

15、tant to quickly identify the injury:Once a day at leastPaying attention to bones prominencesMore frequently in case of worsening of patient's general condition,ACCURATA IGIENE DELLA CUTE,Hygiene have to be accurat

16、e butNOT AGGRESSIVE Detergents which do not alter the skin Ph (4,5-5,5) and that do not remove hydrolipid film of cutaneous surface.Minimize the pressure and the friction applied to the skin,ACCURATA IGIENE DELL

17、A CUTE,ACCURATE HYGIENE OF SKIN,,Use of emollient oils and creams/paste with zinc oxide (氧化鋅) with an elevated protective and filmogenous power. WATER can irritate the skin with its Ph (7,5) and also when used at high t

18、emperature.,ACCURATA IGIENE DELLA CUTE,ACCURATE HYGIENE OF SKIN,,Reduce the enviromental factors which might cause dryness of the skin, such as scarce moisture in the air and exposition to cold temperature.Dry skin shou

19、ld be treated with hydrating products.Alcoholic solutions are not recommended,MINIMIZE THE ENVIROMENTAL FACTORS,,Minimyze the exposition of the skin to wet associated to incontinance:Use continance techiques or support

20、s (condom) or external catheter if any other solution is effectiveSkin needs to be washed after each defecation and urination to minimize the time of contact between the skin and faeces/urine,URINARY-FECAL INCONTINANCE,

21、,Using topical barrier-like products (wraps and protective medications)Protect the ulcers with waterproof medications Insert permanent rectal pluge,URINARY-FECAL INCONTINANCE,l,Right techiques of movement and lifting,

22、such as using a simple crossbeam.DO NOT DRAG patients that are not able to change position, but help them to roll over one side Apply emollient and hydration products, films, protective medications,REDUCE THE DAMAGE CA

23、USED BY RUBBING , FRICTION AND STRETCHING.,,Use the lifter machine to avoid traction or stretchingReduce the risk of excessive load for the operator,REDUCE THE DAMAGE CAUSED BY RUBBING , FRICTION AND STRETCHING.,MOBILIZ

24、ZAZIONE,For those patients who can only alternate bed-position with seated position, should always be used devices to redistribute the pressure: pay attention to the postural alignment of the patient, to ensure stabili

25、ty, balance and guarantee the ditribution of pressure on a wider surface.,REPOSITIONING,,Record positionings (bed and wheelchair) taking note of the frequency and of positions, including an evluation of the result.The f

26、requency of repositioning, should take into consideration material resources and response of patient's skin to the pressure (according to different types of skin),REPOSITIONING,,The rotation of patients at risk of pr

27、essure ulcers is an heavy action in terms of nursing time and disconfort for the patient,REPOSITIONING,,The patient must not be placed directly on medical advices, such as tubes or catheteres and drainage system.,REPOSIT

28、IONING,POSIZIONAMENTO PAZIENTI,During lying on one side a 30° position is recommended, to avoid pressures on trochantereHeels must be lifted up with a pillow under the leg (from thigh to ankle),REPOSITIONING,Posizi

29、onamento pazienti,Seated position must not be kept for a long time with any interruptionChange position every hourKeep the postural alignment,REPOSITIONING,Anti-decubitus equipment 反褥瘡儀器,In our hospital there are diffe

30、rent anti-decubitus equipmentThe choice is based on the evaluation of the risk according to the Braden scale,suggestions for the CARE GIVER,Support the diet with food easy to eat and to digest: baby food, yogurt...Eat

31、 small and light mealsDrink a lot of waterHygienical care with mild soaps...........,References,LINEE GUIDA Consiglio Sanitario RegionaleUlcere da pressione: prevenzione e trattamentoData pubblicazione 2005Data pri