FREE ESSAY ON DECUBITIS ULCERS

DECUBITIS ULCERS

Decubitis Ulcers
J. Caldwell P.N.S.
1. Decubitis Ulcers are also known as bed sores.(Marsh 1) They are mostly seen in
Geriatrics patients. They occur in people who are put on bed rest, or long periods of
wheelchair use. "A traumatic decubitis ulcer is precipitated by continuous pressure on
the skin and deep tissue with ischemic necrosis" (Plewig 369). These particular ulcers
are mainly found on bony parts of the body. They develop when the cells die because there
is a tremendous amount of pressure put on the skin and it is trapped between a mattress
or chair and tiny blood vessels collapse. The parts of the body that are affected by
these ulcers are the back of the head, ear, shoulders, elbows, hips, sacrum, knees,
ankles, and heels. Decubitis ulcers can be classified into three grades. (1) Area is more
reddened, skin is dry. (2) Area is more reddened, epidermal layer of the skin is broken,
and blisters form. (3) Deeper layers of the skin are affected, blisters are broken open,
and bone may be visible. (Hegner, Caldwell 421)
2. Before treating decubitis ulcers, viewing of the nurse or caregivers feelings about
the care is important. He\she should determine whether or not they agree with the
patients wishes and is capable of completing that care. "When making these decisions,
consider the stage of the ulcer and the treatment needed, the benefits and the burdens of
the treatment, and the anticipated treatment outcome" (Darkovich 47). After these views
are looked at, there are many treatments available. If the area is reddened, all that is
needed is a gentle massage. If the skin is open, bacteriostatic agents, antiseptic
sprays, and antibiotic ointments are used to reduce or prevent bacteria. The surgical
process called grafting is practiced to treat these ulcers. This is when a patch of skin
is removed from one part of the body, and is placed onto the infected area. Sheepskin
pads, alternating air pressure mattresses, heel protectors, and egg crate mattresses are
also used. (Hegner, Caldwell 427)
3. The first lab test that I found is a urinalysis. This is a test of the urine to detect
alcohol, drugs, sugar, and other abnormal substences. This tells us if there is any
bacteria in the body, and if it is located in the decubitis ulcer, so we can know if it
is infected or not. The second lab test that is done on these ulcers is CD, this
determines the antigens on the white blood cells. This shows whether or not the patients
immune system can fight off the bacteria in the ulcer. The last lab test, is a culture.
This is done by scraping the side of the infected area and putting it under a microscope
to view the living, harmful organisms in the ulcer. All of the lab tests that are done
determine the seriousness of the ulcer and what the best medication would be to help cure
it.
4. Elase is a drug that helps relieve signs and symptoms of infection. This inhibits
protein synthesis in bacteria at the level of the 50's bacterial ribosome. It is used for
skin and soft tissue infections, intra-abdominal infections, and CNS infections. The
pregnancy category is unknown. The side effects are depression, confusion, headache,
nausea, vomiting, diarrhea, rashes, and fever. It is absorbed orally and distributed
widely. It crosses placenta and enters breast milk. Drug interactions are
oralhypoglycemia agents, warfarin, phenytoin, rifampin, vitamin B, folic acid, and
acetominophen. It is available in 12.5 mg/kg q 6 hours. The assessments are to check for
infection in sputum, urine, stool, and WBC. Check vital signs. Planning-contradicted in
hypersensitivity. Implementation- medication should be given around the clock. Administer
over 30-60 minutes. Evaluation- the length of time for the medication to work depends on
the organisms in the ulcer and the size of it.
5. The normal readings of vital signs should be blood pressure 100-150/60-90, pulse
60-90, respiration 12-20, and temperature 98.6 farenheight. When the patient is in severe
pain the vital signs will increase. The vital signs will also increase if bacteria is
present in the ulcer. In geriatric patients, the vital signs should be monitored often
because they are in more danger than average aged adults. A fever is considered 101
farenheight, and anything higher or lower than the above recordings is abnormal. The
vital signs are not usually affected by the lab tests that are done.
6,7. I am assigned to a make-believe patient. Her name is Mrs. Roberts and she is 67
years 
old. She has a stage 3 decubitis ulcer and I have to give her complete care. The first
thing 
I would do when I walk into the room is check her name band and chart. The chart says to

change her dressing on the decubitis ulcer and give her a complete bed bath. First I
would 
take her vital signs and record them. Then I would start changing the dressing on the
ulcer. 
While I'm changing the dressing I would look for and record everything that I see on the

wound. (Lynch 909) Then, I would give her a bath, making sure her bed sheets are not wet

or wrinkled because that is harmful to the skin. I would also look on the chart to see
how 
long ago it was since her position was changed. If it was two hours ago, I would then 
change her position, but not place her on the ulcer. Next, I would check her intake and 
output, an encourage her to drink more fluids. If she hasn't drank atleast 300 cc. I
would 
also check what her diet is and try to get her to eat more nutritious foods and a lot of
foods 
with iron included. After all of that was completed, I would take her vital signs again
to make 
sure that there was no dramtic changes, and record them on the chart.
8. The evaluation of the care depends on whether or not the ulcer has gotten better or
worse. Five ways to measure your success is to check if the ulcer has gotten bigger or
smaller. If it is smaller, you benefited the patient. Another way is to check if the
ulcer is infected or not. Also, if the patient is in less pain, and the ulcer is starting
to heal, you have succeeded. The last measure is to check if the ulcer is still draining,
or if it has a scab, if it has drainage, you need to start all over again and change the
procedures, (Turkington, Dover 41).
Bibliography
Darkovich, Sharon L. "When is no treatment the right treatment." Nursing 96. July1996.
47.
Hegner, Barbara R. and Ester Caldwell. "A study of maturity." Geriatrics. New York:
Delmar, 
1996. 419+.
Lynch, Sam. Principles and Practices of Dermatology. New York: 1990. 908+.
Marsh, Reta. "Care of Decubitis Ulcers." Independent Living May-June 1994: 21.
Turkington, Carol A. and Jeffrey Dover. Skin Deep. New York: Cox,1996. 41.