Evidence Based Essay on Pressure Injury

This essay explores the literature evidence on pressure ulcers and intervention strategies for managing the injuries, taking the assistance of a case study. It discusses the prevalence of pressure ulcers, risk factors, prevention, and management strategies.

Running head: EVIDENCE BASED ESSAY ON PRESSURE INJURY
Evidence based essay on pressure injury
Name of the student:
Name of the university:
Author note:

1
EVIDENCE BASED ESSAY ON PRESSURE INJURY
Introduction:
Pressure injuries represent the commonly used term pressure ulcer. It can be defined as
the local damage to the skin and the soft tissue within, which is also usually seen to develop over
a bony prominence, which is either created as continual shearing on skin that has reduced skin
integrity (Santamaria et al. 2015). Pressure injuries are also caused due to the shearing on the
skin after the use of any medical invasive device for a long period of time. In most cases, the
pressure injuries are open ulcers which can be infected and be extremely painful. As discussed
by Qaseem et al. (2015)the pressure injuries are a very common complication associated with
long term illnesses and in most acute illnesses which requires a prolonged period of hospice care,
and most preferably for prolonged bed rest. Similarly, acute care patients often develop pressure
injuries due to prolonged period of bed rest and the infection further complicates their existing
conditions and complicates the existing health adversities incredibly. Hence, pressure injuries are
very common issues that the patients face and there is need for adequate evidence based practice
to improve the state of care delivery to prevent and adequately manage the patients with pressure
ulcers (Bhattacharya and Mishra 2015). Evidence based practice involves exploration, analysis
and incorporation of best available care practice, standards and recommendations on a particular
care priority. This essay will attempt to investigate the literature evidence on pressure ulcers and
intervention strategies for managing the injuries taking the assistance of a case study.
The case study that has been chosen for the essay involvesa patient named Joseph Russo,
who presented to the facility with the complaint of unconsciousness and extreme hypotension.
He suffered a pressure injury in one of his heels. Joseph was assessed to have a fluid filled blister
in his left feet which was also infected. The pressure ulcer had been red and had been
considerably big in size being 3 cm / 3 cm in measurement. Although, his hypotension and

2
EVIDENCE BASED ESSAY ON PRESSURE INJURY
related issues other than the pressure injury were resolved, and he was awaiting discharge within
a day or two. As a result, upon his discharge, the nurse would also require to provide a thorough
education to his family or specific carers on proper intervention management and healing of the
pressure ulcer.
Evidence review on pressure injury management:
The purpose of the assignment is to provide and assess the existing evidence base
on the hospital acquired pressure ulcers, its prevention and adequate management. The evidence
review in this case is based on evidence pyramid and the most relevant, accurate and high quality
evidence had been attempted to include in the assignment. The first most notable evidence that
can be incorporated in this context is by Tran et al. (2016), a review study which can be
considered a very high level evidence as per the evidence pyramid. The primary aim of research
article was to discuss how pressure ulcers can be prevented in the acute care settings. The
research study discussed pressure ulcers provide a considerable issue in the health care
environment including higher care cost and enhanced complexity of the care services. The
authors also mentioned the fact that pressure injuries are caused by prolonged ischemia coupled
with subsequent soft-tissue injury that is caused as a direct result of unrelieved pressure over a
bony prominence. The review study incorporated 353 total number of studies were reviewed in
the article and the main data findings that have been identified in the article indicates at the fact
that the use of risk assessment scales are very crucial for preventing the pressure ulcers before
they can fully develop. The advantage of using alternative support surfaces to help in prevention
is also discussed to be more effective than the standard hospital mattresses. The authors have
also discussed that efficient repositioning, using silicone prophylactic dressing to avoid shear,

3
EVIDENCE BASED ESSAY ON PRESSURE INJURY
nutritional changes, microclimate control and most of all patient participation, are effective
management strategies for pressure ulcer prevention.
Similarly the article by Bergquist-Beringer et al. (2013) also suggests that pressure ulcers
are a very common occurrence in the acute care settings and similarly, the pressure injuries are
also preventable if adequate and accurate evidence based practice is implemented. This is a
cohort observational study which is of level three in the evidence pyramid and is of high quality.
The study discovered the fact that in most cases, reduced rates of hospital-acquired pressure
ulcers are associated with a series of preventative actions carried out including “recent
reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine
repositioning, and Magnet or Magnet-applicant designation”. The article by Beeckman et al.
(2014) is a systematic review study which focuses on incontinence-associated dermatitis and its
link with moisture and development of pressure ulcers or injuries. According to the article, there
is an intricate link between IAD and pressure ulcers due to high moisture content, shearing and
other related etiological factors. Similarly, the article by He et al. (2016) has attempted to discuss
the factors that pose enhanced risk for development of pressure injuries. According to this review
study, the overweight and aged patients are extremely at risk for developing pressure injuries,
especially for those that are receiving care in the acute care wards.
Joseph Russo had been an elderly overweight patient and was receiving acute care after
his episode of unconsciousness, which might have contributed as risk factors to development of
the pressures ulcer in his foot. The existing evidence suggests that such acutely ill, aged and
immune-compromised, have very high risk of developing pressure ulcers, and hence there is
need for very intricate and detailed risk assessment and preventative care for such patients so that
they have very minimal chances of developing this complication (Coleman et al., 2014).

4
EVIDENCE BASED ESSAY ON PRESSURE INJURY
Although, along with prevention, adequate management of the pressure injuries is also very
critically required for these patient groups such as Mr Russo. As per the article by Ricci, Bayer
and Orgill (2017), nutrition has a strong impact on the management of pressure ulcers and curing
it. Maintaining a high protein and antioxidant rich diet and hydration of the patient can help in
better maintenance of the pressure injuries. Hence, such care implemented in the initial stages
can prevent the chances of the patient having to go through debridement or similar critical
procedures.
Plan of care:
As per the case study, Joseph here requires a patient centred and personalized care plan
for his pressure ulcer when being discharged to ensure utmost comfort and speedy healing of his
blister.
Issue Goal Intervention Rationale
Infection in the
pressure ulcer
The infection spread
will be stopped and
the infection is
cured.
The nurse would require
administering infection
control of the blisters by
topical and oral antibiotics.
In terms of topical
antibiotic, sulfadiazine can
be a good choice for Russo.
The oral antibiotic might
incorporate
The combination of
oral and topical
antibiotics will have
a strong impact on
controlling the
spread of the
infection and drying
the blister out
(Bhattacharya and
Mishra 2015)

5
EVIDENCE BASED ESSAY ON PRESSURE INJURY
ciprofloxacin and ofloxacin.
The nurse must also
consider any possible
hypersensitivity or drug-
drug interaction before
administration (McInnes et
al. 2015).
Pain and discomfort The patient will be
free from the pain
and discomfort from
the blisters
First and foremost, the use
of soft silicone multi
layered foam dressings on
the blisters.
The nurse will need to
administer mild pain
medication to Joseph for
reducing pain.
The use of soft
silicone multi
layered foam
dressings can help
heal the blisters and
minimize the
discomfort.
The analgesic will
help minimize the
pain and optimize
comfort (Qaseem et
al. 2015).
Continuing care
after discharge
The patient will
receive similar
adequate care his
The nurse would need to
educate the family on
antibiotic medication
The thorough
education and
discussion will

6
EVIDENCE BASED ESSAY ON PRESSURE INJURY
blisters even after
discharge.
regimen and dressing.
The nurse would also need
to educate the family on his
requirement of antioxidant
rich light diet and proper
hydration for speedy
recovery (Qaseem et al.
2015).
The nurse would also need
to Recommend using pH
balanced cleansers or
emollient soaps for cleaning
the ulcer.
ensure Joseph
receiving adequate
care for his blister
even after being
discharged (McInnes
et al. 2015).
Conclusion:
On a concluding note, pressure ulcers are extremely frequent and acute health condition
for acutely ill and elderly patients. These adversities not only affect the comfortable living of the
patient but also cause many complications in the process of recovery for the patients. This essay
helped integrate evidences into understanding the predominance of pressure ulcers in critical care
setting, risks and protective factors, how to prevent and mange it. This essay provided the

7
EVIDENCE BASED ESSAY ON PRESSURE INJURY
ultimate and excellent opportunity to understand how to implement evidence care planning and
implementation. Similarly, it also discussed outlining a thorough plan of care taking the
assistance of evidence and knowledge for a patient with practical care challenges. Hence, it can
be hoped that the knowledge and expertise discussed in the essay can prove to be effective in
clinical practice for such patient group.

8
EVIDENCE BASED ESSAY ON PRESSURE INJURY
References:
Beeckman, D., Van Lancker, A., Van Hecke, A. and Verhaeghe, S., 2014. A systematic review
and meta‐analysis of incontinence‐associated dermatitis, incontinence, and moisture as risk
factors for pressure ulcer development. Research in nursing & health, 37(3), pp.204-218.
Bergquist-Beringer, S., Dong, L., He, J. and Dunton, N., 2013. Pressure ulcers and prevention
among acute care hospitals in the United States. The Joint Commission Journal on Quality and
Patient Safety, 39(9), pp.404-414.
Bhattacharya, S. and Mishra, R.K., 2015. Pressure ulcers: current understanding and newer
modalities of treatment. Indian Journal of Plastic Surgery: Official Publication of the
Association of Plastic Surgeons of India, 48(1), p.4.
Cooper, L., Vellodi, C., Stansby, G. and Avital, L., 2015. The prevention and management of
pressure ulcers: summary of updated NICE guidance. Journal of wound care, 24(4), pp.179-184.
He, M., Tang, A., Ge, X. and Zheng, J., 2016. Pressure ulcers in the intensive care unit: An
analysis of skin barrier risk factors. Advances in skin & wound care, 29(11), pp.493-498.
McInnes, E., Jammali‐Blasi, A., Bell‐Syer, S.E., Dumville, J.C., Middleton, V. and Cullum, N.,
2015. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews,
(9).
Posthauer, M.E., Banks, M., Dorner, B. and Schols, J.M., 2015. The role of nutrition for pressure
ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory
panel, and pan pacific pressure injury alliance white paper. Advances in skin & wound
care, 28(4), pp.175-188.

9
EVIDENCE BASED ESSAY ON PRESSURE INJURY
Qaseem, A., Humphrey, L.L., Forciea, M.A., Starkey, M. and Denberg, T.D., 2015. Treatment of
pressure ulcers: a clinical practice guideline from the American College of Physicians. Annals of
internal medicine, 162(5), pp.370-379.
Qaseem, A., Mir, T.P., Starkey, M. and Denberg, T.D., 2015. Risk assessment and prevention of
pressure ulcers: a clinical practice guideline from the American College of Physicians. Annals of
internal medicine, 162(5), pp.359-369.
Ricci, J.A., Bayer, L.R. and Orgill, D.P., 2017. Evidence-based medicine: the evaluation and
treatment of pressure injuries. Plastic and reconstructive surgery, 139(1), pp.275e-286e.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S.,
Ng, A.W., Manias, E., Liu, W. and Knott, J., 2015. A randomised controlled trial of the
effectiveness of soft silicone multi‐layered foam dressings in the prevention of sacral and heel
pressure ulcers in trauma and critically ill patients: the border trial. International wound
journal, 12(3), pp.302-308.
Tran, J.P., McLaughlin, J.M., Li, R.T. and Phillips, L.G., 2016. Prevention of pressure ulcers in
the acute care setting: new innovations and technologies. Plastic and reconstructive
surgery, 138(3S), pp.232S-240S.