Pressure Ulcer Risk Assessment and Prevention

This assignment delves into the crucial topic of pressure ulcer risk assessment and prevention. It critically evaluates prominent pressure ulcer risk assessment scales such as the Braden Scale, Norton Scale, and Waterlow Scale, analyzing their predictive validity and limitations. The document explores the relationship between various factors like hyponatremia, low blood pressure, executive dysfunction, and frontal lobe blood flow with pressure ulcer development in diverse patient populations. It highlights the importance of comprehensive risk assessment strategies and evidence-based interventions for effective pressure ulcer prevention.

NURSING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Select a defined patient pathway from clinical placement area..................................................1
Justification of the selection of this pathway with reference to national & local agendas.........3
Analysis of the assessment strategies utilised within the selected pathway from a bio-psycho-
social perspective .......................................................................................................................5
Biological assessment ...................................................................................................................5
Results of the cards .........................................................................................................................8
Psychological assessment ...............................................................................................................8
Sociological assessment ................................................................................................................11
Conclusion ....................................................................................................................................12
REFERENCES .............................................................................................................................13

INTRODUCTION
Nursing is defined to be a very considerate field of work that always necessitate the
people associated with it to undertake cautious approach while serving the clients to render them
in the best possible way. Clinical assessments are a principal part of nursing that involves several
measures to evaluate the risks associated with the practice of treatment given by the physicians
(Ambler and Coughlin, 2015). It is together known as a tactic for detecting the need of treatment
to any patient suffering from some sort of unidentifiable disease that is difficult to interpret
easily. It is therefore apparent to assist into the process of planning carried out to determine and
evaluate the wrong circumstances in the health of an individual.
The below report is based upon a similar consideration of a 73 years old man who has been
admitted to the hospital followed by a chronic leg ulcer. After which, he has together been
identified some earlier medical history where he has together suffered from hypertension and
type 2 diabetes (Moráis and Lama, 2014). The below report has hereby intended to demonstrate
the patient pathway in context to NHS. The chosen pathway has been later justified with prompt
analysis of the strategies undertaken to assess the patient’s condition. It is lastly accepted to
support in analysing the planning procedures undertaken to take care of the patient.
MAIN BODY
Select a defined patient pathway from clinical placement area
It is with a special context of an integrated care pathway also termed as ICP which is
basically known as a multidisciplinary summary of projected care. On further defining the term
called ICP, it is required to be positioned in a suitable time frame to fittingly support the patient
to move towards some positive outcomes of clinical practises meant for the progress of the
patient. The present section has discoursed upon an ICP proposed for the wellbeing of the Mr W
as mentioned in the case study who has admitted in NHS followed by a chronic leg ulcer. Herein,
an ICP is meant for managing, observing and recording a patient’s care with the help of clinical
or critical pathways and care plans, maps and paths. ICP can be also defined in several other
ways where in accordance to European Pathway Association (EPA), it is specified to be a
methodology with whose assistance, it is assistive in taking mutual decisions for the well-being
of patients within a specific time duration.
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Beside this, there together exists yet another prompt definition of ICP where it is referred to be a
multidisciplinary tool of assessment as a management tool which is based upon a healthcare
strategy for a particular group of patients and within a foreseeable medical course. This involves
distinct set of responsibilities required to be fulfilled by the set of specialists included in the plan
of patient care and are needed to be clear, revised and in sequence. It is therefore to discourse
upon the defined clinical pathway of NHS in terms for taking care of the patient admitted
followed by a complaint of chronic leg ulcer, several components of ICP has been recognised
(Šáteková, Žiaková, and Zeleníková, 2014).
It is where Mr W firstly came in contact to the general practioner (GP) who diagnosed him well
and referred to his past medical history. In which, two sequential diseases namely hypertension
and diabetes type 2 was revealed that was ascertained to result into chronic leg ulcer to Mr W.
Followed by which, the current state of Mr W was analysed in terms of his suffering due to
chronic leg ulcer which is referred to be a long term illness for the elderly people. Also, this
condition has placed a substantial burden on the accessible resources of the health services where
it is now required to be managed in an effective manner that can only resolve this issue (Guy,
2017. ). Although, there still exists an enormous gap in the evidence based practice due to
several reasons where there are certain complexities in terms of numerous care providers along
with the budget required for the provision of treatment and care. The present study has together
intended to assess the care management procedures and its valuation for the management of
chronic leg ulcer. It is with a special context of the case study based on the situation of Mr W
where it will be done by considering ICP as a part of an enhancement project.
It has in turn followed a six step procedure which is specially outlined for the
improvement of patient pathways with some innovation for improving the services that involved
preparation, diagnosis, designing, planning, implementation and refinement at the end. It is
together followed by two distinct type of analytical measures namely variance analysis and
resulting analysis for the development and use of ICP (Latimer, Chaboyer and Gillespie, 2016).
This is where the variance analysis is responsible to measure the occurrences took place with the
patient on the pathway to determine any deviation from the anticipated pathway. Next is the use
of resulting analysis which is basically meant for the development of the ICP where the followed
procedures are being rectified in case of any discrepancy.
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Justification of the selection of this pathway with reference to national & local agendas
This is to justify the above selected ICP which is intended to improve the management of
chronic foot ulcer with a special context of the conferred case based on Mr W. It is also on
considering the current situation of foot ulcer in Europe where it is becoming one of the
burdening issue of the nation by directly impacting upon its economic condition. At present, the
prevalence of leg ulcer is assessed to range in between 1.65- 1.74% in the adults who are 65
years old or more (Kumari, Sharma and Biswal, 2015). This ratio is likely to rise more in the
upcoming number of years. The aetiology of this disease is multifactorial in nature with a more
complexed pathology that often results in complex situation. In general, leg ulcer is classified
into venous ulceration and arterial ulceration with more number of cases of the former type of
ulcer called venous ulceration. It is on measuring their occurrences where venous ulceration
commonly ranges from 60 to 80% with another form of ulceration called arterial that ranges
from 10 to 20%. In the European region, the budget for the treatment of chronic wound is
expected to range from €6650 for the treatment of leg ulcer with a distinct cost required for the
treatment of foot ulcer that ranges to €10,000.
The above made selection of the ICP is therefore justifiable for the wellbeing of patients
like Mr W who are suffering from an atrocious state of leg ulcer and thus are in requirement of
acquiring effective treatment. NHS with a similar reference to it has involved several
assessments measures to check the validity of their undertaken practices of ICP to serve the
patients in the best possible way (FLETCHER, 2017). This is on together considering the NICE
guidelines for the management of leg ulcers, it has been found that compression therapy is one of
the most effective way for an initial prevention of leg ulcer. However, it should be followed by
some precautionary measures to be followed while provisioning this therapy to the patients.
However, for the patients like Mr W who are detected to be at a critical stage of leg ulcer due to
any prior medical history related to it, it is important to carry out some applicable measures of
assessment, diagnosis and referral.
Also, on comparing the undertaken pathway of NICE for managing the diabetes of patients like
Mr W, it has been found to be more effective for fulfilling both local and national agenda
towards the treatment of this disease that is rising to a great extent. Below is the illustrated
pathway of NICE for the management and prevention of type 2 diabetes in adults-
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Figure 1: Diabetes pathway of NICE
(Source: Type 2 diabetes in adults overview, 2017)
It is basically on considering its extensive concern where it has distinctly involved the
measures for managing the type 2 diabetes in adult patients like Mr W and the patients who are
suffering from an intense form of type 2 diabetes at the time of pregnancy. Also, before
considering the use of medicinal drugs, it has also focussed upon the management of other
related constituents that leads to a greater dispersion of its negative effects. Controlling such
factors will thereby help in an overall reduction of its prevalence. This is for instance on
considering the control of blood pressure and blood glucose that will automatically lead to the
management of any associated cardiovascular risk with less existence of lipids in the body.
Beside this, NICE guidelines have also considered the involvement of individualised care by
educating the patient and suggesting ways for maintaining a healthy lifestyle and avoid any risk
of developing the chronic symptoms of type 2 diabetes.
This way the individuals will be able to recognise any of its syndromes by together being
able of managing its complications. It is therefore on comparing the national guidelines of NICE
with that to the local guidelines of the hospitals associated with NHS, a slight discrepancy has
been found. This is where the local guidelines are less concerned with the concept of
individualised care that is deficient in terms of making people aware of its prevention. However,
it is important considering the minimization of type 2 diabetes which is now becoming a national
concern and burdening the health industry where its management can be itself done by the
individual themselves. It is thus important for the health settings like NHS to follow the national
guidelines and practice in accordance to that.
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Analysis of the assessment strategies utilised within the selected pathway from a bio-psycho-
social perspective
Biological assessment
According to the case study it has been analysed that Mr W is a 73 year old man who has
been admitted to the hospital as he was suffering from Chronic leg ulcer. It has been described in
the case study that the patient has a past medical history of hypertension and for type 2 Diabetes.
In addition to that difficulties have been faced by the patient in controlling his blood sugar. The
patient lives with her 70 years old wife and the patient has recently been recovered from the hip
replacement after a fall and he has also developed leg ulcer. Leg ulcer which he has developed
requires proper and regular dressings (Workplace Health. 2017).
All the situations has lead towards reducing the mobility of the patient and for this reason
he requires assistance in completing his day to day chores and movements. It is vital that proper
assessment of medical conditions faced by the patients should be done so that better and
effective medical care should be provided to them (Mahalingam and Grewal, 2014). Waterlow
cards is used in the community homes for providing better and effective care to the patients and
it provides guidance to the nursing staff. In addition to that it is essential that for making use of
waterlow cards that environment should be totally different from the situations in which the card
was developed. It is a simplistic tools and in this professional judgement is used for determining
and evaluating the risk status of the patients (El-Daly, Ibraheim and Bates, 2015).
The primary aim of the tool is to evaluate various types of risks that are associated with a
patient or a client. The elements which are used in Waterloo assessment comprise of Weight,
Height, Visual assessment of the skin, age, gender, continence, mobility, appetite and some other
special risk factors which are linked with the health of the patients (Pattanshetty, Prasade and
Aradhana, 2015). The score card which is received at water low defines about the level of risks
which are faced by the patient. If a patient gets a score of 10-14 than it can be considered that the
patient is at the the risk (Uchikawa and Liu, 2014). If a patient receives the risk factor of 15-19
than it can be analysed that patient is at the risk level of High risk and further a score of 20 and
above indicates about the very high risk that are facing high risk due to their medical conditions.
Waterlow assessment card for the patient is as follows :-
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Waterflow assessment for Mr W.
Service user name ….................................
Room …................................
Date of Birth …........................................................
6

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Results of the cards
There are 9 different areas in which the Waterlow assessment is carried out the scores
received by the patient is as follows -
Build/Weight for Height 1
Continence 2
Skin Type/Visual Risk 1
Mobility 5
Sex/Age 1
Appetite 1
Tissue Malnutrition 1
Neurological Deficit 2
Major Surgery/Trauma 5
Medication 1
TOTAL SCORE 15
It can be observed from the table that total score of Mr W is 15 on the Waterlow card and
it indicates that he is in the category of High risk. It is required that care professionals should
provide effective treatment to the Mr W so that he can be treated well. It will support for
providing effective and medical support to the patient in effective manner. This tool has
supported for identifying and evaluating the risk that are associated with the patient. Care takers
will properly be aware about the risk involved and situations of Mr W and thus it will create
support and helping help to them for providing treatment to Mr W.
Psychological assessment
It is vital that psychological assessment of Mr W should be carried out so that his mental
stage should be identified. It is very important that the test should be performed so that
depression, anxiety, violent behaviour and emotional stability of the patient. Carrying out this
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test support for identifying the weak mental state of the patient so that on the basis of that
treatment could be provided to them (Kelechi, Arndt and Dove, 2013).
PAIN management for Mr W. :- The patient has been admitted in the hospital as he was suffering
from Chronic leg Ulcer. He was also having past history of Type 2 Diabetes. For managing the
pain level of patient there are various ways that are used. There are emotional distress associated
with the pain and for protecting the patient from this pain mental support will be provided to it.
Initially it is critical that pain assessment should be performed so that it could be made as an
integral part of the pain management process for the ulcer. Providing appropriate treatment will
support for treating the leg ulcer in better and effective way.
Initially dressing will be done for cleaning the ulcer and it will provide healing to the
ulcer. Generally non sticky dressing is used for treating the ulcer and the dressing will be done
once a weak. In addition to that with objective to make improvement in the circulation of blood
in the veins a firm and compression bandage is applied over the affected area. The bandage are
changed in a period of a weak and it will aid for treating the leg ulcer in better and effective
manner. For treating the associated symptoms compression bandages are used and it supports for
treating the associated symptoms of the pain in effective way. In addition to that keeping the legs
in elevated positions ideally with the toes will also help for reducing the impact of swelling of
the legs in effective manner. Patient will be asked to keeping himself active and performing the
regular exercise so that better circulation of blood in the leg area could be ensured.
Substance abuse faced y the patient in past, history of patient, disability perception and
other pain that are felt and observed by the client. There are various benefits that are received by
performing the assessment of the individual and it provide an assistance in finding and analysing
the mental conditions of the patients (Woodhouse and Graham, 2014). It also supports for
understanding the psychological factors which are responsible for perceived disability in the
patient and it also supports for designing better medical interventions for the patient so that
effective medical care could be provided to them. Health habits of the patient are also evaluated
through this test such as smoking habits, drinking habits and other habits which are responsible
for creating negativity in the patient (Latimer, Gillespie and Chaboyer, 2015).
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A normalised scale of 0-10 is used in this method and in that if a patient scores a lower
marks than he can be declared in the low risk category and if a patient is scoring higher than it
reflects that the patient is facing challenges in managing his psychological feelings. In addition
to that changes are tracked in the range of variables which are course of treatment and assessing
outcomes of the treatment (Kellett and Gleeson, 2014). The test which are performed on the
patients measures the coping styles of their behaviour and stress moderators of the patient can
also be identified through this. This test will prove useful for Mr W as it will help the care
professionals for evaluating his personality types and patients can be sent to intensive care
treatments on the basis of requirement of the test. Results of the test for Mr W are as
mentioned :-
Psychological test Score card
Emotional stability 1
Anxiety 1
Depression 0
Emotional dependency 1
Chronic maladjustments 0
Conflict with family and physician 1
Disability perception 1
Substance abuse 1
Total score for Mr W in the psychological test is 6 and it shows that he is at risk and it is
required that assistance should be provided to him. He has faced several types of diseases and
due to that he is now in very weaker emotional state. Currently he has been admitted in the
hospital with the problem of chronic leg ulcer and he was also having past medical history of
having type 2 diabetes (Sternal, Wilczyński and Szewieczek, 2017). He has also struggled with
his wife to control his sugar levels. Her wife also has recovered from hip replacement surgery
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and thus he is also supporting her. He is facing medical cases in his family and thus his
emotional strength has been affected due to it. Further, the patient Mr W is also needing
assistance in performing his day to day activities until he is not recovering from his medical
treatments (Wang and Ding, 2015).
Sociological assessment
Mr W has been admitted in the hospital and he was suffering from leg ulcer and due to
that he was admitted into the hospital. He has been admitted to the hospital for the problem of
chronic leg ulcer and with this patient was also having past medical history for type 2 diabetes.
His mobility was also reduced and he was requiring assistance in performing his day to day
activities. After successfully treatment of the diseases it is essential that appropriate discharge
procedure should be used so that patient can be safely discharged at the home. Moreover, after
discharging from home also it is required that he should be under the surveillance and so that his
proper monitoring should be done (Wright, Dorrington and Hoffman, 2014).
It is vital that proper hospital discharge planning should be there at the place so that Mr
W should be given proper medical treatments. In addition to that when a patient is discharged
from the hospital it is required that proper precautions should be taken and it should be included
in their discharge planning template. Further, details of any type of support required by the
person also need to be identified and care professionals needs to perform appropriate discharge
planning for the person. The hospital discharge plan comprise of name of the specific staff
member who has provided treatment to the patient (Šateková, Žiaková and Zeleníková, 2017).
Care staff are accountable for ensuring that patient gets discharged properly and
hospitals are required to give special care whenever any patient is discharged from the hospital.
Details about any type of contact which needs to be made with the community service and nurse
and social worker also provide better care to the patients. The basic elements which needs to be
included in a discharge plan comprise of evaluation of patient by the professionally qualified
personnel and discussing the patient and their representatives about the diseases sustained by the
person. Planning for transferring the patient to the home are made and it is determined whether
any kind of support is needed to give medical services to the patient at home. Arrangements are
made for follow up tests and referrals so that follow up and appointments test could be
performed (FLETCHER, 2017).
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Further, the major role of care packages is to ensure that the patient should receive
effective and better treatment so that he can recover effectively from the diseases suffered by
him. Moreover, there are some issues faced by the patient and so is the reason that it is vital that
he should be given care discharge packages. Moreover, elderly people will also face some issues
and proper medications need to be given to them so that his recovery should be faster. All the
representatives of the patient should be given clear description about the medical problems
suffered by him (Kumari, Sharma and Biswal, 2015). In addition to that it is vital that
arrangements should be made by the care staff so that detailed follow up should be taken from
the patients on a regular basis.
Conclusion
Summing up the present report it can be mentioned that It is also required that assistance
should be provided to them so that he can move and complete his daily work with out taking any
king of assistance from another member. All the description about medicines which he needs to
take required to be given and with this timing for medicines also need to be described. In
addition to that details about precautions need to be taken by Mr W also required to be described
that what are the precautions which he needs to take while giving treatment to the patients
working in the hospital. All these are included in the discharge packages which is formed for the
Mr W.
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REFERENCES
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FLETCHER, J., 2017. An overview of pressure ulcer risk assessment tools. Wounds UK, 13(1).
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Kelechi, T.J., Arndt, J.V. and Dove, A., 2013. Review of pressure ulcer risk assessment
scales. Journal of Wound Ostomy & Continence Nursing, 40(3), pp.232-236.
Kellett, J. and Gleeson, M., 2014. A four item scale based on gait for the immediate global
assessment of acutely ill medical patients–one look is more than 1000 words. European
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Moráis, A. and Lama, R.A., 2014. PP267-SUN: Assessment of Strongkids Nutritional Screening
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Pattanshetty, R.B., Prasade, P.M. and Aradhana, K.M., 2015. Risk assessment of decubitus ulcers
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Šáteková, L., Žiaková, K. and Zeleníková, R., 2014. PREDICTIVE VALIDITY OF THE
BRADEN SCALE, NORTON SCALE AND WATERLOW SCALE IN SLOVAK
REPUBLIC.
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Uchikawa, K. and Liu, M., 2014. Executive dysfunction is related with decreased frontal lobe
blood flow in patients with subarachnoid haemorrhage. Brain injury, 28(1), pp.15-19.
Wang, L.H. and Ding, J.J., 2015. Inter‐rater reliability of three most commonly used pressure
ulcer risk assessment scales in clinical practice. International wound journal, 12(5), pp.590-
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Woodhouse, L. and Graham, K., 2014. Meeting targets in pressure ulcer prevention in the
community by collaborating with industry. British journal of community nursing, 19.
Wright, K.M., Dorrington, C.A. and Hoffman, G.R., 2014. Pressure injury can occur in patients
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ONLINE
Workplace Health. 2017. [Online]. Available through:
<http://www.bedford.gov.uk/health_and_social_care/bedford_borough_jsna/
wider_determinants/workplace_health.aspx>. [Accessed on 22st July 2017].
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2017].
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