Fundamentals of Nursing Q 266
Which of the following patients is at greatest risk for developing pressure ulcers?
A. An alert, chronic arthritic patient treated with steroids and aspirin.
B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home.
C. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula.
D. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.
Correct Answer: B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home.
Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. Age is also a factor. Thus, the 88-year old incontinent patient who has impaired nutrition (from gastric cancer) and is confined to bed is at greater risk. Pressure injuries are defined as localized damage to the skin as well as underlying soft tissue, usually occurring over a bony prominence or related to medical devices. They are the result of prolonged or severe pressure with contributions from shear and friction forces.
Option A: Risk factors for developing pressure injuries, in general, include immobility, reduced perfusion, malnutrition, and sensory loss. Other patients at increased risk for pressure injury development include those with cerebrovascular or cardiovascular disease, recent fracture of a lower extremity, diabetes, and incontinence. Older patients are also at increased risk for the formation of pressure injuries due to skin changes associated with aging, including thinning of the dermis and epidermis, resulting in decreased resistance to shear forces.
Option C: The pressure of an individual’s body weight or pressure from a medical device above a certain threshold for a prolonged period is thought to be the cause of pressure injuries. In patients with sensory deficits, an absent pressure feedback response may result in sustained pressure for a prolonged period, leading to tissue injury. Many factors are identified in contributing to pressure ulcer and injury formation, such as increased arteriole pressure, shearing forces, friction, moisture, and nutrition status.
Option D: Pressure injuries of the skin and soft tissues affect an estimated 1 to 3 million people in the United States each year. The incidence differs based on the clinical setting. For example, the prevalence of pressure injuries among hospitalized patients is 5% to 15%, with the percentage considerably higher in some long-term care environments and intensive care units.