[Solved] roper logan tierney care plan

Roper-Logan-Tierney Care Plan

A pressure ulcers is ‘ a localised area of cellular damage resulting from direct pressure on the skin causing ischawmia, or from shearing or friction forces causing mechanical stress on the tissues’ (Chapman and Chapman 1981). Common places for pressure ulcers to occur are over bony prominences, such as the sacral area, heels, hip, and elbow. (NICE 2005) Initially to maintain confidentiality the patient will be referred to as Mr Brown. Mr Brown has given permission for his nursing notes and details to be referred to through out this assignment.

He is also aware that is identity will remain unknown and that a false name was chosen for assignment purposes. This can be identified in the NMC Code in ‘respecting people’s right to confidentiality. ’(NMC Code 2008)Moreover the workplace will remain anonymous and be referred to as Ward 1. Mr Brown is 90 years of age, he lives alone in sheltered housing and has careers three times daily to maintain housework and basic care needs. He has a past medical history of angina and is a non insulin dependent diabetic. Initially Mr Brown was admitted to hospital via A and E due to chest pains, which indicated Acute Coronary Syndrome.

Mr Browns cardiac issues have been resolved in another ward prior to his referral to Ward 1. However Mr Brown needs help with improving mobility caused by the cardiac problems therefore he has been moved to Ward 1 which is a rehab ward to help Mr Brown to improve his mobility and analyse if his care package needs to be increased. Prior to admission to Ward 1 Mr Brown had pressure ulcers present on his left and right buttocks. From the Priliminary Pressure Risk Assessment carried out on admission to ward 1 it can be identified that Mr Brown has seven broken skin ares on his sacrum,which have a EPUAP grade of 2. (Tissue Viability 2009).

When using the Adapted Waterlow Pressure Area Risk Assessment Chart, Mr Browns initial score was 12 putting him on treatment plan B when admitted to hospital. However due to cardiac issues causing mobility problems, Mr Browns score significantly increased over the period of 11 days so that when assessed in ward 1 it give him a score of 20,putting him at high risk of developing pressure ulcers and to follow treatment plan C. Step 2 When admitted to Ward 1 Mr Brown was having issues with dealing with urinary incontence, which lead to the skin becoming excoriated due to the excess moisture(Tissue Viability 2009).

This becomes a risk of developing further pressure ulcers as urine causes the skin to become macerated and makes it easier for the epidermis to erode. (Kozier et al. 2008) therefore nursing staff felt as a last resort a catheter should be put in place as this was effecting the healing process. Further issues of incontence lead to Mr Brown becoming doubily incontent within the space of two days. Faecal incontenance will create micro-orgasms that irritate the skin leading to further breakdown of the epidermis and increased risk of infection (kozier et al. 2008).

Moreover this causes external risks with the dressings that Mr Brown has for his Grade 2 pressure ulcers that are already present. This is due to the dressing acting as a barrier that will increase the risk of infection. Additionally an intrincic factor leading to increased risk of pressure ulcer is the fact that Mr Brown is 90 years of age which indicates that his skin is less elastic due to lack of collagen in the dermis,the sebaceous glands produce less oil causing dryness to the skin and a thinning of the epidermis. (kozier et al. 2008). Therefore his skin is a lot more fragile.

As we age the rate that skin heals is decreased; also glands in the skin such as the sebaceous glands lose there ability to function; as a result there is an increase in water loss. ( Christiansen and Grzyboskii 1993)Therefore healing time is increased. Additionally nutritional and fluid intake is an intrinsic risk factor that determines the development of pressure ulcers. Especially as mr Brown already has pressure ulcers,this puts an increasing demand on the body for a diet rich in protein,saccharides,vitamins A and C along with minerals such as iron. (Kozier et al. 008) In addition Mr Browns mobility is an extrinsic factor that plays a risk in developing pressure ulcers’ Brown already has pressure ulcer which if we consider his mobility status it causes him to have restricted movement due to pain. If we consider the Waterlow Assessment Mr brown scores of three. Moreover due to immobility Mr Brown is unable to reposition his to relieve pressure. Moreover the external factor of sheering of the skin occurring when Mr Brown is being repositioned with slide sheets could lead to further risks of pressure sore development. This is because shearing causes tissue ischaemia by moving vessel laterally and impeding the flow of blood” (Kozier et al. 2008) In addition the intrinsic factor that Mr Brown is diabetic leads the fact that his skin bleeds quick etc REFERENCE Additionally external factors that effect the mattress Step 3 Moreover infection can occur in pressure ulcers. In general ‘the ulcer bed plus adjacent tissue are invaded, with cellulitus developing as a result’ (wound care book). This evident due to granulating tissue. Moreover to protect the granulating tissue.

Moreover to protect the granulating tissue from becoming infected a dressing should be put in place. If we consider the Tayside wound formulary for dressing pressure ulcers. It suggests for the granulating tissue, that it aim is to promote angiogenesis resulting in wound healing. It suggests for the treatment option, to dress the wound using MEPILEX, ALLEVYN Lite, TRICOTEX, AND TEGASORB. Moreover the dressing can protect against shearing and friction. Pegasus Step 4 Initially when admitted to hospital the Malnutritional Universal Screening Tool (MUST) is completed within 24 hours of admission throughout NHS Tayside. NHS Tayside must sheet)MUST is supported by the royal college of nursing and the registered nursing home association. NHS Tayside have adapted their MUST Tool from BAPEN. Bapen is a multi-professional association with its members consisting of the healthcare professionals found in a multi-disiplinary team. (the explanary booklet). The purpose of the MUST Tool is to ‘identify adults who are underweight and at risk of malnutrition,as well as those who are obese. ’ There are five steps to using the MUST tool,which can help when completing a careplan. utrition plays an important role in the assessment of pressure ulcers as inadequate nutrition can lead to delayed recovery and healing time leading to a longer stay in hospital(MUST report 10 key points). The initial step is to measure the height and weight of the patient to calcuylate BMI. This then enables a score to be obtained for step 1. Step 2 identifies the percentage of unplanned weight loss and enables a score to be obtaioned. Step 3 establishes the effect of acute disease,that there has been no nutritional intake. Step 4 consists of adding the scores from steps,2 and 3 together.

The higher the score equals a higher risk to malnutrition. Finally Step 5 consists of Management guidelines to help to develop a care plan,and identify the level of risk the patient is at. (must,must steps BAPEN) When Mr Brown arrived to ward 1,nursing staff decided not to calculate his MUST score for the first week. This is recorded in the MUST assessment,that they are enable to weight patient due to increased sacral pain. However when considering if mr Brown has a recent history of weight loss a self- reported weight loss of Mr Brown may be considered a realistic indicator.

Also nursing staff were able to analyse wether/wheather Mr Browns clothes were lose fitting (the MUST explanatory booklet) Another method used to record the management of pressure ulcers in NHS Tayside is Preminary Pressure Ulcer Risk Assessment(PPURA) Its purpose is to quickly identify those at risk of developing a pressure ulcer. However this should not replace the nurses clinical judgment and observations. (tissue visability Web) Within this there is an adapted version of The Waterlow Pressure Area Risk Assessment Chart.

This tool ‘when used with the nurses clinical judgement can indicate the patients risks of developing pressure ulcers. ’(kozier pg 314 waterlow)The waterlow identifies the level of risk a patient has of developing a pressure ulcer. It also identifies a treatment plan for the patient. In addition the multi-disciplinary team record of care is a compulsory risk assessment and analysis treatment plans, and its carried out 3 times a day for each patient. These are scored on a traffic light system, which identifies 18 different risk assessments.

Which NHS Tayside policies indicate if amber or red scoring then action should be recorded in the nursing notes? The four compulsory risks include nutrition; which risk is identified through the MUST tool, also pressure ulcer prevention; which is analysed through the waterlow scoring system. However both tools are not a replacement, for a nurse’s clinical judgement. In addition, manual handing and mobility is analysed, which can help identify risks of friction and shearing on the skin, and also help with analysis of repositioning. QUOTE Step 5:

Pressure ulcers are a risk in various heal care settings, and are a major financial burden on the NHS. Due to this many hospitals and community trusts are supported by a tissue viability service. (Dealey p849). Its ‘estimated that in the UK the annual cost of treating pressure ulcers is between ? 1. 4 and ? 2. 1 billion (price year 2000), that is about 4% of total NHS expenditure’. (NICE guidelines p41) Furthermore, pressure ulcers can affect the patient socially; due to pain and discomfort causing embarrassment and avoiding social contact.

"Looking for a Similar Assignment? Order now and Get a Discount!

"Looking for a Similar Assignment? Order now and Get a Discount!