Question

Working on a geriatric unit, the nurse knows that the bed bound hospitalized older adult is at risk for pressure ulcers. Which factors seen in the unit’s clients would increase the risk for pressure ulcers? A. Diminished sensory perception B. Dry fragile skin C. Decreased mobility D. Indwelling urinary catheter E. Decreased appetite since hospitalization F. Nursing assessment every shift

Short answer

Factors that increase the risk for pressure ulcers in hospitalized older adults include diminished sensory perception, dry fragile skin, decreased mobility, and decreased appetite since hospitalization.

Step-by-step solution

Understanding Pressure Ulcers

Pressure ulcers, also known as bedsores or decubitus ulcers, are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. They most commonly develop on skin that covers bony areas of the body, such as the heels, ankles, hips, and tailbone.

Identifying Risk Factors

Patients who are bed bound are more susceptible to pressure ulcers due to a combination of factors. Risk factors for pressure ulcers include impaired mobility, sensory deficits, poor nutrition, age-related skin changes, and medical devices that exert pressure on the skin.

Evaluating the Options

Examine each option to identify which are established risk factors for the development of pressure ulcers: A. Diminished sensory perception can prevent the individual from feeling the need to change position, leading to prolonged pressure. B. Dry, fragile skin is more likely to break down under pressure and is commonly found in older adults. C. Decreased mobility limits the individual's ability to reposition themselves to alleviate pressure. E. Decreased appetite could lead to malnutrition, which can make the skin more vulnerable to breakdown.

Excluding Non-risk Factors

D. The presence of an indwelling urinary catheter does not directly increase the risk of pressure ulcers, though it could be indirectly related if the catheter causes the patient to move less or if it exerts pressure itself. F. Regular nursing assessment should decrease the risk of pressure ulcers, as it would hopefully lead to interventions that prevent prolonged pressure on the skin.

Key concepts

Bedsores Prevention

Preventing pressure ulcers, commonly known as bedsores, is a critical aspect of healthcare, especially in the geriatric population. To provide effective bedsore prevention, it is important to understand that these are not merely the result of prolonged pressure on the skin, but also the compromise of the skin's integrity due to multiple factors.

• Regular Repositioning: One of the most effective preventive measures is regular repositioning of patients to relieve pressure, particularly on bony prominences such as hips and heels.
• Skin Care: Maintaining skin integrity with proper hygiene and moisturization can help prevent the skin from breaking down. Dry and fragile skin in the elderly requires gentle and frequent care.
• Nutritional Support: Adequate nutrition plays a crucial role in skin health, so ensuring an appropriate diet is vital for at-risk individuals. A decreased appetite should be addressed promptly.
• Support Surfaces: The use of specialized mattresses and cushions that redistribute pressure is also beneficial in preventing ulcers.
• Educating Caregivers and Patients: Education about the risks and preventive strategies is crucial, as engagement can enhance adherence to recommended care practices.

Enabling an environment that fosters these practices can significantly reduce the occurrence of bedsores. In geriatric nursing care, clear protocols for the prevention of pressure ulcers are integral to patient safety and quality of care.

Geriatric Nursing Care

Geriatric nursing care focuses on the unique needs of the elderly population, who are often at increased risk of chronic conditions and functional impairments such as bedsores. As our skin and bodily functions change with age, a tailored approach becomes essential.

• Comprehensive Assessments: A thorough evaluation of each patient's risk factors for pressure ulcers including sensory perception, mobility level, and nutritional status is fundamental in geriatric care.
• Individualized Care Plans: Care should be personalized to address specific vulnerabilities, such as providing appropriate skin care for those with dry, fragile skin or mobility aids for those with decreased movement capabilities.
• Interdisciplinary Teams: A collaborative approach, involving dietitians, physical therapists, and other healthcare professionals ensures that all potential risks are managed.
• Frequent Monitoring: Nursing assessments every shift serve as a proactive measure to identify early signs of skin breakdown and intervene accordingly.

The role of the geriatric nurse is not only to administer direct care but also to advocate and coordinate for the well-being of the older adults, ensuring a respectful and dignified approach to their complex care needs.

NCLEX-RN Exam Preparation

Preparing for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) entails a thorough understanding of the principles of nursing care, including those related to the management of pressure ulcers. To excel in questions on this topic, candidates should focus on the following:

• Identifying Risk Factors: Knowing the risk factors for pressure ulcers, such as immobility and sensory deficits, is crucial for determining preventive measures and care strategies.
• Understanding Preventive Techniques: The NCLEX-RN exam will often test the nurse's ability to apply prevention techniques, such as using pressure-reducing devices and implementing turn schedules.
• Assessment Skills: Recognizing early signs of pressure ulcer development and understanding how to assess skin integrity is a key expectation on the exam.

In addition to studying textbooks and taking practice exams, simulation and hands-on patient care scenarios are highly beneficial in integrating knowledge into practical skills. As candidates prepare for this segment of the NCLEX-RN exam, they must be proficient not only in the memorization of information but also in its application toward patient-centered care.