Newsy Obok slidera Odleżyny Profilaktyka

Profilaktyka odleżyn u pacjentów OIT – najważniejsze zasady

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Pacjenci przebywający w oddziałach intensywnej terapii to jedna z grup szczególnie narażonych na wystąpienie ran odleżynowych. Profilaktyka odleżyn w tej grupie chorych wymaga wielokierunkowych działań ze strony zespołu terapeutycznego.

Profilaktyka odleżyn u pacjentów OIT obejmuje pielęgnację skóry, odpowiednie układanie chorego, odciążanie miejsc o zwiększonym ryzyku wystąpienia odleżyn, odżywianie i nawadnianie oraz fizjoterapię.

Pielęgnacja skóry

U pacjentów przebywających w OIT  mogą wystąpić takie problemy jak wzmożona potliwość, nietrzymanie moczu i stolca, obfity wysięk z rany. Długotrwała, nadmierna wilgotność skóry przyczynia się do maceracji i zwiększa jej podatność na uszkodzenia, rany i zakażenie.

Z tego względu skóra pacjenta powinna być pielęgnowana w taki sposób, by była czysta i sucha, a jednocześnie zachowywała odpowiednie pH i elastyczność. W tym celu skórę pacjenta należy co najmniej raz na dobę umyć w ciepłej wodzie z mydłem o neutralnym pH. Bardzo istotne jest, by po myciu skórę dokładnie osuszyć, zwłaszcza w miejscach, gdzie dwie powierzchnie stale się stykają (np. bruzda pośladkowa).

Do zabezpieczenia skóry należy stosować kremy i maści ochronne. Podczas aplikacji tych preparatów należy zwrócić uwagę na to, by nie stosować zbyt silnego masowania lub oklepywania.

Pozycjonowanie chorego

Pozycja chorego powinna być zmieniana co dwie godziny w dzień oraz co cztery godziny w nocy w celu uniknięcia nadmiernego nacisku na miejsca obarczone ryzykiem odleżyn. Pacjenta należy ułożyć w taki sposób, by barki i biodra zachowały symetrię, a głowa i stopy były ułożone prawidłowo. Warto również stosować akcesoria takie jak poduszki piankowe, kliny, wałki, podpórki, aparaty stabilizujące i ochraniacze, które pomogą w zapewnieniu choremu bezpiecznej i komfortowej pozycji.

Odciążanie

W celu odciążenia miejsc narażonych na rozwój odleżyn należy stosować zabiegi pobudzające ukrwienie oraz zmiennociśnieniowe materace przeciwodleżynowe. Wysokiej klasy materace mogą być ponadto wyposażone w funkcję chłodzenia, regulacji ciśnienia lub możliwość wyłączenia poszczególnych komór. Niektóre modele materacy mogą również pomagać w regulacji temperatury ciała pacjenta oraz wilgoci pomiędzy skórą a powierzchnią materaca.

Przy odciążaniu należy również uwzględnić cewniki, rurki tracheostomijne, wkłucia centralne i dożylne oraz stomie. Położenie wszelkiego rodzaju drenów należy regularnie zmieniać oraz zabezpieczać opatrunkami specjalistycznymi (opatrunki silikonowe, hydrokoloidy, folie poliuretanowe). Nie należy natomiast stosować opatrunków gazowych, które mogą powodować dodatkowy ucisk.

Leczenie żywieniowe

Pacjenci narażeni na rozwój odleżyn powinni otrzymywać dietę bogatą w białko, cynk oraz witaminy. Cynk jest niezbędny w syntezie białek i procesach regeneracyjnych, natomiast witamina C uczestniczy w syntezie kolagenu. Witamina A ma działanie ochronne wobec skóry, z kolei witamina B2 odpowiada za oddychanie komórkowe.

Dieta powinna być ustalana indywidualnie według potrzeb danego pacjenta. Monitorowanie stanu żywienia (pomiary antropometryczne, badania laboratoryjne) należy przeprowadzać minimum dwukrotnie na miesiąc.

Fizjoterapia

Fizjoterapia w ramach profilaktyki odleżyn powinna być nakierowana na odciążanie tkanek narażonych na ucisk, poprawę krążenia (ogólnego oraz miejscowego w okolicach narażonych na odleżyny lub objętych zmianami odleżynowymi), utrzymanie pełnego zakresu ruchomości w stawach oraz zapobieganie zanikom mięśniowym. Program fizjoterapii powinien być ustalany indywidualnie i zgodny z ogólnymi celami terapii.

Źródło:

S. Krzemińska, A. Borodzicz, „Profilaktyka przeciwodleżynowa i metody prognozowania ryzyka rozwoju odleżyn w oddziałach intensywnej terapii”, „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece” 2016, 2(4): 117-124.

 

 

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143 thoughts on “Profilaktyka odleżyn u pacjentów OIT – najważniejsze zasady

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