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Incidence
Stage III and IV pressure ulcers is a serious health issue that is difficult to cure. It requires the constant attention of the health care providers. During the III stage, the patient experiences the loss of tissue, subcutaneous can also be visible. Also, during this stage, the ulcer may involve certain undermining or tunneling. Stage IV is characterized by tissue loss, where a bone or muscle is already exposed. Also, at this stage the wound includes tunneling. The incidence of III and IV stage pressure ulcers vary due to the type of the health care facility, yet it is estimated that 15% of acute patients have pressure ulcers, where the overall incidence may vary from 2% to 25% depending on the type of facility (Brem et al., 2010). For instance, in Nursing Homes, the prevalence of patients with stage III and IV pressure ulcers will be higher comparing to the other health care facilities, as there are a lot of disabled patients in Nursing Homes. It is also considered that the incidence of pressure ulcers has to be below 2% to mark the level of quality of the health care services. It has to be noted that 95% of stage III and IV pressure ulcers cannot be cured in the 8 weeks period due to the severity of the wound (Brem et al., 2010). Taking into account the importance of this issue, it is essential to actualize the most appropriate preventive and curing measures that will help to decrease the incidence of pressure ulcers among patients.
The Main Causes
Stage III and IV pressure ulcers develop as a deterioration of the health care issue. Initially, pressure ulcers emerge in the patients who lose their ability to move due to various reasons, like paralysis, severe bone and muscle damage, coma, or any other illness that affects the mobility of the individual. In general, pressure ulcers occur due to friction, sustained pressure, and shear. Further, if the problem is not mitigated by the health care providers or the wounds are not cured in time, pressure ulcers shift to stage II, III, and IV, where the last two are considered critical and hard to cure due to the loss of thickness tissue and protrusion of muscle or bone. During stages III and IV, it is difficult to recover the wounded surface and it requires the constant attention of the medical personnel as well as the cooperation of the patient.
It is considered that the development of pressure ulcers to the stages III and IV is caused by the inadequate actions of the health care providers, failed evaluation of the patient, and lack of communication between the patients and caregivers (Lyder et al., 2012). Moreover, inadequate work conditions of nursing staff and lack of personnel in the facility may increase the incidence of pressure ulcers and their development to stage III and IV, as these factors affect the quality of health care provided in the facility (García-Fernández et al., 2014). It was admitted that it is more likely to develop stage III and IV pressure ulcers in the hospital than acquire them at home in the reason of the limited abilities in the hospitals to provide the essential care in time (Lyder et al., 2012). Overall, the development of this issue can be caused by multiple reasons, from the lack of personnel to the ineffective evaluations performed by the caregivers during the patients’ stay at the facility. Therefore, the resolution of a high prevalence of stage III and IV pressure ulcers vary.
Consequences
The outcomes of stage III and IV pressure ulcers for the patients are dramatic. Patients feel pain, ulcers limit their mobility, even more, the problem decreases the time for healing, and affects the overall health state of a patient. Also, the consequences of the problem may depend on the illness and the choice of the treatment prescribed by the physician. During this stage of the problem, the inability to treat the lesions may lead to the amputations or even death of the patient due to the infection. Also, some of the stage IV pressure ulcers cannot be cured without surgical treatment. Therefore, the healthcare personnel has to pay attention to the development of the problem, an illness that caused the development of pressure ulcers, and the state of the patient. For instance, Porreca & Giordano-Jablon (2008) assessed a medical case where a patient with quadriplegia suffered from a long term stage III and IV pressure ulcers that were present for about 6 years and caused septic shock and deterioration of his general health as well as the ability to move. In this case, the health care personnel had to choose multiple methods of treatment due to the complicated health issue (Porreca & Giordano-Jablon, 2008). Yet still, the inability to treat pressure ulcers for a long-term period may indicate that the caregivers did not provide adequate evaluations or the assessment of the treatment options.
Preventive Methods
The main preventive tool in addressing stage III and IV pressure ulcers is a timely evaluation of the patients as well as effective healing process of the initial stage of this problem. When nurses and physicians assess the patients in a timely manner as well as treating pressure ulcers efficiently at the first stage of the illness, they will not progress to stage III and IV. It is considered more effective to implement ongoing assessment procedures of the patients with the initially recognized pressure ulcers with the introduction of effective treatment of this problem (Keelaghan et al., 20008). The assessment may be provided during the initial admission of the patients and during the hospital stay, where the nurses may make the proper evaluation with the graphic indication of the stage of the pressure ulcers. This information will help the further treatment of this problem and prevent pressure ulcers from progressing to the chronic stage III and IV. It is essential to implement a hospital-wide program that would affect all patients and involve all required personnel, including registered nurses, their assistants, physicians and other personnel that will help the patients to decrease the pressure, eliminate the friction, and make them more mobile to prevent the deterioration of the pressure ulcers.
References
Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D. Lyder, C. & Vladeck, B. (2010). High Cost of Stage IV Pressure Ulcers. American Journal of Surgery, 20(4), 473-477.
García-Fernández, F. P., Agreda, J. J., Verdú, J., & Pancorbo-Hidalgo, P. L. (2014). A New Theoretical Model for the Development of Pressure Ulcers and Other Dependence-Related Lesions. Journal of Nursing Scholarship, 46(1), 28-36.
Keelaghan, E., Margolis, D., Zhan, M. & Baumgarten, M. (2008). Prevalence of pressure ulcers on hospital admission among nursing home residents transferred to the hospital. Wound Repair and Regeneration, 16(3), 331-336.
Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R. & Hunt, D. R. (2012). Hospital-Acquired Pressure Ulcers: Results from the National Medicare Patient Safety Monitoring System Study. Journal of the American Geriatrics Society, 60, 1603-1608.
Porreca, E. G. & Giordano-Jablon, G. M. (2008). Treatment of Severe (Stage III and IV) Chronic Pressure Ulcers Using Pulsed Radio Frequency Energy in a Quadriplegic Patient. Open Access Journal of Plastic Surgery, 8, 49-59.
