PIC0 for Pressure Ulcers

Pressure ulcers are caused by among other factors unrelieved pressure and shearing forces on the surfaces of the body. This condition can be prevented and treated if it is noted early enough in a patient (Yarkony, 1994). If noted late, it can be very deadly. It poses a lot of challenge to the medical practitioners in the developed world as it causes substantive iatrogenic deaths. There are four pressure ulcer stages namely stage I to IV. Stage I is superficial and appears to be similar to reactive hyperemia witnessed after the skin has been exposed to prolonged application of pressure. Stage II becomes evident when damage to the epidermis extends to the dermis thereby forming a blister. Stage III is known to extend to the layer of the subcutaneous tissue which has poor blood supply hence its inability to heal faster. Stage IV pressure ulcers can extend into the muscles and the bones. It is the deepest pressure ulcer. This essay intends to come up with a Patient Intervention Comparison Outcome (PICO) statement for pressure ulcers to conform to the proposed capstone project, by reviewing the PICO websites and other learning resources given in the course resource folder.

PICO model is used in structuring questions that can be answered, and formulation of clinical questions (Allman, 1989). Questions are broken into four key elements. The element of the patient takes the aspect of patient’s gender, the condition, the stage of the condition, and the care setting. Intervention captures the drug administered, its dosage, whether it is supposed to help in prevention or other purpose, and the delivery of the drug (Nordenstrom, 2004). Comparison encompasses the possibility of availability of an alternative to the standard treatment. This is about whatever the physician is interested in like the healing process, improvement of quality of life, and the costs involved (Booth, 2004).

The patient in question has been receiving treatment at a health care facility where she was turned over only once in a day. She lay on her back for the better part of the day and was only turned at 6 p.m. in the evening everyday. This was the routine from the time she was admitted at the facility 2 months ago. As a result, the patient has developed superficial pressure ulcer that seemed not to subside even after relieving pressure. Visually the condition looked like it was a reactive hyperemia but it is only that the condition did not resolve itself within the ¾ of the time of application of pressure. Moreover, the condition did not blanche with the application of pressure. The skin was consequently colder than expected with a characteristic odd texture painful to the patient. There were shades of purple on the skin of the patient.

Patient/problem Intervention Comparison Outcome
Patient has superficial ulcerations on her back that do not subside, the ulceration visually looked like reactive hyperemia, the condition did not blanche even after application of pressure, and the patient’s skin was colder than normal with shades of purple. Relieving pressure by turning the patient after every 2 hours, and recommending specialty beds for patients with pressure ulcers, the head of the bed should be kept lower than 45 degrees to minimize shearing forces, and fluidized beds should be used, or pressure relieving cushions of air. Conventional treatment regimes The healing of the wound

Reference List

Allman, R.M. (1989). Pressure ulcers among the elderly. N Engl J Med. 320(13): 850-3.

Booth, A. (2004). “Formulating answerable questions” in Booth, A. and Brice, A. Evidence-based practice for information professionals: a handbook. London: Facet Publishing. pp. 61-70.

Nordenstrom, J. (2007) Evidence-based medicine in Sherlock Holmes’ footsteps. London: Blackwell Publishing.

Yarkony, G.M. (1994). Pressure ulcers: a review. Arch Phys Med Rehabil. 75(8), 908-17.

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