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Nursing Experience about Treatment of Pressure Ulcer by MEBO
Add Timeㄩ2013/12/24 9:22:41

                                                      Nursing Experience about Treatment of Pressure Ulcer by MEBO

                               Hao Jinyan and Ding Minghua with Central Hospital of China Railway 12th Bureau Group Co., Ltd

With the coming of aging society in China and changes of disease spectrum, senior patients would be more possible to suffer from diabetes, Parkinson, high blood pressure, cardiovascular and cerebrovascular diseases and other chronic diseases. On the other hand, the immune system of senior citizens worsens, the reactions become slower, movement is restricted and the body is pressed locally for longer period of time. All these result in obvious higher rate of incidence rate of pressure ulcers. Since 2008, my hospital has received 32 cases of pressure ulcers of IV degree by adopting in-situ skin regeneration medical techniques for standard treatment. The results were satisfactory. Now, we offer the treatment process as below.

Clinical Information
Altogether, there were 32 patients with IV degree pressure ulcers and 64 wounds. Among all of them, 21 cases were males and 20 were females, aging from 62 to 82. The area of pressure ulcer is between 7cm x 8cm to 18cm x 20cm. The depth of pressure ulcers: it can all reach to muscle and bone tissues. The lasting time of wounds is usually 7 to 35 days. Twenty-five cases suffer from wounds complicated with infections. The location of pressure ulcers: 35 were on sacrococcygeal region, 16 were on hip, 5 were on ankle and 8 were on heel. The protopathy: altogether there were 28 cases, including diabetes, Parkinson, cardiovascular and cerebrovascular disease and paraplegia. The complications: altogether there were 15 cases, including hypoproteinemia, anemia, electrolyte disturbance and etc.

Treatment Methods
Debridement 每 Iodine shall be used for first debridement to sterilize the skin surrounding the ulcers, and the wounds shall be washed with hydrogen dioxide solution and normal saline and the necrotic tissues shall be removed with the help of maggots. The principle of ※Three Nos§ shall be followed in debridement, e.g. no more pains, no more bleeding and no more damaging over normal tissues.

Dressing Change on Wounds 每 No sterilizer shall be used during dressing change and the principle of ※Three No Accumulations and Three Prompts§ shall be followed, e.g. no more accumulation of necrotic tissues, no more accumulation of residual MEBO and no more accumulation of liquefactions. The liquefactions and necrotic tissues shall be promptly cleansed and medications shall be provided promptly. At early stage, the ulcerative wounds (infection and swelling phase) can be directly smeared with MEBO with a thickness of 1.0mm to 1.5mm. As for potential cavities, MEBO gauze can be filed based on the depth and area of the cavities in order to realize full contact between medicine liquid and wounds. The dressing shall be changed twice every day. At middle stage, MEBO can be smeared on ulcerative wounds (growth phase of granulation tissues), with a thickness of 0.5mm to 1.0mm, the dressing shall be changed once or twice every day. At the advanced phased, the MEBO can be adopted together with wound and ulcer paste on ulcerative wounds (growth phase of epidermis). The dressing shall be changed once every day until the wounds heal completely.
Treatment of Protopathy 每 The protopathy and complications shall be actively treated, e.g. keeping blood glucose within normal range, correcting hypoproteinemia, anemia and electrolytes disturbance, enhancing nutrition and improving body conditions, promoting blood circulation and dissolving stasis, improving micro-circulation, the application of antibiotics shall be as early as possible and as short as possible together with other medicines with sufficient volume.

Treatment Methods
Wound Care 每 Under the guidance of doctors, treatment and care of patients in the Department are the responsibility of nurses responsible for affairs related to patients and those competent in particular treatment. With regard to the debridement of wounds, the principle of debridement through maggots, the principle of ※Three Nos§ and the principle of ※Three No Accumulation and Three Prompts§ shall be followed.

Treatment for Decompression 每 The main cause of the pressure ulcer is pressure, fraction and shear. And, we take measures according to the causes of pressure ulcers. First, the responsible nurses and nurses of night shift shall evaluate and record the conditions of skin being compressed. The best way to relieve compression is turning body. Patients shall be guided and assisted to change body positions once every 1 to 2 hours. Air bed can be adopted and family members of patients shall be guided with the purposes and meaning of turning body for better cooperation. In addition, patients shall not be dragged or pulled when turning over body. The movement shall be gentle in order to prevent skin from being damaged by fraction. The patients shall be assisted to handle limb function exercises on bed three to four times a day in an effort to maintain a sound body position and prevent limb functions disuse syndrome and improve cardiovascular and pulmonary functions.

Fundamental Treatment 每 Usually, patients shall be settled in single ward facing the south, and the ward shall be kept quiet, clean and hospital. The room temperature shall be maintained between 22 to 24 degrees, the humidity shall be 50% to 60%. Patients shall be provided necessary conveniences to feel ease.

Treatment of Protopathy 每 Most patients with pressure ulcers suffer from skin damages due to improper treatment of other protopathy. In this article, 28 patients suffer from different protopathy. And, the core of treating pressure ulcer lies on active treatment. The responsible nurses shall urge patients to take various medicines timely, sufficiently and regularly and shall observe the vital signs, including psychological conditions, diet, defecation, sleeping and blood sugar. The ward round shall be made routinely, and any abnormal conditions shall be reported to competent doctors for settlement.

Care of Various Channels 每 Most patients in this article have been equipped with long-term or short-term tubes, e.g. venous indwelling needle, stomach tube and urine tube. Therefore, care of such tubes shall be enhanced to reduce infections. The settlement and care of venous indwelling needle shall be strictly handled in accordance with the operation procedures related to the care of such needle under sterilized conditions; the care of using long-term stomach tube for nasal feeding: family members of patients shall be explained about purposes of nasal feeding, temperature and volume of nasal liquid and the washing of stomach tube. The care of mouth cavity shall be done twice every day to maintain clean and moist environment. The stomach tube made from silica gel shall be changed once every month to prevent ulcer in nose, pharynx and esophagus and gastrorrhagia. The care of urine tube: the time of keeping urine tube shall be in proportion with the infections and damages of urinary tract. Therefore, the nurses shall keep aseptic cleaning techniques, frequency of changing urine tube and bag under strict control in order to prevent urine system infections and lithangiuria.

Care of Diet 每 The patients shall take better breakfast, less lunch and a full supper, and the diet shall be of high protein, vitamin and easy to be digested. In addition, the diet shall be diversified in order to maintain intake of protein, fat, vitamin and mineral substances, which is good to the healing of wounds and improving immunity.

Care of Psychological Conditions 每 Good relationship between nurses and patients can facilitate nursing. The responsible nurses shall follow various means to communicate with patients and establish good relations as soon as possible. They shall talk to patients and understand requirements of patients, and they shall take treatment measures and provide them with the most sincere help and make them happy in order to relieve their psychological pressure and realize their goals as soon as possible. During dressing change, apart from body language, they shall talk to them and introduce them with wound conditions and current medical progress, observe the pictures and videos of wound healing of patients in order to make them more confident.

Treatment Results
After treatment, 59 wounds were healed, among which, 25 healed within 60 to 90 days, 21 healed within 90 to 120 days and 13 healed after over 120 days. In addition, efficacy of treatment can be observed on 4 wounds and no efficacy can be found on one wounds. The healing rate for the group is 92.2% and the efficacy rate is 98%.

Clinical Discussions

The main element for in-situ skin regeneration medical techniques is MEBO which can prevent infections and inflammations by changing the biological features of bacteria. MEBO contains elements that can promote blood circulation and blood stasis, improve local micro-circulation, promote venous return and relieve edema. MEBO can protect exposed and damaged nerve endings. It also contains many amino acids and vitamins, provides nutrients to wounds and facilitates granulation growth and promotes wound healing. MEBO Wound and Ulcer Dressing is a preparation with special framework which can liquefy and discharge the necrotic tissues and activate potential cells and differentiate them into epithelial cells, fibrous cells and vascular endothelial cells. In addition, it can shrink the wounds by mechanical tension and speed up wound healing. MEBO, by combining with Wound and Ulcer Dressing, can give full play to in-situ skin regeneration medical techniques to treat refractory wounds and ulcers.

Patients with pressure ulcers are usually old and weak. They are usually bedridden for long period of time and are complicated with diabetes and cardiovascular diseases and Parkinson. At the same time, the senior citizens suffer from slow metabolism, poor nutrition supply, unsatisfactory immune system, high incidence rate of pressure ulcer, rapid development, refractory ulcer wounds and chronic and stubborn diseases. Through years of clinical practice, we believe the therapy combining in-situ skin regeneration medical techniques and customized and high quality care shall be the most satisfactory means to deal with pressure ulcers among senior citizens. It is scientifically advanced, satisfactory in treatment results, popular among patients and their family members and worth being promoted.



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