Basınç Yaraları: Basınç Yaralanmalarında Riskli Bölgeler ve Korunma Yöntemleri
Özet
Basınç yaralanmaları; basınç, sürtünme ve makaslama etkisiyle genellikle kemik çıkıntıları üzerinde veya tıbbi araç gereçlerin temasıyla gelişen karmaşık sağlık sorunlarıdır. Topuk, sakrum ve dirsek gibi bölgeler başta olmak üzere, hastanın pozisyonuna ve kullanılan tıbbi cihazlara göre riskli alanlar değişiklik gösterir. Doku kaybının boyutuna göre Evre I’den Evre IV’e, evrelendirilemeyen, derin doku ve mukozal membran hasarı olarak sınıflandırılan bu yaralanmalar; hastanede kalış süresini, maliyetleri ve mortaliteyi artırarak yaşam kalitesini olumsuz etkiler. Basınç yaralanmalarını önlemek için disiplinler arası bir yaklaşımla, kuruma kabulden sonraki ilk 8 saat içinde risk ve cilt değerlendirmesi yapılmalı, Braden veya Norton gibi ölçekler kullanılmalıdır. Deri bütünlüğünü korumak adına cilt temiz tutulmalı, uygun pH'ta ürünlerle nemlendirilmeli ve riskli bölgelere masaj yapılmamalıdır. Beslenme durumunun takibiyle günlük enerji ve protein alımı optimize edilmeli, dehidratasyonu önlemek için yeterli hidrasyon sağlanmalıdır. Ayrıca hastanın durumuna göre en az iki saatte bir pozisyon değişimi sağlanmalı, sürtünmeyi azaltacak transfer araçları ile basıncı yeniden dağıtan ileri özellikli köpük şilteler gibi destek yüzeyler ve profilaktik örtüler kombine şekilde kullanılmalıdır.
Pressure injuries are complex health problems that generally develop over bony prominences or due to contact with medical devices under the influence of pressure, friction, and shearing. Risk areas vary based on the patient's position and the medical devices used, particularly in regions such as the heel, sacrum, and elbows. Classified from Stage I to Stage IV, unstageable, deep tissue, and mucosal membrane injuries according to the extent of tissue loss, these injuries negatively impact the quality of life by increasing the duration of hospital stay, costs, and mortality. To prevent pressure injuries, a risk and skin assessment must be performed within the first 8 hours of admission using an interdisciplinary approach, utilizing scales like Braden or Norton. To maintain skin integrity, the skin should be kept clean, moisturized with appropriate pH products, and massage should be avoided on risky areas. Daily energy and protein intake must be optimized by monitoring the nutritional status, and adequate hydration should be provided to prevent dehydration. Furthermore, patients must be repositioned at least every two hours depending on their condition, and support surfaces that redistribute pressure, such as advanced foam mattresses, should be used in combination with transfer devices that reduce friction and prophylactic dressings.
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