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Diminished tissue tolerance: Influence on pressure sore development in the institutionalized elderly
RESEARCH BRIEFS
96
D i m i n i s h e d Tissue Tolerance: Influence on P r e s s u r e Sore D e v e l o p m e n t in the I n s t i t u t i o n a l i z e d E l d e r l y Nancy Bergstrom, Barbara Braden, Kristine Norvell, Patricia Lenaghan, and Patricia Boynton
HE CRITICAL determinants of pressure sore T (PS) development are intensity and duration of pressure, and tissue tolerance for pressure. Conceptually, factors affecting tissue tolerance can be categorized as intrinsic or extrinsic. Undernutrition, aging, elevated body temperature, and low arteriolar pressure are the primary intrinsic factors associated with PS development. The purpose of this prospective study was to describe the intrinsic factors that differ between institutionalized elderly persons who develop ( + ) and who do not develop From the University of Nebraska College of Nurslng and the Creighton University School of Nursing, Omaha, NE. Nancy Bergstrom, PhD, RN: Professor of Nursing, University of Nebraska College of Nursing; Barbara Braden, MS, RN: Associate Professor, Creighton University School of Nursing; Kristine Norvell, MSN, RN: Research Nurse, University of Nebraska College of Nursing; Patricia Lenaghan, MS, RN: Research Nurse, University of Nebraska College of Nursing; Patricia Boynton, BSN, RN: Research Nurse, University of Nebraska College of Nursing, Omaha, NE. Address correspondence to Nancy Bergstrom, PhD, RN, University of Nebraska College of Nursing, 4111 Dewey Ave., Omaha, NE 68105. © 1988 by W.B. Saunders Company. 0897-1897/88/0102-0011505.00/0
( - ) PS. Subjects included 200 elderly patients assessed to be at risk (Braden Scale Score <16) for PS development but were P S - on admission to the study. Subjects were studied weekly for 4 weeks, then biweekly for 8 weeks for risk, skin condition, dietary intake, and blood and serum values. The percentage of recommended daily allowance intake of calories, protein, iron, copper, calcium, and phosphorus were all significantly lower in PS + subjects than in PS - subjects. Laboratory indices of serum albumin, serum iron, and serum total protein were also significantly lower in PS + subjects. Additionally, PS + subjects were significantly older, had a significantly higher mean temperature, significantly lower systolic and diastolic blood pressure, and significantly lower" Braden Scale scores than P S - subjects. The results of this study suggest that patients who are older, have poorer nutritional status, and have decreased tissue perfusion are at greater risk for PS development. Nursing interventions that focus on meeting nutritional requirements, maintaining adequate tissue perfusion, and controlling body temperature are important in the prevention of PS, especially in older patients.
96
D i m i n i s h e d Tissue Tolerance: Influence on P r e s s u r e Sore D e v e l o p m e n t in the I n s t i t u t i o n a l i z e d E l d e r l y Nancy Bergstrom, Barbara Braden, Kristine Norvell, Patricia Lenaghan, and Patricia Boynton
HE CRITICAL determinants of pressure sore T (PS) development are intensity and duration of pressure, and tissue tolerance for pressure. Conceptually, factors affecting tissue tolerance can be categorized as intrinsic or extrinsic. Undernutrition, aging, elevated body temperature, and low arteriolar pressure are the primary intrinsic factors associated with PS development. The purpose of this prospective study was to describe the intrinsic factors that differ between institutionalized elderly persons who develop ( + ) and who do not develop From the University of Nebraska College of Nurslng and the Creighton University School of Nursing, Omaha, NE. Nancy Bergstrom, PhD, RN: Professor of Nursing, University of Nebraska College of Nursing; Barbara Braden, MS, RN: Associate Professor, Creighton University School of Nursing; Kristine Norvell, MSN, RN: Research Nurse, University of Nebraska College of Nursing; Patricia Lenaghan, MS, RN: Research Nurse, University of Nebraska College of Nursing; Patricia Boynton, BSN, RN: Research Nurse, University of Nebraska College of Nursing, Omaha, NE. Address correspondence to Nancy Bergstrom, PhD, RN, University of Nebraska College of Nursing, 4111 Dewey Ave., Omaha, NE 68105. © 1988 by W.B. Saunders Company. 0897-1897/88/0102-0011505.00/0
( - ) PS. Subjects included 200 elderly patients assessed to be at risk (Braden Scale Score <16) for PS development but were P S - on admission to the study. Subjects were studied weekly for 4 weeks, then biweekly for 8 weeks for risk, skin condition, dietary intake, and blood and serum values. The percentage of recommended daily allowance intake of calories, protein, iron, copper, calcium, and phosphorus were all significantly lower in PS + subjects than in PS - subjects. Laboratory indices of serum albumin, serum iron, and serum total protein were also significantly lower in PS + subjects. Additionally, PS + subjects were significantly older, had a significantly higher mean temperature, significantly lower systolic and diastolic blood pressure, and significantly lower" Braden Scale scores than P S - subjects. The results of this study suggest that patients who are older, have poorer nutritional status, and have decreased tissue perfusion are at greater risk for PS development. Nursing interventions that focus on meeting nutritional requirements, maintaining adequate tissue perfusion, and controlling body temperature are important in the prevention of PS, especially in older patients.