Background and aims: pressure Ulcers affect many patients, mainly at the end of life, with a prevalence between 14% and 47% in Hospice and Home Palliative Care. The main goal of Palliative Care is the management of symptoms. The aim of this thesis is to identify which symptoms related to Pressure Injury are perceived by Palliative Care patients, followed at home, and the role of the nurse with the aim of assure a good quality of life for the terminally ill patient. Materials and methods: a literature review was performed. After having identified search questions, by using the PIO/PICO method, search strings, constructed with Boolean operators, were entered into the main scientific databases (PubMed and CINAHL). Finally, 14 articles related to the topic in exam, published in the last 10 years, were selected. Results and Discussion: from the articles reviewed came out that the main role of the home Palliative Care nurse is to build a trusting relationship with the patient, holistically assessing his or her needs and requirements and sharing with him or her the goals to achieve. It’s important to build a therapeutic alliance also with the caregivers because they can help to maintain good symptom control in the patient and prevent from new sores, even when the nurse is not there. The symptoms, related to Pressure Injuries, that patients report to be the most critical are: pain, exudate, and odor. Pain may be chronic, treated following the OMS guidelines, or associated with the injury, so its course throughout the day should be assessed and an appropriate analgesic treatment should be chosen, or related to dressing replacement procedures. In the latter case, it is important to premedicate the patient (20-30 minutes before the procedure) and choose nonadherent dressings. Odor is due to localized bacterial growth; therefore, an antibacterial or antimicrobial is used as the main treatment. Exudate, is part of the normal inflammatory process but can increase due to bacteria, so the choice of dressings, with a good absorbency and an antibacterial power, is necessary. From the economic point of view, wound management costs are influenced by the time they require, so it’s important to choose the right medications and use them properly. The use of advanced medication by the way relapse to the patient. One of the limitations of research is the lack of studies targeting terminal patients. Conclusions: nurse is one of the health care professionals most in contact with the patient in Home Palliative Care, this allows him to build a trusting relationship with the patient by being the reference for his needs, in order to ensure comfort and dignity. It is important for nurses to build a therapeutic alliance with the caregivers as well, and to educate them to actions and behaviours to promote their loved one's well-being and ensure them a continuous quality care. Palliative Cares primary focuses is symptomatic control, and the priority wound-related symptoms are: pain, odour, and exudate. To integrate studies regarding Pressure Ulcers in terminal patients, it would be desirable record the interventions and dressings used and observe and analyse the results.
Background e obiettivi: le Lesioni da Pressione (LdP) sono un problema che colpisce molti pazienti, principalmente nel fine vita, con una prevalenza tra il 14 ed il 47% negli Hospice e nelle Cure Palliative (CP) Domiciliari. Le Cure Palliative hanno come obiettivo principale la gestione della sintomatologia. L’obiettivo di questa tesi è quello di individuare quali sono i sintomi secondari alle Lesioni da Pressione percepiti dai pazienti in Cure Palliative, seguiti a domicilio, e il ruolo dell'infermiere in merito, al fine di assicurare una buona qualità di vita al malato terminale. Materiali e metodi: è stata eseguita una revisione di letteratura. Dopo aver individuato i quesiti di ricerca con il metodo PIO/PICO, sono state inserite stringhe di ricerca, costruite con operatori booleani, nelle principali banche dati scientifiche (PubMed e CINHAL). Sono stati infine selezionati 14 articoli inerenti all’argomento trattato, pubblicati negli ultimi 10 anni. Risultati e Discussione: dagli articoli analizzati è emerso che il ruolo principale dell’infermiere di Cure Palliative Domiciliari è quello di costruire una relazione di fiducia con il paziente, valutando in modo olistico i suoi bisogni e le sue necessità e condividendo con lui gli obiettivi da raggiungere. L’alleanza terapeutica è importante venga costruita anche con i caregiver, in quanto possono contribuire a mantenere un buon controllo dei sintomi nel paziente e prevenire l’insorgenza di nuove lesioni, anche quando l’infermiere non è presente a domicilio. I sintomi principali da trattare, legati alle Lesioni da pressione, sono: dolore, essudato e odore. Il dolore può essere cronico, trattato secondo le linee guida dell’OMS, associato alla lesione, quindi, va valutato il suo decorso nell’arco della giornata e scelto un trattamento analgesico appropriato, oppure legato alle procedure di sostituzione della medicazione. In quest’ultimo caso è importante premedicare il paziente (20-30 minuti prima della procedura) e scegliere medicazioni non aderenti. L’odore è dovuto alla crescita batterica localizzata nella lesione; quindi, come trattamento principale viene utilizzato un antibatterico o antimicrobico. L’essudato, invece, è parte del normale processo infiammatorio ma può aumentare a causa di batteri, per questo è necessaria la scelta di medicazioni con un buon grado di assorbenza e antibatteriche. Dal punto di vista economico il costo della gestione delle LdP è definito dal tempo che queste richiedono, costo che può essere ridotto scegliendo la medicazione più appropriata ed utilizzandola correttamente. L’uso di medicazioni avanzate però, spesso grava sul paziente. Uno dei limiti, emerso durante a ricerca, è la carenza di studi rivolti a pazienti terminali. Conclusioni: l’infermiere è una delle figure sanitarie più a contatto con il paziente in CP Domiciliari, ciò gli permette di costruire un rapporto di fiducia con il malato facendosi portavoce dei suoi bisogni al fine di garantirgli comfort e dignità. È importante l’infermiere costruisca un’alleanza terapeutica anche con i caregiver, e i educhi ad azioni e comportamenti che promuovano il benessere del proprio caro, al fine di assicurare un’assistenza di qualità continua. L’assistenza nel paziente in CP si concentra principalmente sul controllo sintomatico, e i sintomi prioritari legati alla lesione sono: dolore, odore ed essudato. Al fine di integrare gli studi in merito alle LdP nei pazienti terminali, sarebbe auspicabile registrare gli interventi e le medicazioni utilizzate, osservandone e analizzandone i risultati.
Trattamento e gestione delle Lesioni da Pressione nel paziente terminale in Cure Palliative domiciliari: una revisione di letteratura
ISEPPI, ALICE
2022/2023
Abstract
Background and aims: pressure Ulcers affect many patients, mainly at the end of life, with a prevalence between 14% and 47% in Hospice and Home Palliative Care. The main goal of Palliative Care is the management of symptoms. The aim of this thesis is to identify which symptoms related to Pressure Injury are perceived by Palliative Care patients, followed at home, and the role of the nurse with the aim of assure a good quality of life for the terminally ill patient. Materials and methods: a literature review was performed. After having identified search questions, by using the PIO/PICO method, search strings, constructed with Boolean operators, were entered into the main scientific databases (PubMed and CINAHL). Finally, 14 articles related to the topic in exam, published in the last 10 years, were selected. Results and Discussion: from the articles reviewed came out that the main role of the home Palliative Care nurse is to build a trusting relationship with the patient, holistically assessing his or her needs and requirements and sharing with him or her the goals to achieve. It’s important to build a therapeutic alliance also with the caregivers because they can help to maintain good symptom control in the patient and prevent from new sores, even when the nurse is not there. The symptoms, related to Pressure Injuries, that patients report to be the most critical are: pain, exudate, and odor. Pain may be chronic, treated following the OMS guidelines, or associated with the injury, so its course throughout the day should be assessed and an appropriate analgesic treatment should be chosen, or related to dressing replacement procedures. In the latter case, it is important to premedicate the patient (20-30 minutes before the procedure) and choose nonadherent dressings. Odor is due to localized bacterial growth; therefore, an antibacterial or antimicrobial is used as the main treatment. Exudate, is part of the normal inflammatory process but can increase due to bacteria, so the choice of dressings, with a good absorbency and an antibacterial power, is necessary. From the economic point of view, wound management costs are influenced by the time they require, so it’s important to choose the right medications and use them properly. The use of advanced medication by the way relapse to the patient. One of the limitations of research is the lack of studies targeting terminal patients. Conclusions: nurse is one of the health care professionals most in contact with the patient in Home Palliative Care, this allows him to build a trusting relationship with the patient by being the reference for his needs, in order to ensure comfort and dignity. It is important for nurses to build a therapeutic alliance with the caregivers as well, and to educate them to actions and behaviours to promote their loved one's well-being and ensure them a continuous quality care. Palliative Cares primary focuses is symptomatic control, and the priority wound-related symptoms are: pain, odour, and exudate. To integrate studies regarding Pressure Ulcers in terminal patients, it would be desirable record the interventions and dressings used and observe and analyse the results.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/57208