Pressure Ulcer Prevention in High Risk Unstable Spine Patient Using Multiple Evidence -Based Intervention

Topic: This case study documents the Nursing process to prevent pressure ulcers (PUs) in a complex, high-risk patient. Appropriate informed consent and ethical approvals have been received prior to collecting, analyzing, and reporting information presented in this case history.

Clinical Problem: The patient was a 53-year-old, male, 177 cm tall, 149.68 kg, unstable spine patient with inability to turn and multiple comorbidities over an extended length of stay. The patient’s comorbidities included osteomyelitis of the spine, degenerative disc disease, lumbosacral spondylosis, warfarin anticoagulation with history of deep venous thrombosis, atrial fibrillation, type 2 diabetes mellitus, obstructive sleep apnea with use of constant positive airway pressure, thoracolumbar ankylosing spondylitis, complex distraction anterior, posterior fracture at L2, and severe spinal stenosis with acute paraplegia. The patient was status post-surgical interventions with right L2 hemilaminectomy, medial facetectomy and formaminotomy; right L3 medial facetectomy, hemilaminectomy, lateral recess decompression, and foraminotomy; and in situ arthrodesis L1-L2 and L2-L3.

Past Management: The patient was in critical condition, intubated postoperatively, and on strict bed rest, in a flat position, and restricted to log roll for 95 days. Inability to turn this patient for PU prevention presented a clinical practice challenge, which required interventions tailored to this patient’s needs.

Current Clinical Approach: The patient was log rolled once a day after stooling, liquid cyanoacrylate barrier film applied every 3 days, with wicking incontinence pad and antifungal powder applied as needed to skin folds. In addition, a non-powered gel, low air-loss pressure redistribution support surface was utilized.

Patient Outcomes: The patient was hospitalized for a total of 115 days without PU development.

Limitations: Single patient study may not be able to be generalized and is limited by investigator sensitivity.

Conclusion: These set of interventions allowed this patient to maintain an intact integumentary system.