Which patient is most prone to pressure ulcers?

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

Bedridden patients are the most susceptible to pressure ulcers due to prolonged immobility.
Immobility leads to sustained, unrelieved pressure on the skin over bony prominences (e.g., sacrum, heels, hips), which obstructs blood flow.
This lack of circulation, known as ischemia, causes tissue damage and the formation of a pressure ulcer.
The Braden Scale, a standard risk assessment tool, identifies being 'Bedfast' (confined to bed) as the highest risk category for the 'Activity' parameter, confirming this vulnerability.

Option A: An ambulatory patient is mobile and can independently shift their weight. This regular movement prevents the sustained pressure necessary for ulcer formation.
Option C: While postoperative patients have a temporary increase in risk due to limited mobility immediately after surgery, this risk is typically short-lived. Modern care emphasizes early ambulation to prevent this and other complications. Their risk is not as high as that of a chronically bedridden patient.
Option D: This option is incorrect because the risk levels are not equal among the different patient types. Bedridden patients have a significantly higher and more consistent risk compared to ambulatory or most postoperative patients.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risk factors for pressure ulcers (decubitus ulcers) to guide bedside assessment, documentation, and the next nursing action.
Nurses use standardized risk assessment tools like the Braden Scale to systematically identify patients at high risk for pressure ulcers and to justify preventive interventions.
Prevention is the most critical nursing intervention. It involves a multi-faceted approach including a strict turning schedule (e.g., every 2 hours), use of pressure-reducing surfaces, meticulous skin care, and nutritional support.
Pressure ulcers are considered a significant indicator of the quality of nursing care and can lead to severe complications, including pain, infection, and increased length of hospital stay.

How to Approach the Question

First, identify the core concept of the question, which is identifying the highest risk factor for pressure ulcers.
Recall the primary cause of pressure ulcers: sustained, unrelieved pressure on the skin, which is directly related to immobility.
Evaluate each option based on the level of mobility it implies.
An 'ambulatory patient' is mobile, which is low risk.
A 'postoperative patient' has temporarily reduced mobility, which is a moderate risk.
A 'bedridden patient' is immobile, which is the highest risk.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 pp. 111-113, 109-111

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