Article Text

PRESSURE ULCERS IN CRITICALLY ILL CHILDREN
  1. M Cicak Novak 1,
  2. D Sofic1,
  3. M Saratlija1,
  4. A Maric1
  1. 1PICU and NICU, Departrment of Paediatrics, University Hospital Center Zagreb, Zagreb, Croatia

Abstract

Background Pressure ulcers are a well-known old and immobile patient’s problem, but are also considered a poor nursing care consequence. They are a serious and expensive complication of critically ill children’s care.

Aim Two critically ill children are presented, both mechanically ventilated, aged 3 years, with the same nursing care conditions. The first was a child after open heart surgery and the other was a child with non-identified neuromuscular disease. The first patient had pressure ulcers stage 2–4, the second patient had only skin breakdown. These examples help us to identify the importance of intrinsic and extrinsic factors for the appearance of pressure ulcers. We scored both of the patients for the risk of pressure ulcers by the Norton scale and Braden Q scale. Both of them on the Norton scale had a score of 4 but on the Braden scale they had a score of 9 for the first patient and 15 for the patient with neuromuscular disease.

Results In spite of adequate nursing care, dominant intrinsic factors can cause skin breakdown in critically ill children. We also find that the Braden Q scale is more appropriate for the scoring of critically ill children than the Norton scale.

Conclusion Pressure ulcers are relatively common complications of critically ill children’s treatment. Paediatric intensive care unit admission has to be the beginning of pressure ulcer or skin breakdown preventive measures. Particular nursing skills for prevention, on time recognising, scoring, and treatment of lower stages of pressure ulcers are emphasised.

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