الفهرس 
Abstract
Normal Structure and Function of Healthy SkinOnly 14 pages are availabe for public view
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Abstract
Summary Critically ill patients are at a higher risk for pressure ulcers than patients in general care unites. Several factors increase the risk: severity of illness; increased length of stay; poor tissue perfusion due to hemodynamic instability, use of vasoactive medications, and anemia; sensory impairment resulting in a reduced sensitivity and/or reaction to pressure due to sedation or underlying abnormality; skin maceration due to moisture; immobility; and poor nutritional status. Care of pressure ulcers in intensive care units requires that: pressure be relieved with frequent repositioning and pressure intensity be reduced with adequate support surfaces; nutrition be addressed and malnutrition corrected; and topical or local wound care be based on the use of physiologic products to cleanse the wound, the removal of necrotic tissue via debridement, and the use of dressings that support moist wound healing Therefore the Aim of this study was to evaluate effect of nursing protocol in preventing pressure sores in critically ill patient and effect on patient’s outcomes. Quasi-experimental research design was used to conduct this study. The sample of this study consisted of 60 patients, who were admitted to trauma intensive care unit and general ICU at Assuit University Hospital. Tools used in this study consisted of three main tools: First Tool: assessment of patient profile:-
This tool was developed by the researcher based on reviewing of the relevant literature and used to assess the studied patients regard the socio-demographic data and medical related data as base line data, it includes 3 main parts as follwing.
Part I-Socio- demographic and clinical data of the patient:-Which include:-
Patient data as( age& sex). History of current disease, past medical diseases, cause of admission, medical diagnosis and assess risk factors for pressure ulcer.
Part II-Assessment for anthropometric measurement
Which include:-Patient weight, height, body mass index and Mid arm circumference.Part III: this part consists of five main categories as following 1-Assessment of hemodynamic parameters: Which includes (Temperature, pulse, blood pressure, respiration, pulse oximetry &urine output ) developed by the researcher daily for 7 days.
2- Respiratory assessment:-
This is indicator of respiratory system condition that includes (secretions and skin and lips color) developed by the researcher daily for 7 days.
3- Assessment of blood gases measurements which include:-
Arterial oxygen tension (pao2), arterial carbon dioxide tension (paco2), (sao2), PH and Hco3 & BE taken by the researcher daily for 7 days.
4- Assessment of the ventilator parameters:- Which include the (Mode of ventilation, Tidal volume (vt), Respiratory rate (f), Fraction of inspired oxygen(fio) ,Positive end expiratory pressure(PEEP)).
5-laboratory investigation:-as Blood picture. (WBC, RBC, hemoglobin, lymphocyte), Blood glucose level, Prothrombine time, Liver function test and Renal function test.
Second Tool: Which include two part
Part I:- Neurological assessment by use the Glasgow Coma Scale.
Part II :- Total intake and output.
Third Tool: It composed of two parts
Part I:- The Braden scale to assess Skin state. Part II:- Ulcer data.
The main results:
The result of the current study show that the mean age in study group (51.83±12.59) years and (48.67±12.46) years in control groups with no significance difference (p=0.325). Also there were (13.3%) of sample in study group were female (16.7%) in control group .
Also show no significant difference (P>0.05) between both group regard risk factors except found significance difference in between study and control group in cases of stroke( P<0.04). As regard temperature there were significance difference between study & control groups at 3rd to 7th day (P<0.05). also as regard to systolic blood pressure, there were significance difference between study & control groups at 7th day (P<0.05). As regard diastolic blood pressure there were no significance difference between study & control groups at 1st to 7th day (P>0.05).
As regard the Braden scale assessment it showed mean score (11.20±0.66vs11.73±2.33) in study and control group respectively on day of admission, with no significant difference at first day (P>0.05), but at the 7th day mean score were (15.13±2.56vs13.00±2.65) in study and control group, with significance difference at 2nd to 4th day (P<0.05), also there were moderate significance difference at 5th -6th day (P<0.001) and there were highly significance difference at day 7 (P<0.000).
In relation to sites, stage and size of bed sores between two groups, With highly significance about site, size, exposed tissue, color wound, exudates, wound edge and signs of wound infection (P<0.000). There were moderate significance difference about stage, odor and condition of surrounding skin (P<0.001) and there were a significance difference with type wound of tissue.