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Gepubliceerd in:

2008 | OriginalPaper | Hoofdstuk

4 Preventie van decubitus

Auteurs : dr. L. Schoonhoven, prof. dr. T. Defloor

Gepubliceerd in: Decubitus te lijf

Uitgeverij: Bohn Stafleu van Loghum

Samenvatting

Effectieve decubituspreventie richt zich op het beïnvloeden van de oorzaak van decubitus: druk en schuifkrachten.

Preventie van decubitus begint bij het opsporen van patiënten die risico lopen op het ontwikkelen van decubitus. Hiervoor wordt gebruikgemaakt van risicoscorelijsten en de klinische blik van de verpleegkundige. Ontwikkelt een patiënt niet-wegdrukbare roodheid, dan moeten onmiddellijk preventieve maatregelen worden gestart.

Grofweg zijn er twee principes voor preventie: preventie door de grootte van de druk en schuifkracht te verminderen (drukverlaging) en preventie door de duur van de druk en schuifkracht te verminderen (drukpuntverandering). Uiteraard kunnen deze twee principes ook gecombineerd worden.

Maatregelen die zich richten op de weefseltolerantie (bijv. maatregelen met betrekking tot voeding en vocht) kunnen slechts een aanvullende waarde hebben, maar kunnen preventie niet vervangen.

Drukverlaging wordt bereikt door de houding van de patiënt aan te passen en/of door gebruik van een drukverlagend matras of kussen. Bij een semi-fowlerhouding van 30° zijn de druk en schuifkracht in rugligging het laagst. In zijligging wordt een patiënt bij voorkeur gepositioneerd in zijligging 30°.

Foammatrassen verlagen de druk, maar dienen gecombineerd te worden met wisselhouding. Andere drukverlagende matrassen zijn ‘air-fluidised’ bedden en ‘low air-loss’ bedden. Bij opzitten kan een patiënt het best gepositioneerd worden met de rugleuning achterover gekanteld en de onderbenen gesteund op een bankje (hielen niet ondersteund). Dikke luchtkussens worden aanbevolen. Bij zitten is de druk hoger dan bij liggen, waardoor wisselhouding nodig is. Drukpuntverandering wordt bereikt door het geven van wisselhouding of door inzet van een alternerend matras. De frequentie waarmee van houding gewisseld moet worden is afhankelijk van de onderlaag. Bij liggen om de twee tot vier uur, bij zitten om het uur.

vorige hoofdstuk 3 Diagnostiek van decubitus

volgende hoofdstuk 5 Wondzorg bij patiënten met decubitus

Sensitiviteit = percentage patiënten dat decubitus ontwikkelt binnen de groep die volgens de scorelijst risico loopt op decubitus.

Specificiteit = percentage patiënten dat geen decubitus ontwikkelt binnen de groep die volgens de scorelijst geen risico loopt op decubitus.

Statische systemen zijn niet-elektrisch aangedreven systemen die als doel hebben de grootte van de druk en de schuifkracht te verminderen door het drukoppervlak (contactvlak tussen patiënt en matras) te vergroten.

Dynamische systemen zijn elektrisch aangedreven systemen.

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Titel: 4 Preventie van decubitus
Auteurs: dr. L. Schoonhoven
prof. dr. T. Defloor
Uitgeverij: Bohn Stafleu van Loghum
Boek: Decubitus te lijf
Print ISBN: 978-90-313-5025-4

Elektronisch ISBN: 978-90-313-6284-4

Copyright: 2008
DOI: https://doi.org/10.1007/978-90-313-6284-4_5

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

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