Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification

Palagi, Sofia; Severo, Isis Marques; Menegon, Dóris Baratz; Lucena, Amália de Fátima

doi:10.1590/S0080-623420150000500017

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EXPERIENCE REPORT • Rev. esc. enferm. USP 49 (05) • Oct 2015 • https://doi.org/10.1590/S0080-623420150000500017 copy

Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification

Laserterapia en úlcera por presión: evaluación por la Pressure Ulcer Scale for Healing y nursing outcomes classification

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC).

METHOD

Case report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.

RESULTS

A reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.

CONCLUSION

There was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.

Descriptors
Pressure Ulcer; Laser Therapy; Wound Healing; Treatment Outcome; Nursing Process; Intensive Care Units

Indicators	Initial assessment before the intervention	Goals to be achieved after the intervention
Granulation ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	4	5
Scar formation ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	1	5
Decreased wound size ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	1	5
Purulent drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5
Serous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5
Sanguineous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5
Serosanguineous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	5
Surrounding skin erythema ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	2	5
Paeriwound edema ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	5
Blistered skin ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5
Macerated skin ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	5
Foul wound odor ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	4	5

PUSH	Initial assessment before intervention
Length x width ^* * 0=0cm2; 1=<0.3cm2; 2=0.3 - 0,6 cm2; 3=0.7 - 1.0cm 2; 4=1.1cm 2- 2.0cm2; 5=2.1 - 3.0cm2; 6=3.1 - 4.0cm 2;7=4.1 - 8.0cm2; 8=8,1 - 12,0cm2; 9=12,1 - 24cm 2; 10=>24cm2.	10
Exudate amount ^† † 0=None; 1=Light; 2=Moderate; 3= Heavy.	2
Tissue type ^§ § 0= Closed/Resurfaced; 1=Epithelial tissue; 2=Granulation tissue; 3= Slough; 4=Necrotic tissue.	2

Indicators	Day 1 - 1st week - 1º Semana	Day 6 - 2nd week - 2º Semana	Day 9 - 3rd week - 3º Semana	Day 12 - 4th week - 4º Semana	Day 15 - 5th week 5º - Semana
Granulation ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	4	5	5	5	5
Scar formation ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	1	3	3	4	4
Decreased wound size ^* * 1=None; 2=Limited; 3=Moderate; 4=Substantial; 5=Extensive.	1	4	5	5	5
Purulent drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5	5	5	5
Serous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5	5	5	5
Sanguineous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5	5	5	5
Serosanguineous drainage ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	3	3	4	4
Surrounding skin erithema ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	2	3	4	5	4
Periwound edema ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	4	4	5	5
Blistered skin ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	5	5	5	5	5
Macerated skin ^† † 1=Extensive; 2=Substantial; 3=Moderate; 4=Limited; 5=None.	3	2	3	4	4
Foul wound odor wound	4	5	5	5	5

Push	Day 1 - 1st week	Day 6 - 2nd week	Day 9 - 3rd week	Day - 12 4th week	Day - 15 5th week
Length x width ^* * 0=0cm2; 1=<0.3cm2; 2=0.3 - 0,6 cm2; 3=0.7 - 1.0cm 2; 4=1.1cm 2- 2.0cm2; 5=2.1 - 3.0cm2; 6=3.1 - 4.0cm 2;7=4.1 - 8.0cm2; 8=8,1 - 12,0cm2; 9=12,1 - 24cm 2; 10=>24cm2.	10	8	7	5	4
Exudate amount ^† † 0=None; 1=Light; 2=Moderate; 3= Heavy.	2	2	2	1	1
Tissue type ^§ § 0= Closed/Resurfaced; 1=Epithelial tissue; 2=Granulation tissue; 3= Slough; 4=Necrotic tissue.	2	2	2	1	1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Amália de Fátima Lucena. Rua São Manuel, 963, Bairro Rio Branco. CEP 90620-110 - Porto Alegre, RS, Brazil. afatimalucena@gmail.com