Prepared to complete one of the English course assignments on

"Decubitus"

Group III

1. Alidun Djabumir (P2012040)

2. Brayen Marantika (P2012006)
3. Brian N Mangol (P2012045)
4. Dianty Riupassa (P2012010)
5. Dorci K Aio (P2012050)
6. Frans Y Labok (P2012056)
7. Grishela Sesilia Sarak (P2012018)
8. Helen D Darakay (P2012061)
9. Kornelia Rahadat (P2012008)
10. Lesly Teslatu (P2012012)
11. Siti Hadija Rumwokas (P2012030)

BANGUN PERSADA FOUNDATION

PASAPUA AMBON COLLEGE OF HEALTH SCIENCES
UNDERGRADUATE NURSING PROGRAM
ACADEMIC YEAR 2020/2021
 PREFACE

We hereby appeal to The One True God, because of His guidance and
inclusion to us, so that the paper discussing this "Decubitus" can be completed.
This paper we compiled to add knowledge and to fulfill one of the tasks in
the course "English" . We realize that in the preparation of this paper is far from
perfect. Therefore, the author expects constructive suggestions and criticism from
the reader.

With the composition of this paper may be useful, especially for writers
and readers in general. For that we say thank you, if there is more or less we
apologize.

Ambon, July 01, 2021

Group III

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 TABLE OF CONTENTS

PREFACE ............................................................................................................... i
TABLEOF CONTENTS ....................................................................................... ii

CHAPTER I INTRODUCTION
A. BACKGROUND ..........................................................................................1
B. PROBLEMFORMULATION .......................................................................1
C. PURPOSE OF WRITING ..........................................................................2
D. BENEFITS OF WRITING..........................................................................2

CHAPTER II DISCUSSION
A. DEFINITION OF DECUBITUS ................................................................3

B. ETIOLOGY DECUBITUS .........................................................................3

C. THE PROCESSOF DECUBITUS ............................................................4

D. RISK FACTORS DECUBITUS ................................................................ 4

E. STAGE OF DECUBITUS WOUND .........................................................6

F. PREVENTION OF DECUBITUS .............................................................7

CHAPTER III CLOSING

A. CONCLUSION ..........................................................................................10

B. SUGGESTIONS .........................................................................................10

BIBLIOGRAPHY ............................................................................................... iii

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 CHAPTER I
INTRODUCTION

A. BACKGROUND

One of the important aspects in nursing services is maintaining and

maintaining the integrity of the client's skin to always be maintained and
intact. Interventions in client's skincare will be one indicator of the quality
of nursing services provided. Damage to skin integrity can come from
trauma and surgical wounds, but it can also be caused by long periods of
skin distress that cause irritation and will develop into press or decubitus
wounds (Mukti, 2005 in the journal "Relationship Level of Knowledge And
Attitude With Nurse Behavior In Efforts to Prevent Decubitus At Cakra
Husada Klaten Hospital", Setiyawan.)

Decubitus injuries are a problem for some clients who are hospitalized
or other care homes. They have a risk of decubitus occurrence during
treatment. Research shows that the prevalence of dexubitus wounds varies,
but in general it is reported that 5-11% occur inacute caresettings, 15-25%
inlongterm care,and 7-12% inhome health care settings. Decubitus ulcus
can be progressive and difficult to cure. Complications of press wounds
are very frequent and life-threatening. Decubitus problems become quite
serious problems. Therefore, it is necessary to have sufficient knowledge
of decubitus in order for the diagnosis to be established early so that the
management can be done immediately.

B. PROBLEM FORMULATION

1. What is the definition of decubitus?

2. What are the etiology of decubitus?
3. How does decubitus occur?
4. What are the risk factors for decubitus exposure?
5. What are the stages of decubitus injury?
6. How do Iprevent decubitus disease?

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C. PURPOSE OF WRITING

1. Know the definition of decubitus

2. Know the etiology of decubitus
3. Knowing the process of decubitus
4. Know the risk factors of decubitus
5. Knowing the stage of decubitus wounds
6. Know how to prevent decubitus disease
7. Fulfilling one of the english course assignments

D. BENEFITS OF WRITING
1. For Constituents
With this paper, the author is expected to better understand what
decubitus is and how to prevent it.

2. For Readers
With this paper, it is expected to add insight to the reader about
decubitus.

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 CHAPTER II
DISCUSSION

A. DEFINITION OF DECUBITUS
Decubitus wounds are an area localized with necrosis and usually
occur on the surface of the bone that protrudes, as a result of prolonged
pressure causing an increase in capillary pressure (Suriadi 2004). Decubitus
is an area of necrosis tissue that arises when soft tissue is pressed between
the protruding bone and the external surface (lying place) for a long time
(Potter &Perry, 1997).
From the above understanding can be concluded the sense of
decubitus is damage to the skin and tissues underneath as a result of long
suppression so that the blood vessels are pinched and the tissues around the
area do not obtain blood supply, food, and oxygen resulting in the tissues
experiencing death.

B. ETIOLOGY OF DECUBITUS
The skin is rich in blood vessels that transport oxygen throughout its
layers. If the blood flow is cut off for more than 2-3 hours, then the skin
will die, which begins in the uppermost layer of the skin (epidermis). The
cause of reduced blood flow to the skin is pressure. If the pressure causes a
cut of blood flow, then the skin that has oxygen deprivation will initially
appear red and inflamed and form an open wound(ulcer). Normal
movement will reduce the pressure so that the blood will continue to flow.
The skin also has a layer of fat that serves as a protective pad against
pressure from the outside.
High risk of decubitus ulcers is found in:
1. People who are unable to move (e.g. paralyzed, very weak, dipasung).
2. People who are unable to feel pain, because pain is a sign that normally
encourages a person to move. Nerve damage (e.g. due to injury, stroke,
diabetes)and coma can lead to reduced ability to feel pain.
3. People who experience malnutrition (malnutrition)do not have a layer of
fat as a protector and the skin does not experience a perfect recovery
due to lack of essential nutrients.
4. Friction and other damage to the outermost layer of the skin can cause
ulcers to form.

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 5. Clothes that are too big or too small, wrinkles on sheets or shoes that rub
against the skin can cause injury to the skin. Prolonged exposure to
moisture (due to sweating, urine or stool) can damage the surface of the
skin and allow ulcers to form.

C. THE PROCESS OF DECUBITUS

Decubitus will run in the following order: first the skin that
experiences emphasis will be red (erithema) in this phase is still reversible
and becomes the beginning of the development of decubitus events then the
skin will appear, blue and then the tissue will die (necrosis) characterized
by the appearance of black color. These dead tissues will attempt to dispose
of the body which will then develop into ulcers. Ulcers that occur can be
shallow or deep.

D. DECUBITUS RISK FACTORS

Risk factors for decubitus include:
1. Mobility and activity
Mobility is the ability to change and control the position of the
body, while activity is the ability to move. Patients who lie
continuously in bed without being able to change positions are at high
risk of developing press wounds. Immobility is the most significant
factor in the incidence of press injuries. Research conducted by Suriadi
(2003) in one of the hospitals in Pontianak also showed that mobility is
a significant factor for the development of press injuries.

2. Decreased sensory perception

Patients with decreased sensory perception will experience a
decrease in pain due to pressure above the protruding bone. If this
happens for a long time, the patient will be easily exposed to press
wounds.

3. Humidity
Moisture caused by incontinence can result in maceration of skin
tissue. Macerated tissues will easily erode. In addition, moisture also
results in the skin easily exposed to friction (friction)and tearing tissue
(shear). Alvi incontinence is more significant in the development of
press sores than urinary incontinence due to the presence of bacteria
and enzymes in the stool can damage the surface of the skin.

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4. Power that rips ( shear)
It is a mechanical force that stretches and tears the tissues, blood
vessels and deeper tissue structures adjacent to the protruding bone.
The most frequent example of this tearing power is when the patient is
positioned in a semi fowler position that exceeds 30 degrees. In this
position the patient can slump down, resulting in the bone moving
downwards but the skin is still left behind. This can result in occlusion
of blood vessels, as well as damage to inner tissues such as muscles,
but only cause minimal damage to the surface of the skin.

5. Friction ( friction)
Friction occurs when two surfaces move in the opposite direction.
Friction can result in abrasion and damage the surface of the skin
epidermis. Friction can occur during the replacement of bed linen of
patients who are not careful.

6. Nutrition
Hypoalbuminemia, weight loss, and malnutrition are commonly
identified as predisposing factors for the occurrence of press sores.
According to Guenter's research (2000) stage three and four of the
stress wounds in parents are associated with weight loss, low levels of
albumin, and insufficient food intake.

7. Age
Older patients are at high risk of developing press sores because the
skin and tissues will change with age. Aging results in muscle loss,
decreased serum albumin levels, decreased inflamatori response,
decreased skin elasticity, as well as a decrease in cohesion between the
epidermis and dermis. This change combines with other aging factors
that will make the skin less tolerant of pressure, friction, and tearing
energy.

8. Low arteriolar pressure

Low arteriolar pressure reduces the skin's tolerance to pressure so
that with low pressure application it is able to cause tissue to become
ischemia. A study conducted by Nancy Bergstrom (1992) found that
systolic pressure and low diastolic pressure contribute to the
development of press sores.
9. Emotional Stress
Depression and chronic emotional stress for example in psychiatric
patients are also risk factors for the development of press sores.

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 10. Smoking
Nicotine contained in cigarettes can decrease blood flow and have
a toxic effect on the endothelium of blood vessels. According to the
results of Suriadi's research (2002) there is a significant link between
smoking and the development of press wounds.

11. Skin Temperature

According to the results of Sugama research (1992) temperature
increase is a significant factor with the risk of press injuries.

E. STAGE OF DECUBITUS WOUNDS

According to NPUAP(National Pressure Ulcer Advisory Panel)in
figure 1, decubitus wounds are divided into four stages, namely:
1. Stadium I
Changes in the skin that can be observed. When compared to normal
skin, it will appear one of the following signs: changes in skin
temperature (colder or warmer), changes in tissue consistency (harder or
softer), changes in sensation (itching or pain). In white people, the
wound may appear as persistent redness. While on dark skinned, the
wound will appear as a sedentary red color, blue or purple.
2. Stadium II
Partial loss of the skin layer is the epidermis or dermis, or both. Its
features are superficial wounds, abrasion, blisters, or forming shallow
holes. If the skin is injured or torn then there will be a new problem,
namely infection. Infection slows the healing of superficial ulcers and
can be fatal to deeper ulcers.

3. Stage III
Complete loss of skin layer, including damage or necrosis of
subcutaneous tissue or deeper, but not to the fascia. The wound looks
like a deep hole.

4. Stage IV
Complete loss of skin layer with extensive damage, tissue necrosis,
damage to muscles, bones or tendons. The presence of deep holes as
well as sinus ducts.

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 Figure 1.
Dekubitus Wound Stadium according to NPUAP (Courtesy of Prof. Hiromi
Sanada, Japan)

F. PREVENTION OF DECUBITUS
According to Mukti (2005) nursing interventions used to prevent
decubitus occur consist of three categories, namely:
1. Self-care and skin care, including:
 Assessment and observation of high risk patients and areas
affected by decubitus.
 Improvement of the general state of the sufferer
 Maintenance and skin care
 Prevention of wounds
 Position settings
 Massse the client's skin
2. Good board/bedding
3. Provide education to clients and families.

According to Notoatmodjo (1993), health education can be done using

a variety of methods and approaches. One of them is by doing bed side
teaching which only takes about 10-15 minutes while the nurse performs
her nursing duties such as when helping mobilize, feeding or bathing
clients.

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 CHAPTER III
COVER

A. CONCLUSION
It is necessary to be aware of the occurrence of decubitus if there are
signs such as redness of the skin that does not disappear after the pressure
is removed, in a further state of redness of the skin along with the presence
of slight exfoliation. If this condition is left after 1 week there will be skin
damage with a firm limit. Usually this damage can reach the bones and
layers under the skin. Poorly handled stress cuts can result in long patient
care periods and increased hospital costs.
Decubitus prevention efforts include mobilization, skin care,
fulfillment of adequate fluid and nutritional needs, the use of tools /
facilities and the arrangement of the care environment and health
education.
Nurses involved in health education to be more aware that their
actions in an effort to improve the knowledge and skills of clients to
prevent the occurrence of decubitus wounds will greatly affect the attitude
and behavior of the client in taking measures to prevent the occurrence of
decubitus wounds.
Therefore nurses need to understand comprehensively about decubitus
wounds in order to provide appropriate nursing prevention and intervention
for clients at risk of stress injuries as well as increasing the active role of
clients and their families to be able to carry out treatment independently.

B. SUGGESTIONS
Nurses need to learn more and dig up information from various
sources, such as attending seminars, training etc. In order to apply the
knowledge obtained as best as possible and can prevent the occurrence of
decubitus in patients. Nurses need to be more agile and careful in seeing the
signs and symptoms of decubitus and can handle it quickly so that the
decubitus wound does not reach the final stage. It is also necessary to
motivate patients to give education about decubitus to patients.

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 BIBLIOGRAPHY

Doenges, Marilynn E. 2000. Nursing Plan : Guidelines for Planning and

Documenting Patient Care. Jakarta : EGC.

R. Siti Maryam. 2013. Decubitus, how nurses prevent it. (online).

http://www.stuffspec.com/publicfiles/R_Siti_Maryam_Jurusan_Keperawatan_Pro
di_Keperawatan.html

Setiyawan. 2010. Relationship Level of Knowledge And Attitude With Nurse

Behavior In Efforts to Prevent Decubitus At Cakra Husada Klaten Hospital.
(online) T Knowledge - KesMaDaSka Journal, 2010 -
jurnal.stikeskusumahusada.ac.id

Sanjaya, I Dewa Gede Windu. Ketut Suarjana. 2013. Managerial Factors Behind
the High Incidence of The Number of Patients With Decubitus (Patient Safety
Indicator) In Inpatients At Puri Raharja General Hospital in 2012. (online). I
Sanjaya - Community Health, 2013 - ojs.unud.ac.id

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