MANAGEMENT OF PRESSURE ULCER
Wound Care Training Module
Wound Care Training Module - National Wound Care Committee
Wound Care Training Module
Wound Care Training Module - National Wound Care Committee
Content
Wound Care Training Module - National Wound Care Committee
DEFINITION
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
(NPUAP 2007)
Wound Care Training Module - National Wound Care Committee
PATHOPHYSIOLOGY
Wound Care Training Module - National Wound Care Committee
1. Primary Factor
Kosiak 1961 Arch Phys Meds & Rehab (Animal Study)
Wound Care Training Module - National Wound Care Committee
Wound Care Training Module - National Wound Care Committee
FRICTION + SHEAR + PRESSURE
=
EXTENSIVE INJURY
Wound Care Training Module - National Wound Care Committee
2. Secondary Factor
Wound Care Training Module - National Wound Care Committee
COMMON SITES OF �PRESSURE ULCERS
Knees
Toes
Male Genitalia
Breasts
Shoulder
Cheek and Ear
Heel
Sacrum
Elbow
Scapula
Occiput
Malleolus
Fibula head
Trochanter
Elbow
Ear
Skull
Shoulder
Heels
Ischium
Sacrum
Shoulder
Occiput
Elbow
Wound Care Training Module - National Wound Care Committee
HOW TO ASSESS PRESSURE ULCER
Wound Care Training Module - National Wound Care Committee
Wound Care Training Module - National Wound Care Committee
Staging of Pressure Ulcer:
Stage I
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
Wound Care Training Module - National Wound Care Committee
Stage II
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-
filled blister.
Wound Care Training Module - National Wound Care Committee
Stage III
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
Wound Care Training Module - National Wound Care Committee
Stage IV
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.
Wound Care Training Module - National Wound Care Committee
Unstageable
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
Wound Care Training Module - National Wound Care Committee
Suspected Deep Tissue Injury
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
Wound Care Training Module - National Wound Care Committee
MANAGEMENT
What is the best management of pressure ulcer?
Wound Care Training Module - National Wound Care Committee
1. Prevention is paramount
Wound Care Training Module - National Wound Care Committee
2. General treatment
Wound Care Training Module - National Wound Care Committee
3. Local treatment
Management of wounds - please refer algorithm on wound care.
Please refer chapter on principle of wound closure and wound debridement.
Wound Care Training Module - National Wound Care Committee
TAKE HOME MESSAGE
Wound Care Training Module - National Wound Care Committee
REFERENCES
Wound Care Training Module - National Wound Care Committee
REFERENCES
Wound Care Training Module - National Wound Care Committee
THANK YOU
Wound Care Training Module - National Wound Care Committee