UNDERSTANDING DECUBITUS ULCERS

(PRESSURES SORES)

1

DECUBITUS ULCERS

• It is a physiological injury to the skin +/- the underlying structures caused by circulatory insufficiency in a region related to prolonged counter pressure to the skin.
• Management depends on the stage of involvement.

​

2

ETIOLOGY

• Pressure ulcers are caused by unrelieved pressure, applied with great force over a short period that disrupts blood supply to the capillary network, impeding blood flow and depriving tissues of oxygen and nutrients.

3

RISK FACTORS

INTRINSIC

• Limited mobility
• Spinal cord injury
• Fractures
• Postsurgical procedures
• Coma or sedation
• Poor nutrition
• Dehydration
• Depression or psychosis
• Aging skin

​

​

NOTE: Every patient with limited mobility is at risk of developing a pressure sore.

EXTRINSIC

• Pressure from a hard surface
• Friction from patient’s inability to move well in bed
• Shear from involuntary muscle movements
• Moisture
• Bowel or bladder incontinence
• Wound drainage

4

MANAGEMENT

• Treatment depends on the stages and it involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. Debridement is indicated when necrotic tissue is present. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs. Wound cleansing, preferably with normal saline and appropriate dressings. Topical antibiotics should be considered if there is no improvement in healing after 14 days. Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection.

​

5

STAGING DECUBITUS ULCERS

Stage I

• Intact skin with nonblanchable redness of a localized area, Usually over a bony prominence; dark pigmented skin may not have visible blanching, and the affected area may differ from the surrounding area; the affected tissue may be painful, firm, soft, or warmer or cooler compared with adjacent tissue.

Stage II

• Partial- thickness loss of dermis appearing as a shallow, open ulcer with a red-pink wound bed, without slough, may also appear as an intact or open/ruptured serum-filled blister; this stage should not be used to describe skin tears, tape burns, perineal dermatitis, macerations, or excoriations.

6

CONTINIUTION

Stage III

• Full-thickness tissue loss; subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed; slough may be present, but does not obscure the depth of tissue loss; may include undermining and tunneling.

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 includes undermining and tunneling.

Unstageable

• Full-thickness tissue loss with the base of the ulcer covered by slough (yellow, tan, gray, green, or brown) or eschar (tan brown, or black) in the wound bed.

​

7

THE SKIN

8

Sampled photos of pressure injury staging

9

10

MANAGEMENT

11

AREAS PRONE TO DECUBITUS ULCERS

12

PREVENTION

• Skin assessment and care education
• Turn patient every two hours if bed ridden.
• Keep the skin clean and dry. (skin hygiene)
• Optimize nutritional status(provide adequate intake of protein and calories)
• Maintain current levels of activity, mobility and range of motion.
• Use positioning devices to prevent prolonged pressure bony prominences.
• Keep the head of the bed as low as possible to reduce risk of shearing
• Keep sheets dry and wrinkle free.
• Address incontinence

​

​

​

13

Teamwork divides the task and multiplies success

​

​

​

14

THANK YOU

PRESENTED BY;

DOREEN NJAGI

STOMA WOUND SPECIALIST.

​

15