PRESSURE ULCERS

Issah J. Kiswagala

(M.B.B.S)

INTRODUCTION

DEFINITION:

• A Pressure Ulcer or Pressure Sore or Decubitus Ulcer or Bedsore is localized injury to the skin and other underlying tissue, usually over a body prominence, as a result of prolonged unrelieved pressure.

RISK FACTORS

• Friction
• Shear
• Impaired Sensory Perception
• Impaired Physical Mobility
• Altered Level Of Consciousness
• Fecal And Urinary Incontinence

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• Malnutrition
• Dehydration
• Excessive Body Heat
• Advanced Age
• Chronic Medical Conditions- Diabetes,
• Cardiovascular Diseases.

PATHOPHYSIOLOGY

COMMON SITES

STAGES/CLASSIFICATION

• Staging systems for pressure ulcers are based on the depth of tissue destroyed.
• Based on the depth there are four stages of bedsores
• Stage I
• Stage II
• Stage III
• Stage IV

STAGE I: NON-BLANCHABLE REDNESS OF INTACT SKIN

• Intact skin presents with non-blanchable erythema of a localized area usually over a bony prominence.
• Discoloration of the skin, warmth, edema or pain may also be present
• Stage I indicates “at-risk” persons.
• Involves only the epidermal layer of skin.

STAGE II: PARTIAL-THICKNESS SKIN LOSS OR BLISTER

• A partial thickness loss of dermis presents as a shallow open ulcer with a red-pink wound bed without slough
• Stage II is damage to the epidermis and the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.

STAGE III: FULL-THICKNESS SKIN LOSS (FAT VISIBLE)

• A stage III ulcer is a full-thickness tissue loss. Subcutaneous fat may be visible; but bone, tendon, or muscle is not exposed.
• Epidermis, dermis and subcutaneous tissues involved
• Subcutaneous layer has a relatively poor blood supply. So its difficult to heal.

STAGE IV: FULL-THICKNESS TISSUE LOSS

• A stage IV ulcer is the deepest, extending into the muscle, tendon or even bone.
• Full thickness tissue loss with exposed bone, tendon or muscle.

TREATMENT

1. Changing positions often.
• Carefully follow the schedule for turning and repositioning — approximately every 15 minutes if in a wheelchair and at least once every two hours when in bed.
• If unable to change position on own, a family member or other caregiver must be able to help.
2. Using support surfaces.
• These are special cushions, pads, mattresses and beds that relieve pressure on an existing sore and help protect vulnerable areas from further breakdown.

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BEDS THAT RELIEVE PRESSURE

3. Cleaning.
• It's essential to keep wounds clean to prevent infection.
• A stage I wound can be gently washed with water and mild soap, but open sores should be cleaned with a saltwater (saline) solution each time the dressing is changed.
4. Controlling incontinence
5. Removal of damaged tissue (debridement).
• To heal properly, wounds need to be free of damaged, dead or infected tissue.

6. Dressings.
7. Oral antibiotics.
8. Healthy diet.
9. Educating the caregiver

SURGICAL REPAIR

• Tissue flap.
• Plastic surgery may be required to replace the tissue.

COMPLICATIONS

• Cellulitis
• Bone and joint infections such as Osteomyelitis and Septic arthritis
• Sepsis
• Cancer

PREVENTION

• Bedsores are easier to prevent than to treat. Although wounds can develop in spite of the most scrupulous care, it's possible to prevent them in many cases.
• 1. Position changes
• Changing position frequently and consistently is crucial to preventing bedsores. Experts advise shifting position about every 15 minutes for a patient in a wheelchair and at least once every two hours, even during the night, if a patient spends most of the time in bed.
• 2. Skin inspection
• Daily skin inspections for pressure sores are an integral part of prevention

• 3. Nutrition
• A healthy diet is important in preventing skin breakdown and in aiding wound healing
• Adequate hydration to maintain the skin integrity.
• 4. Lifestyle changes –
• Quitting smoking
• Exercise - Daily exercise improves circulation
• 5. Use pressure-relieving devices such as air mattress, water mattress.