Pressure Sores

Tehmina Noreen
Post RN 2nd Year
Objectives

 Definition
 Epidemiology
 Causes
 Risk Factors
 Stage & Risk Assessment
 Management
 Prevention
 Complication
 Conclusion
Definition

 A Pressure sore is a localized injury to the skin or underlying tissue as a result

of unrelieved pressure.
 Decubitus Ulcer, bedsore
Epidemiology

 Between 1-3 million US affected

 11 - 18% nursing home residents (2004)
 9 - 60% hospital
 3 - 18% home
 Health care expenditure $5 Billion US/year
 1.4 – 2.1 Billion pounds (UK)/year
 More than 17,000 lawsuits annually
 The longer the patient stays in a hospital
 or nursing home the greater the risk
Causes

 Prolonged Pressure
 Friction
 Shearing Forces
 Moisture
Intrinsic Risk Factors

 Limited Mobility
 Spinal cord injury
 CVA
 Alzheimer Disease
 Pain
 Fractures
 Postsurgical
 Coma or sedation
Extrinsic Risk Factors

 Pressure from external surface e.g.

 bed, chair
 Friction from being unable to move well
 Shear forces form involuntary
 movement
 Moisture – bowel or bladder
 incontinence, perspiration, wound
 drainage
National Pressure Ulcer Advisory Panel
Pressure Ulcer Staging Classification
 Stage 1 – Intact skin with non-blanchable redness of a localized area,
usually over a bony prominence. The area may be painful, firm, soft,
warmer or cooler than adjacent tissue.
National Pressure Ulcer Advisory Panel
Pressure Ulcer Staging Classification
 Stage 2 – Partial thickness skin loss, presenting as a shallow open ulcer with
a red-pink wound bed without slough. May also present as an intact or
open serum-filled blister. Includes tears, tape burns, maceration or
excoriation
National Pressure Ulcer Advisory Panel
Pressure Ulcer Staging Classification
 Stage 3 – Full thickness skin loss. Fat may be visible but bone, tendon or
muscle tissue are not. Slough may be present.
National Pressure Ulcer Advisory Panel
Pressure Ulcer Staging Classification
 Stage 4 – Full-thickness tissue loss with exposed bone, tendon or muscle.
Slough or eschar may be present.
National Pressure Ulcer Advisory Panel
Pressure Ulcer Staging Classification
 Unstageable – Full thickness tissue loss in which the base of the ulcer is
covered by slough or eschar. Until enough of the base is exposed, the true
depth and stage cannot be determined.
Management

 Based on Staging and Investigation

 2Wound swabs and cultures usually
 show mixed growth
 Blood – CBC, CRP, ESR, Serum
 Protein/Albumin
 MRI
 X-Rays
 Ultrasound
 Tissue Biopsy – suspect malignancy
Management

 Clean, barrier
 Antibiotic where appropriate
 Debride necrotic tissue
Prevention

 Aims
 Reduce Pressure and Shearing effects
 Reduce Moisture
 General Skin Care
 Nutrition
 Co-morbidities
 Involve patient, family, caregivers
Prevention

 Daily skin inspection

 Bathing and skin cleaning frequency
 Moisturize skin; avoid hot water or harsh
 solutions
 Assess and treat incontinence; use topical
 barriers or absorbent padding when needed
 Proper re-positioning frequently; q2hrly for
 those bed-bound, q1hrly for those in
 wheelchairs; self re-positioning every 15
 minutes for those in wheelchairs
 Avoid manipulating bony prominences
Complications

 Sepsis, cellulitis, endocarditis, meningitis

 Fistula formation
 Osteomyelitis, septic arthritis
 Sinus tracts
 Squamous Cell Carcinoma (Marjolin’sulcer)
 Amyloidosis
 Drug resistant bacteria
 Maggot infestation
Conclusion

 Risk
 Prevention
 Identify early
 Manage
The End

Thank You