Plaies de pression, Périné, G-U Flashcards
Which patients are at highest risk for developing pressure ulcers (5)
- elderly with femoral neck fracture (66%)
- quadriplegics (60%)
- Neurologically impaired (quadraplegic, paraplegic)
- spina bifida
- cachectic patients
- Chronically hospitalized patients
- Palliative patients
True or false - Pressure sores are directly related to increased mortality in patients
False - patients succumb to their overall disease burden which leads to severe malnutrition, immobility and decreased tissue perfusion that allow pressure sores to form.
In decreasing order, which areas are most susceptible to pressure ulcers (5)
- sacrum (36%)
- heel (30%)
- ischial tuberosity (20%)
- trochanter (20%)
- scalp
Name 4 extrinsic factors that affect the development of pressure ulcers
- Shear (stress parallel - superficial necrosis)
- Pressure (stress perpendicular - deep necrosis)
- Friction
- Moisture
Name 5 intrinsic factors that increase patient’s risk of developing pressure ulcers
- sepsis
- decreased autonomic control (incontinence)
- infection
- increased age
- sensory loss/spasticity
- vascular disease
- anemia
- malnutrition
- altered level of consciousness
- comorbidities (diabetes)
What is the scale used for assessment of pressure ulcers and which factors (4) are most predictive
Braden Scale
Most predictive
- perception
- mobility
- friction
- moisture
Which factors (7) are taken into consideration in the Braden Scale
- sensory perception
- skin moisture
- activity
- mobility
- friction
- shear
- nutritional status
What does a low score on the Braden scale represent
Increased risk of developing a pressure ulcer
Describe the Pressure Ulcer Advisory Panel stages
Stage 1
- Non-blanchable erythema on intact skin
- seen within 30 mins and erythema gone after 1hr
Stage 2
- partial thickness loss
- presents clinically as a blister, abrasion or shallow open ulcer
- Within 2-6 hours and erythema lasting more that 36hrs
Stage 3
- full-thickness tissue loss down to but NOT through fascia
- subcutaneous fat may be exposed
Stage 4
- full thickness tissue loss with involvement of underlying muscle, bone, tendon, ligament, cartilage or joint capsule
Unstagable
- full thickness skin or tissue loss with unknown depth (obstructed by slough or eshar)
Name 5 things you can do to prevent pressure ulcer formation in patients
- adequate skin care
- adress spasticity (diazepam, baclofen, dantrolene)
- pressure dispersion (padding of at least 4 inches, alternate weight baring positions)
- suport surfaces (alternating air mattress, static pads, low air loss mattress, fluid debs
- minimize head of bed elevation
- incontience management
- optimize patient nutrition
- treat other comorbidities (ie. diabetes)
What is Kosiak’s principle
Kosiak’s principle
Tissue can tolerate increased pressure if interspersed with pressure free periods.
- Seated must be listed for 10 seconds every 10 minutes
- Supine must be turned every 2 hours
Which laboratory studies should you order before proceeding to surgical intervention for a patient with a pressure ulcer (5)
- CBC
- Glucose/HbA1c
- ESR/CRP
- Albumin
- Pre-albumin
What levels of albumin and pre-albumin should you target for a patient with a pressure ulcer
Albumin = 3g/dl
Pre-albumin = 20mg/dl
List 5 management options for a patient who has developed a pressure ulcer
- relieve pressure
- infection control
- control of extrinsic factors (ie. shear, moisture, etc)
- debridement (surgical or topical)
- adequate dressings/wound care
You suspect that your patient with a pressure ulcer is colonized with pseudomonas. What is your dressing of choice for this patient?
Dakin solution soaked dressing
You suspect that your patient’s pressure ulcer has an underlying osteomyelitis. What is the best next step in confirming your diagnosis?
Bone biopsy
What are the goals of reconstruction for the management of pressure ulcers (8)
- debridement of all devitalized tissue
- complete excision of pseudo-bursa
- ostectomy of devitalized bone (down to clinically hard, healthy bleeding bone)
- adequate hemostasis
- obliteration of dead space with well vascularized tissue
- selection of flaps that do no jeopardize future flap coverage
- tension free closure
- pressure offloading or reconstructed area
- flap as large as possible with suture lines away from area of direct pressure
Name 3 surgical treatment option for a SACRAL ulcer
- Lubosacral fasciocutaneous perforator flap
- Fasciocutaneous/myocutaneous gluteal rotation flaps
- Gluteal myocutaneous V-Y advancement flap
- SGAP
Name 3 surgical treatment options for a ISCHIAL ulcer
- gluteal fasciocutaneous/myocutaneous rotation flap
- posterior hamstring or biceps femoris (myocutaneous V-Y advancement flap)
- Posterior thigh flap (fasciocutaneous V-Y)
- Tensor fascia lata flap ** can be sensate**
