5 - Pressure Ulcer

Question 1

MC sites of pressure ulcers from the waist down?

Answer 1

Iliac crests
Sacrum
Greater trochantres
Ischial tuberosities
Lateral malleli

Question 2

Who gets pressure ulcers?

Answer 2

> 70 y/o
15-20% - nursing home pts
5-20% hospitalized

The rest get them at home

Question 3

What causes pressure ulcers?

Answer 3

Prolonged pressure on skin exceeds pressure in end-arterioles and capillaries

• impedes blood flow
• deprives tissue of o2

Causes ischemic necrosis

Question 4

Extrinsic factors that cause pressure ulcers?

Answer 4

Pressure
Friction
Shearing
Maceration of skin (excess moisture)

Question 5

Risk factors for pressure ulcers?

Answer 5

• intrinsic factors
• immobility/inactivity
• incontinence
• malnutrition
• naturally aging skin
• medical problems

Question 6

What effect does aging have on the skin?

Answer 6

Decreased elasticity
Decreased cutaneous blood flow
Changes in pH
Loss of cutaneous fat

Question 7

Medical problems that contribute to pressure ulcers?

Answer 7

PVD
DM
Dementia

Question 8

Prevention of pressure ulcers?

Answer 8

• ID at risk pts
• Protect pressure points
• Provide adequate nutrition
• Avoid excess sedation
• Soft pillows
• Train care givers
• turning schedule orders q 2hrs
• head of bed <30* (shearing)
• special mattress

Question 9

Types of “special mattresses” to prevent pressure ulcers?

Answer 9

Foam (egg crate)
Static flotation
Alternating pressure
Water/air filled

Question 10

Stages of pressure ulcer?

- stage 1

Answer 10

Stage 1: non-blanching erythema of intact skin

• warm
• edema
• induration

Question 11

Stages of pressure ulcer?

- stage 2

Answer 11

Stage 2: partial thickness involving epidermis and dermis, superficial
- appears as a blister or abrasion

Question 12

Stages of pressure ulcer?

- Stage 3

Answer 12

Stage 3: full thickness, deep crater involving necrosis of subcutaneous tissue that may extend to the underlying fascia

Question 13

Stages of pressure ulcer?

- stage 4

Answer 13

Stage 4: tissue necrosis and destruction that includes damage to:
- bone 
- muscle
- supporting structures
With or w/o full thickness skin loss

Question 14

Pressure ulcer documentation?

Answer 14

Each ulcer individually must have:

• size
• location
• eschar/granulation tissue
• exudate
• odor
• sinus tract
• signs of infection
• undermining (separation of skin/mucosa from stroma)
• staging (I-IV)

Question 15

Treatment for stage 1 and 2?

Answer 15

Only clean w NS
Apply protective transparent dressing
Avoid “skin cleaners” and antiseptics
Remove necrotic tissue

Question 16

Ulcers that dont need debridement?

Answer 16

Heel ulcers with stable dry eschar do not need debridement if there are no signs of infection

Question 17

Stages 3 and 4 tx?

Answer 17

Prolonged, expensive tx by

• irrigation
• debridement
• healing by 2ndary intent
• appropriate dressing
• surgical closure

Question 18

Type of debridement of stage 3 and 4?

Answer 18

Mechanical enzymatic autolytic debridement

Question 19

With 3 and 4 dont forget?

Answer 19

To maintain appropriate wound moister and remove excessive external moisture

Question 20

Complications of pressure ulcers?

Answer 20

Cellulitis
Osteomyelitis
Bacteremia
Sepsis

Question 21

Antibiotics for pressure ulcer?

Answer 21

Topical abx if no healing achieved after 14 days
- silver sulfadiazine

Systemic abx if advanced infection
- MRSA, anaerobes, enteroccocci and gram neg coverage needed - pending culture

Question 22

Child: can you put the cat out?

Answer 22

Dad: I didnt know it was on fire