Pressure injuries Flashcards
(20 cards)
Definition
Localized injury to the skin and/or underlying tissue usually over a bony prominence due to pressure or shear forces
Pressure ulcers are preventable.
Pathophysiology of pressure ulcers
- pressure +/- shear/poor padding—>
- poor perfusion—>
- Excoriation, poor healing
How quickly can pressure ulcers develop?
Within 2-6 hours
What are the most vulnerable areas for pressure ulcers?
- heels
- coccyx
- sacrum
- femoral trochanter
Risk factors for pressure ulcers
- advanced age
- shock/high Vasopressor req male
white race - smoker
- low BMI/poor nutrition
- impaired mobility
- urinary and faecal incontinence
- history of pressure ulcers
- altered mental state
- fever
- requiring physical restraints
- inadequate care/repositioning
What comorbidities increase the risk of pressure ulcers?
- malignancy
- diabetes mellitus
- stroke
- pneumonia
- heart failure
- sepsis
- malnutrition
- renal failure
What laboratory findings can be risk factors for pressure ulcers?
- anaemia
- lymphopenia
- hypoalbuminaemia
What are some risk assessment scales used for pressure ulcers?
- Braden score
- Norton score
- Waterlow score
What are the features to assess in a pressure ulcer?
- ulcer location
- area
- depth
- drainage
- tissue type present
- presence of cellulitis
What is Stage I in the International NPUAP-EPUAP pressure ulcer staging?
Non-blanching erythema
What is Stage II in the International NPUAP-EPUAP pressure ulcer staging?
Partial thickness, skin involvement
What is Stage III in the International NPUAP-EPUAP pressure ulcer staging?
Full thickness skin loss — involving subcutaneous tissue (underlying fascia is intact)
What is Stage IV in the International NPUAP-EPUAP pressure ulcer staging?
Full thickness tissue loss — involving underlying bone, tendon, muscle or cartilage
What is the main goal of pressure ulcer management?
Provide the ulcer the optimal environment for healing
Management
prevention
Aim - to provide the ulcer the optimal environment for healing
#specific therapy
#supportive care
Prevention strategies
- risk assessment and monitoring
- treat underlying critical illness and reversible factors
- mobilize
- manage urinary incontinence and diarrhoea
- avoid pressure and friction
- ensure adequate nutrition
- skin care
- minimise sedation
- promote wound healing
- staff education
Specific therapy
Debridement
– mechanical (wet to dry gauze)
— autolytic (dressings that promote breakdown of necrotic tissue by body’s own enzymes)
— enzymatic (proteolytic enzymes)
— scalpel or laser debridement
— magot therapy
– silver impregnated dressing or silver sulfadiazine
– avoid excessive moisture
— > 300 dressings available!
Monitor healing
rarely required
— direct closure, skin grafting, skin flaps, musculocutaneous flaps, free flaps, stents and revascularization
Adjunctive therapies
— electrical stimulation, topical growth factors, skin equivalents, hyperbaric oxygen
What are the methods of debridement for pressure ulcers?
- mechanical (wet to dry gauze)
- autolytic (dressings promoting breakdown of necrotic tissue)
- enzymatic (proteolytic enzymes)
- scalpel or laser debridement
- maggot therapy
What is a method for managing bacterial burden in pressure ulcers?
Silver impregnated dressing or silver sulfadiazine
What are some adjunctive therapies for pressure ulcers?
- electrical stimulation
- topical growth factors
- skin equivalents
- hyperbaric oxygen
