Pressure sores

Question 1

Define

Answer 1

DEFINITION: damage to the skin, usually over a bony prominence, as a result of pressure.

May present as persistently red, blistered, broken or necrotic skin and may extend to underlying structures - e.g., muscle and bone

Question 2

Causes

Answer 2

Constant pressure limits blood flow to the skin leading to tissue damage

They occur as a result of pressure, friction and shear

Risk Factors

• IMMOBILITY
• Alzheimer’s disease
• Diabetes

Question 3

Epidemiology

Answer 3

Very COMMON in hospitals

Most commonly occurs in the ELDERLY

Question 4

Symptoms

Answer 4

Occurs over bony prominences - most commonly the SACRUM and HEEL

Pressure scores can be staged from Stage 1-4

They are very TENDER

They may become infected leading to fevers, erythema and foul smell

• Mild tissue damage results in skin discoloration (brown/purple appearance)
• Initial area of discoloration can progress to form open blisters or sores
• More severe pressure ulcers can begin to expose muscle and even bone, forming a deep crater
• The area around the dead tissue will become red and inflamed
• Bed sores are very vulnerable to infection

Question 5

Investigations

Answer 5

NO investigations necessary

Clinical diagnosis

Waterlow Score is used to predict risk of pressure sores in patients

European Pressure Ulcer Advisory Panel (EPUAP) grading system

 Grade 1: non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on pts with darker skin - in whom it may appear blue/purple.

 Grade 2: partial-thickness skin loss involving epidermis, dermis, or both.
The ulcer is superficial and presents clinically as an abrasion or blister. Surrounding skin may be red or purple.

 Grade 3: full-thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. Deep crater

 Grade 4: extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures, with or without full-thickness skin loss. Extremely difficult to heal and predispose to fatal infection.

 Unstageable (depth unknown): full-thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed, resulting in the true depth, and therefore Category/Stage, being unable to be determined.