Pressure Ulcers

Question 1

Localized Area of tissue necrosis that develops when soft tissue is compressed between a firm surface and underlying bony prominence is known as

Answer 1

Pressure ulcer (or any wound caused by unrelieved pressure or a combination or pressure and shear forces)

Question 2

What types of patient possess the greatest risk?

Answer 2

1. SCI
2. Hospitalized pts.
3. patients in Long term care facilities

Question 3

T/F as pressure is increased, the duration required for formation of a pressure ulcer decreases.

Answer 3

T (pressure and time have an inverse relationship)

Question 4

What areas possess the greatest risk for developing a pressure ulcer?

Answer 4

Over bony prominences (note that muscle is more sensititive than skin)

Question 5

What is defined as localized area of blanchable erythema?

Answer 5

Reactive Hyperemia

Question 6

List the Risk Factors of Pressure Ulcer Formation?

Answer 6

1. Shear Forces
2. Malnutrition
3. Excessive Moisture
4. Impaired Mobility
5. Impaired Sensation
6. Adavanced Age
7. History of Pressure Ulcer

Question 7

What is the number 1 cause for pressure ulcer Formation?

Answer 7

1. Immobility

Question 8

Define Shear force

Answer 8

force that is parallel to soft tissue

Question 9

What nutritional fact is correlated with severity and development of pressure ulcer?

Answer 9

low serum albulim (hypoalbuminemia causes interstitial edema and signals that the body lacks the protein stores necessary for building and repairing tissues)

**ALSO considered the 2nd most common risk factor.

Question 10

What populations would be at risk to developing impaired sensation?

Answer 10

-SCI, spina bifida, stroke, DM, full-thickness burn, peripheral neuropathy.

Question 11

50% of patients who are ____years old possess a greater risk due to their advanced age

Answer 11

70 years old. Age related changes include changes in the Dermis and Epidermis, decrease collagen and elastin, decrease tissue strength and stiffness and decrease ability to fight infection

Question 12

History of Pressure Ulcers: Scar tissue only attains_____% of strength of original tissue

Answer 12

80%

Question 13

Braden Scale 
List the
Range of Score
Meaning of Scores
Reliability of Scores
Subscales

Answer 13

Scores Range from 6-23, lower scores indicate GREATER impairment and higher risk

an at risk patient : cut off score: 18
less than 13 high risk
13-14 mod risk
15-18 mild risk
High Inter-rater Reliability

Sub Scales:

1. Mobility
2. Acitivity
3. Sensory Perception
4. Skin moisture
5. Nutritional stat
6. Friction and shear

(there is also a braden for peds)

Question 14

Nortion Risk Assessment
List the
Range of Score
Meaning of Scores
Reliability of Scores
Subscales

Answer 14

Scale rate 1-4, LOWER scores mean greater risk of PU development
Range: 5-20
Cut off: scores less than 16 considered at risk
Reliability; may overpredict indicidence or pressure ulcers

Subscales:

1. Physical condition
2. Mental condition
3. Acitvitiy
4. Mobility
5. Incontinence

there is also a Norton plus pressure scale (that deducts points for co-morbidities and for patients on 5 or more medications)

Question 15

Declining NORTON Scores parrallel a decline in

Answer 15

patient medical status

Question 16

GOSNELL PRESSURE SORE RISK ASSESSMENT
List the
Range of Score
Meaning of Scores
Reliability of Scores
Subscales

Answer 16

Sub Scales

1. Mental Status
2. continence
3. Mobility
4. Acitivity
5. Nutirition

Range 5-20, 16 cut off score. HIGHER SCORES indicate greater risk.

Least Research done on this tool

Question 17

NPUAP Pressure Ulcer Classification

Stage 1

Answer 17

Non Blanchable erythema of intact skin
May be superificial or first sign of deeper tissue involvement

May INDICATE person is at risk for pressure ulcer

Question 18

NPUAP Pressure Ulcer Classification

Stage 2

Answer 18

Superficial ulcer that presents as shallow crater

Partial-thickness ulcer involving the epidermis, dermis or both

Question 19

NPUAP Pressure Ulcer Classification

Stage 3

Answer 19

Deep ulcer that presents as deep crater, may have undermining or tunneling.

Full thickness skin loss involving epidermis, dermins, and subcutaneous tissue. Bone and tendon are not visible or palpabable

Question 20

NPUAP Pressure Ulcer Classification

Stage 4

Answer 20

Deep ulcer with extensive necrosis, often has undermining or sinus tracts

Full-thickness skin loss involving the epidermis, dermis, subcutaneous tissue, fascia and underlying structures sucha as muscle, tendon bone..capsule

Question 21

NPUAP Pressure Ulcer Classification

Unstageable/Unclassified

Answer 21

A pressure ulcer should be described as unstageable if the base is obsured or identifiable by eschar or slough.

Full-thickness will be in the category of 3 or 4

Question 22

NPUAP Pressure Ulcer Classification

Suspected Deep Tissue

Answer 22

Blood filled blister (tissue involvement is unknown)

local area looks purple or maroon, painful mushy or boggy area

Question 23

Stage 3-4 ulcers do not______

Answer 23

HEAL! they will close but the tissue damage is done. WIll not have the same integrity as prior to damage. Max 80% normal tissue strength after closing

Question 24

List 3 Benefits of NPUAP/EPUAP

Answer 24

1. Promotes uniform understanding of depth of involved tissue
2. Clinicians must stage PUs for Medicare Reimbursment
3. Can be used for research

Question 25

List 2 Limitations of NPUAP/EPUAP

Answer 25

1. Stage 1 PU is not an ulcer by definition | 2. Clinicans may erroneously reverse stage to imply progression, but can't do that

Question 26

5 PT in Pressure Ulcers Pain

Answer 26

Just note that Stage 1 PU may be tender not painful and patient with Neuro deficits may not perceive pain

Question 27

5 PT in Pressure Ulcers Position

Answer 27

Sacrum, greater troch, ishcial tub, posterior cal, lateral mal. majority lower half of body and over bony prominences

Question 28

5 PT in Pressure Ulcers Presentation

Answer 28

patients with full-thickness pressure ulcers are more likely to have multiple ulcers

Question 29

5 PT in Pressure Ulcers Periwound

Answer 29

No-blanchable Mottled RIng of Inflammation around ulcer Dermatitis

Question 30

5 PT in Pressure Ulcers Pulses

Answer 30

Normal (n/a)

Question 31

5 PT in Pressure Ulcers Temperature

Answer 31

Increased in areas of reactive hyperemia | Decreased in areas of Ischemia

Question 32

``` Sessing Scale List the Use Range of Score Meaning of Scores Reliability of Scores ```

Answer 32

1. 7 point obesrvational scale describing wound and periwound 2. range 0-6 3. Used in clinic and Research 4. HiGHER SCORES represent more sever pressure ulcer status.

Question 33

How does a clinican assess change over time using the sessing scale?

Answer 33

reassessment score is subtracted from initial score. A positive value indicates improvement

Question 34

``` Bates-Jensen Wound Assessment Tool (BWAT) List the Use Range of Score Meaning of Scores Reliability of Scores ```

Answer 34

Describes Wound and Periwound characterisitics 13 items rated 1-5 RANGE: 13-65 Higher scores means increased severity Reliable and valid tool 10 minutes

Question 35

``` Pressure Ulcer Scale for Healing (PUSH) List the Use Range of Score Meaning of Scores Reliability of Scores ```

Answer 35

**Requires less than 5 minutes to complete Total score from 8-34 HIGHER score means increased serverity LIMITED RESEARCH

Question 36

Prognosis for pressure ulcers (remember very slow healing) 1. Category 1: 2. Category 2: 3: Category 3/4:

Answer 36

1. 1-3 weeks 2. days to weeks 3. average of 8-13 weeks, can take months

Question 37

Full thickness are more likely to be______and if a patient has a better baseline they have a _____healing rate.

Answer 37

infected, faster

Question 38

PT interventions: | Name 2 main interventions

Answer 38

70-90% of PT interventions can be maanged conservatively. through: 1. Dietary consult 2. Positioning

Question 39

List 3 Precuations of PU

Answer 39

1. Pressure ulcer depth can be decpetive 2. Probe regularly 3. Ensure wound care goals and interventions are consitent with POC (clincian must acknowledge that not all pressure ulcers can be healed and that wound closure may not be consistenc with overall POC, like for terminal patient)

Question 40

List 4 guidelines for Managing PU

Answer 40

1. Control pressure and shear forces, by shifting weight every 2 hours and while lying down. 15 min while sitting 2. take care of skin, daily skin checks, wash with mild soap and water temp shouldn't be very hot 3. take care of ulcer, wear bandages as instructed 4. Control meds by taking them as prescribe. All patients should eat a well balanced diet and take supplements as directed. make sure to educate patient and caregiver

Question 41

What is considered to be "breakdown pressure"

Answer 41

32 mmhg

Question 42

Pressure reducing devices do not reduce pressure below____

Answer 42

23-33 mmHg

Question 43

Pressure-relieving devices decrease pressure below____

Answer 43

23 mmHg

Question 44

Medicare and Medicaid support Surface Classification Category 1: Category 2: Category 3

Answer 44

1. Mattresses and mattress overlays 2. Speciality mattresses pressure reducing: Foam, low air..alt. air. 3. Air fluidized beds