Pressure ulcers presentation

8,980 views

Published on

Published in: Health & Medicine
1 Comment
6 Likes
Statistics
Notes
  • great to see someone from my university
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
8,980
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
189
Comments
1
Likes
6
Embeds 0
No embeds

No notes for slide
  • Intrinsic: physiologic factors or disease states that increase the risk for pressure ulcer developmentAgeNutritional statusDecreased arteriolar blood pressureLocal skin disorderSoft tissue edema, under nutrition, dehydration, atherosclerosis lead to impaired tissue repair and healing.DiabetesAnemia: decreases O2 to the woundNutritional State (Serum chemistries, Albumin, Prealbumin)Weight Loss (oxandrelone)Coagulopathic state Multiple comorbiditiesIncontinence;foleyImmobility:turning q2 hours Extrinsic: external factors that damage skinPressure, friction, shearMoisture, urinary, or fecal incontinence
  • Epidermal turnover rates decrease by 30% to 50% by the age of 70, resulting in rougher skin with decreased barrier function, delayed wound healing.The dermal- epidermal junction fattens resulting in decreased contact between the two layers. As a result the two layers may easily separate, making older skin more likely to tear and blister.Basal and peak levels of cutaneous blood flow are reduced by about 60%, resulting in compromised vascular responsiveness during injury or infection.Collagen synthesis decreases and degradation increases, resulting in a loss of the connective tissue matrix and impaired wound healing.Elastic fibers decrease in number and size, resulting in decreased skin elasticity. Subcutaneous fat decreases with age, decreasing its ability to protect deeper structures from injury. Distribution of subcutaneous fat changes (decreasing in face and hands, increasing in thighs and abdomen), which decreases pressure diffusion over bony prominences.
  • Stage I: Persistent non-blanchable erythema of intact skinStage II: Partial-thickness skin loss involving epidermis, dermis, or both. Ulcer is superficial and presents as an abrasion, blister, or shallow craterStage III: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.Stage IV: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g. tendon, joint capsule). Undermining and sinus tracts may also be present.
  • by site, sensation, surrounding inflammation, underlying pressure points, viability of the floor
  • Pressure ulcers presentation

    1. 1. Pressure ulcersDr. Doha Rasheedy
    2. 2.  Definition Risk factors Diagnosis, staging prevention Treatment
    3. 3. A 75yrs elderly male pt, with PH of DM, recurrent CVS, bed ridden of 2 yrs duration and has urinary incontince. On exam. There was an ulcer about 2×3×2 cm with necrotic non viable base , painless, on the sacrum.What is the most likely diagnosis ?Venous UlcerDiabetic ulcerPressure ulcer
    4. 4.  A localized area of soft-tissue injury resulting from compression between a bony prominence and an external surface. It a type of a vascular necrosis
    5. 5. RISK FACTORSIntrinsic Extrinsic
    6. 6. Clinical pictureand Stages
    7. 7. The Norton Scale•Patients at risk ofdeveloping Pus can beidentified clinically by:Norton ScaleIt detect the physicaland mental condition,the activity, mobility andincontinentA score 10-12------Highrisk of PUS development
    8. 8.  Unstageable: Full thickness tissue loss in which slough (yellow, tan, gray, green or brown), eschar (tan, brown or black), or both in the wound bed cover the base of the ulcer. Pictures - Royal College of Surgeons of Edinburgh
    9. 9. Sites
    10. 10.  Any skin exposed to continuous pressure. Internal viscera exposed to unusual pressure, as trachea pressed by balloon of endotracheal tube
    11. 11.  Over Bony Prominences 1. Occiput 2. Ears 3. Scapula Internal 4. Spinous Processes organs 5. Shoulder 6. Elbow 7. Iliac Crest 8. Sacrum/Coccyx 9. Ischial Tuberosity 10.Trochanter 11.Knee 12.Malleolus 13.Heel 14.Toes
    12. 12.  Any skin surface subject to excess pressure Examples include skin surfaces under: ◦ Oxygen tubing ◦ Urinary catheter drainage tubing ◦ Casts ◦ Cervical collars
    13. 13. Differential diagnosis
    14. 14. Not all Pressure ulcer to heel ulcers are Neuropathic diabetic foot ulcer pressure ulcersArterial ulcer on toes and forefoot Venous leg ulcer 19
    15. 15. Preventionandtreatment
    16. 16. focuses on: Skin care Mechanical loading Support surfaces
    17. 17.  Daily systematic skin inspection and cleansing factors that promote dryness Avoid massaging over bony prominences moisture (incontinence, perspiration, drainage)It requires gentle washing and drying Minimize friction and shear
    18. 18.  Reposition at least every 2 hours (may use pillows, foam wedges) Keep head of bed at lowest elevation possible Use lifting devices to decrease friction and shear Remind patients in chairs to shift weight every 15 min “Doughnut” seat cushions are contraindicated, may cause pressure ulcers Pay special attention to heels (heel ulcers account for 20% of all pressure ulcers)
    19. 19. **Use for all older persons at risk for ulcers** Static  Foam, static air, gel, water, combination (less expensive) Dynamic  Alternating air, low-air-loss, or air-fluidized
    20. 20. Heal protector Air mattress; Alternate pressure / low air loss / air fluidized Other media; gel / water/ foamhttp://www.diamond-medical.com/images/database/medlinesupracxc.jpg
    21. 21. GENERAL ASSESSMENT Risk factor elimination ULCER ASSESSMENT, MONITORING HEALINGMANAGEMENT Cleaning Debridement Dressings SURGICAL REPAIR
    22. 22.  Health problems (e. g, urinary incontinence) Nutritional status Pain level
    23. 23.  ULCER  MONITORING ASSESSMENT: HEALINGLocation  Document all Stage observations over time Area Depth  Describe each ulcerDrainage to track progress of Necrosis healing Granulation  Use validated tools (eg, PUSH) Cellulitis
    24. 24.  Cleaning Avoid topical antiseptics because of their tissue toxicity DebridementIs necessary to remove dead tissue it include1. Autolytic debridement using hydrocolloid or foam dressings2. Enzymatic debridement using exogenous collagenase (IRUXOL)3. Mechanical debridement4. Surgical, sharp Scalpel, scissor to remove dead tissue; laser debridement5. Bio surgery: Larvae to digest dead tissue
    25. 25.  DressingsBy wet to dry saline or hydrocolloid (duo-derm), or polyurethane, in exudative wounds fill the wound by aligniates or hydro gel. SURGICAL REPAIRMay be used for stage III and IV ulcers Direct closure, skin grafting, skin flaps, musculocutaneous flaps, free flaps
    26. 26. Complications
    27. 27.  Sepsis (aerobic or anaerobic bacteremia) Localized infection, cellulitis, osteomyelitis Pain Depression Mortality rate = 60% in older persons who develop a pressure ulcer within 1 year of hospital discharge
    28. 28. The mainstay in pressure ulcer treatment isprevention of risk factors.
    29. 29.  Older adults are at high risk for development of pressure ulcers Pressure ulcers may result in serious morbidity and mortality Techniques that reduce pressure, moisture, friction, and shear can prevent pressure ulcers Pressure ulcers should be treated with proper cleansing, dressings, debridement, or surgery as indicated
    30. 30. a)Pressure ulcer = decubitus ulcer= bed sores.b)Stage 1 PU is partial skin thickness loss.c)One important risk factor for PU development is moisture.d)One of the complications of PU is cellulitis.e)A cornerstone in management of PU is debridement
    31. 31.  First line treatment for pressure ulcer1. Surgical closure2. Debridement3. Pressure relief4. Dressing Stage 3 pressure ulcer is:1. Persistent non-blanchable erythema of intact skin2. Full-thickness skin loss involving necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.3. Partial-thickness skin loss4. Full-thickness skin loss with damage to muscle, bone, or supporting structures (e.g. tendon, joint capsule).
    32. 32.  First line treatment for pressure ulcer1. Surgical closure2. Debridement3. Pressure relief4. Dressing Stage 3 pressure ulcer is:1. Persistent non-blanchable erythema of intact skin2. Full-thickness skin loss involving necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.3. Partial-thickness skin loss4. Full-thickness skin loss with damage to muscle, bone, or supporting structures (e.g. tendon, joint capsule).

    ×