IN DEPTH ABOUT PRESSURE SORE

1. PREPARED BY,
ASWATHY.O
LECTURER
KIMS COLLEGE OF NURSING

2. PRESSURE SORE/ PRESSURE ULCER

3. INTRODUCTION
Occur when immobilized and confined to bed for a
prolonged period of time. Unrelieved pressure on specific areas of the
body can result in an injury that causes skin breakdown and an open
sore. Bedsores typically form over a bony area such as the back, tailbone,
buttocks, hip, heels, elbows, and shoulders.
If left untreated, bedsores can require surgery and result in complicating
health conditions including sepsis, bone and joint infections, and even
cancer.

4. OTHER NAMES
Pressure ulcer
Pressure sore
Decubitus ulcer
Studies have found decubitus ulcers account
for 34,320 deaths annually. In addition, pressure
ulcer treatments total over $11 billion in hospital
costs each year.

5. DEFINITION
Any lesion caused by un relieved pressure (a
compressing downward force on a body area)
that results in damage of underlying tissues.

6. RISK FACTORS
Friction & Shearing
Immobility
Inadequate nutrition
Fecal & Urinary Incontinence
Decreased mental status
Diminished Sensation

7.  Excessive Body heat
 Advanced age
 Chronic medical conditions
 Other Factors
Poor lifting & transferring techniques
Incorrect positioning
Hard support surface areas
Incorrect application of pressure relieving devices

8. PATHOGENESIS OF PRESSURE ULCERS
If pressure ulcer due to localized ischemia & tissue compression
capillary occlusion pressure greater than 32mm Hg
Blood cannot reach the tissues
Deprivation of oxygen & nutrients to the cells

9. Waste products of metabolism accumulate in the cells
Consequently tissue death occurs due to prolonged unrelieved pressures
Due to vasodilatation
Skin appears pale & bright red flush
If redness disappears in time Not disappears
No tissue damage Tissue damages

10. PRESSURE ULCER STAGES

11. STAGES OF PRESSURE ULCER
STAGE I
Intact skin with non
bleachable redness of a
localized area , usually over
a bony prominence

12. STAGE II
Partial thickness skin loss
involving epidermis,
dermis clinically as
abrasion, blister etc

13. STAGES OF PRESSURE ULCER
STAGE III
Full Thickness skin loss.
Subcutaneous fat may be
visible.

14. STAGES OF PRESSURE ULCER
STAGE IV
Full Thickness tissue loss
with exposed bone, tendon
or muscle. Slough or eschar
may be present

15. RISK ASSESSMENT
TOOL

16. RISK ASSESSMENT TOOL
 BRADEN SCALE

17. BRADEN SCALE SCORING

18. COMMON PRESSURE SITES

19. COMMON PRESSURE SITES
 SUPINE POSITION

20. COMMON PRESSURE SITES
 LATERAL POSITION

21. COMMON PRESSURE SITES
 PRONE POSITION

22. COMMON PRESSURE SITES
 FOWLER’S POSITION

23. PREVENTION OF PRESSURE ULCERS
 Reposition the person every 2 hours, at minimum. Older
persons who remain in bed need to be turned to avoid
prolonged pressure on the body.

24. PREVENTION OF PRESSURE ULCERS
 When helping the person move in the bed, use a lifting device such
as a Hoyer lift or lifting sheet to avoid dragging the person’s body on
the sheets and causing excess friction on the skin.

25. PREVENTION OF PRESSURE ULCERS
Record the time that you turned and positioned the
person in addition to other observation about the
person’s care. Caregivers should use a tool to
document .

26. PREVENTION OF PRESSURE ULCERS
 Use pressure-reducing aids such as cushions, mattresses,
beds, and elbow pads to reduce pressure on the skin.
Cushions that contain foam, gel or air are particularly
effective. Do NOT use any donut type devices because they
create uneven pressure that can lead to pressure ulcers.

27. PREVENTION OF PRESSURE ULCERS
Position the head of bed to be as flat as possible.
Elevating the head at an angle forces the body to
slump down deeper into the mattress, causing
potentially damaging shearing force on the skin.

28. PREVENTION OF PRESSURE ULCERS
 Perform a daily skin inspection to identify vulnerable areas.
Look for signs of redness in areas where bedsores are more likely to
occur: bony areas including the buttocks, tailbone, knees,
shoulders, hips, and ears.

29. PREVENTION OF PRESSURE ULCERS
 Make sure skin is kept clean from dampness and perspiration, which
can accelerate breakdown. Clean the skin with mild soap and warm
water. Avoid products that contain alcohol, as they will dry the skin.
Do not rub hard, but use gentle strokes when cleansing the person.
Pat dry with a soft towel.

30. PREVENTION OF PRESSURE ULCERS
 Lubricate the skin with body lotion. Use talcum powder on areas
where moisture is likely to develop, such as under the breasts or
armpits.

31. PREVENTION OF PRESSURE ULCERS
 Change bedding immediately if it becomes wet. Wash, rinse and dry all linens.
Opt for sheets that are wrinkle-free and softened

32. PREVENTION OF PRESSURE ULCERS
 Monitor fluid intake. Adequate hydration is critical for skin
health. The average person needs to consume at least eight
glasses of water per day. Pay attention to signs of
dehydration such as darker urine, dry mouth, and
constipation.

33. PREVENTION OF PRESSURE ULCERS
 Maintain a nutritious diet. Encourage the person to eat a protein rich diet.
A physician may prescribe dietary supplements such as nutrition shakes,
omega-3, and zinc. Make meal time a happy experience and make sure to
document if the person if eating their whole meal or refusing portions.

34. MECHANICAL DEVICES FOR REDUCING
PRESSURE ON BODY PARTS

35. MECHANICAL DEVICES
HEEL PROTECTORS ALTERNATING PRESSURE MATRESS

36. MECHANICAL DEVICES
GEL FLOATATION PADS PILLOWS

37. MECHANICAL DEVICES
AIR CUSHIONS LOW-AIR-LOSS BED

38. SUMMARY