Pressure Ulcer Management dr M Gaber .pptx
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very nice lectures informative done by the Consultant Dr Moh Gaber ICU consultant about the common complications of icu and bedridden patient
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Pressure Ulcer Management dr M Gaber .pptx
- 1. Pressure Injury Management ICU Senior Specialist Lecturer of Anesthesia and intensive care Al-Azhar University Dr Mohammed Gaber Saad
- 3. What is the largest organ in the body? Liver Skin Small intestine
- 6. Overview Decreased immobility Malnutrition lack of sensation Reduced tissue perfusion
- 7. Overview
- 9. What Mechanism is responsible for pressure injury development? Pressure against hard surface Friction force Shear force
- 12. Shear Force 2 Friction force 3 Compression force 1 Development mechanism
- 19. pressure ulcer Localised damage to the skin and/or underlying tissue, as a result of pressure, or pressure in combination with shear. It is usually occur over a bony prominence, but may also be related to a medical device or other object (EPUAP, 2019).
- 23. Prevention
- 24. How long time of ischemia is enough to start pressure injury development? 1-2 hours 6-8 hours 12-14 hours
- 25. Team work
- 26. Assessment Improve mobility Improve skin perfusion Provide proper skin care Support surfaces Positioning Supportive intervention Pressure redistribution Nutritional support
- 27. Assessment Mobility state Nutritional state Skin Integrity Sensory Loss
- 28. Braden scale
- 30. Supportive interventions 01 Improve mobility Mobilization program Physical therapy. Reduce sedatives Proper skincare 03 primary goal: Avoid excess dryness and moisturising of the skin Improve Skin perfusion Hypotension vasoconstrictive agents cardiac contractility 02
- 31. Supportive interventions Proper skincare Cleansing Emollients Leave-on products Maintain moisture and protection. Should be applied in one direction Under pads or adult briefs Consistent skin cleansing Barrier products Zink oxide At regular intervals Agents with a balanced PH Avoid water and soap washing Avoided the hot water Avoid Vigorous massage over bony prominences Incontinence
- 32. Supportive interventions Proper skincare On dressing removing Take time to remove dressings slowly ('low and slow’) Mark the dressing with an arrow to indicate the correct direction of removal and make sure Use adhesive removers Use a skin barrier product to protect the surrounding skin
- 33. Pressure redistribution 01 Support surfaces 02 Positioning Overlays Bed mattresses Air or gel-filled Position and inclination Repositioning
- 34. Pressure redistribution Overlays Bed mattresses Air or gel-filled
- 36. Pressure Mode Pressure redistribution Bed mattresses Static Alternating Adjusted according to manufacturer or body weight
- 44. Pressure redistribution Repositioning from the back, to one side Gently Properly Assistant devices Must to be documented in reposition sheet At least every 2 hours
- 45. Vitamins Glutamate Zink Ca Protein 1.25-2 g/kg Hydration 30 ml/kg Energy 30-35 Kcal/kg Nutritional support Correct malnutrition Assessment Screening
- 46. Assessment Improve mobility Improve skin perfusion Provide proper skin care Support surfaces Positioning Supportive intervention Pressure redistribution Nutritional support
- 47. Treatment
- 48. An early systemic antibiotic is recommended once the wound gets infected? Yes NO
- 49. Wound Treatment 01 02 03 04 Wound assessment Class Size Exudate Infection Dead tissue Debridement Mechanical Surgical Autolytic Enzymatic Infection treatment Topical Systemic Optimize Wound Environment Cleansing Maintain moisture balance Protect the wound and peri-wound skin
- 50. Wound Treatment Debridement Stage 1-2 Stage 3-4 Unstageable Do not have necrotic tissue and therefore will not require debridement Avoid debridement on the heel
- 51. Wound Treatment Infection treatment The extent of the infection Superficial cellulitis Deep topical agents silver sulfadiazine Dressings impregnated with silver, honey, or cadexomer iodine As Superficial + systemic antimicrobial therapy Debridement As Superficial + Antimicrobial therapy for at least 6 weeks Debridement of necrotic tissue.
- 52. Wound Treatment Optimize Wound Environment Optimize Wound Environment Maintain moisture balance Protect the wound and peri-wound skin Cleansing Wound Dressing An absorptive dressing: Aliginate - Foam Dressings that maintain a moist wound environment while keeping the surrounding intact skin dry: saline-moistened gauze, transparent films, hydrocolloids, and hydrogels.
- 53. Wound Treatment Optimize Wound Environment Optimize Wound Environment Maintain moisture balance Protect the wound and peri-wound skin Cleansing Topical Applicants In the wound to promote epithelization process and start regeneration Around the wound to protect from the soiling and skin damage: Zinc oxide
- 54. Wound Treatment Optimize Wound Environment Optimize Wound Environment Maintain moisture balance Protect the wound and peri-wound skin Cleansing Adjuvants Negative pressure wound therapy (NPWT) Hyperbaric oxygen therapy (HBOT) Electrical stimulation
- 55. Creams Wound condition 1st stage 2nd stage 1) (Tegaderm or Mepore)+ soft dressing 2) Foam Dressing 1) Tegaderm 2) Foam Dressing 3rd stage Exudate amount Scanty 2ry dressing Foam Large to moderate 1ry dressing 1) Alginate 2) Plain exufiber 1ry dressing 1) Plain exufiber Creams Exudate amount Scanty 2ry dressing Foam Large to moderate 1ry dressing 1) Alginate 2) Plain exufiber 1ry dressing 1)Plain exufiber Creams 4th stage Consider systemic antibiotic when: • Clinical evidence of systemic sepsis • Spreading cellulitis • Underlying osteomyelitis Exudate amount Scanty 2ry dressing Foam Large to moderate 1ry dressing 1) Exufiber Silver 1ry dressing 1) Exufiber Silver Creams Corakjen (cream+spray) 3rd stage Nano silver (stop when no pus) Exudate amount Scanty 2ry dressing Foam Large to moderate 1ry dressing 1) Exufiber Silver 1ry dressing 1) Exufiber Silver Creams Corakjen (Jel+spray) Nano silver (stop when no pus) 4th stage Pressure ulcer treatment Chronic Care Specialized Hospital • Surgical debridement • Hydrogel Black Pink - Red Not-infected Maroon Deep Tissue Injury Foam dressing Infected (Green)