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Pressure Sore
- 1. PRESSURE SORES Chosen CareGroup Ltd.
- 2. OBJECTIVES • Definition • Epidemiology •Pathogenesis • Risk Factors • Stage and Risk Assessment • Prevention • Management
- 3. Definition • A Pressuresore is a localized Injury to the skin or the underlying tissue as a result of unrelieved pressure. • The other names are Decubitus ulcer or bed sore.
- 4. EPIDEMIOLOGY • Between 1to 3 million UK affected • 11-18 % nursing home residents • 9-60% hospital • 3-18% home • Health care expenditure 1.4 to 2.1 Billion pounds per year.
- 5. PATHOGENESIS • Prolonged pressure •Friction • Shearing forces • Moisture
- 6. COMMON SITES • Commonlyoccur at bony prominences, example: heels • 95% occur in the caudal aspect of the body; 65% in the pelvic area; 30% on the lower limbs.
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- 8. Intrinsic risk factors •Limited mobility • Spinal cord Injury • Pain • Alzheimer's disease • Fractures • Post Surgical • Coma or Sedation • Parkinson Disease
- 9. INTRINSIC RISK FACTORS •Poor Nutrition • Anorexia • Poor Dentition • Poverty or lack of access to food • Dietary Restriction
- 10. Intrinsic risk factors •Dementia • Diabetes • Depression • Renal disease • Cancer
- 11. Extrinsic risk factors •Pressure from external Surface e.g. bed, chair • Friction from being unable to move well • Shear forces from involuntary movement • Moisture – Bowel or bladder Incontinence, Perspiration, Wound Drainage
- 12. Staging classification • Stage-1: Intact skin with non blanchable redness of a localized area, usually over a bony prominence. The area may be painful, firm, soft, warmer or cooler than adjacent tissue.
- 13. Staging classification • Stage2 – Partial thickness skin loss, presenting as shallow open ulcer with a red pink wound bed without slough(pus).May also present as an intact or open serum filled blister.
- 14. Staging classification • Stage3 – Full thickness skin loss. Fat may be visible but bone , tendon or muscle tissue are not ,slough may be present.
- 15. Staging classification • Stage4 – Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present.
- 16. prevention Aims: • Reduce pressureand shearing effects • Reduce Moisture • General skin care • Nutrition • Co Morbidities • Involve Patient, family, care givers
- 17. prevention • Daily skininspection • Bathing and skin cleaning frequency • Moisturize skin; avoid hot water or harsh solutions • Assess and treat incontinence: use tropical barriers or absorbent padding when needed • Proper repositioning frequently • Avoid manipulating bony prominenses
- 18. Prevention cont.… • Practiceproper positioning , transferring and turning techniques to avoid friction and shearing forces. • Use dry lubricants or protective coverings to reduce friction injury. • Consider nutritional supplements . • Use adjunct devices e.g. air mattresses, limb padding where necessary • Have a fixed repositioning schedule.
- 22. management • Based onstaging and Investigation • Wound swabs and cultures shows mixed growth • Clean Barrier • Antibiotic where appropriate • Debride necrotic tissue
- 23. complications • Sepsis, Cellulitis,endocarditis, meningitis • Fistula formation • Septic arthritis • Sinus tracts
- 24. conclusion • Risk • Prevention •Identify early • Manage
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