9 - Pressure Ulcer Flashcards
Describe the skin layers. Teaching Lecture 🔑🔑 OSCE Dr. Jamal
The skin is the largest organ in the body, composed of three layers:
(1) epidermis, the outermost layer of the skin
(2) dermis, the layer beneath the epidermis, composed of connective tissue, glands, and follicles
(3) the subcutaneous deeper layer (hypodermis), made up of fat and connective tissue.
https://now.aapmr.org/pressure-ulcer-management/
At what anatomic sites are pressure ulcers most likely to develop? 6 Marks 🔑🔑 MOCK
- Sacrum
- Coccyx
- Ischium
- Trochanter
- Malleolus
- Heel
PMR Secrets
Three main mechanisms of developing pressure ulcer 🔑🔑 MOCK 2022
💡 Local soft tissue ischemia results due to prolonged pressure over bony prominences that exceed supracapillary pressure
- Pressure
- Friction (shearing forces)
- Ischemia
Cuccurollo 4th Edition Chapter 7 SCI pg607
List 3 mechanical factors that causes pressure ulcer. 🔑🔑 MOCK 2022
- Friction
- Shear force
- Pressure
https://www.researchgate.net/figure/Mechanical-Factors-causes-Decubitus-Ulcers-DU_fig1_326110991
List 6 risk factors for developing pressure ulcer in SCI patient 🔑🔑
MECHANICAL
- Persistent pressure
- Shear forces
- Body weight (too thin or overweight)
- History of a prior pressure injury
- Poorly fitting orthoses
- Tightly fitting clothes
MOBILITY
- Higher level and greater severity of the injury (complete tetraplegia)
- Immobility
- Spasticity and contractures
SKIN
- Loss of sensation
- Incontinence
PSYCOSOCIAL
- Psychosocial illness (i.e., depression)
- Unemployment status, lower educational achievement
NUTRITION
- Tobacco and alcohol use
- Poor nutritional status (malnutrition, low calories or protein)
- Anemia
Cuccurollo 4th Edition Chapter 7 SCI pg607
SCIRE Pressure Injuries - Patient Information
List 4 ways to prevent pressure ulcer 🔑🔑
Bed & Wheelchair
- Change position every 2 hours
- Proper mattress/bed overlay
- Pressure relief (weight shifting) and repositioning should be done for more than 2 minutes at a time, every 15 to 30 minutes when sitting
- Proper cushioning and WC seating
- Pressure mapping
- Hygiene
Cuccurollo 4th Edition Chapter 7 SCI pg607
SCIRE Pressure Injuries - Patient Information
Two groups at high risk of developing pressure ulcer
- Spinal cord injured
- Elderly.
What is the transcutaneous oxygen partial pressures (PtcO2) of the foot?
Normal transcutaneous oxygen partial pressures (PtcO2) > 40 mmHg
Important elements of assessing a pressure ulcer (6) 🔑
- Anatomic Location
- Stage
- Size
- Tissue Quality
- Exudate
- Wound margins
How are pressure ulcer staged? 🔑🔑 MOCK
STAGE 1
- Non-blanchable erythema of intact skin
STAGE 2
- Partial thickness skin loss involving the epidermis +/- dermis.
- Present as abrasion, blister & shallow crater.
STAGE 3
- Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
- Present as deep crater with granulation tissue and high adiposity
STAGE 4
- Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting muscle structure.
PMR secrets, 2nd edition, P 462
What are the components of the Braden Scale? 🔑🔑
Braden Scale
- Sensory perception
- Moisture
- Activity
- Mobility
- Nutrition
- Friction & Shear
https://www.aafp.org/afp/2008/1115/afp20081115p1186-s1.pdf
List 4 types of wound debridement 🔑
1- Mechanical Debridement
Wet to dry dressing or high-pressure irrigation, pulsed lavage hydrotherapy to remove necrotic tissue
2- Enzymatic Debridement
Topical application of proteolytic enzymes such as collagenase, fibrinolysin, to remove necrotic tissue
3- Autolytic Debridement
Uses semi occlusive (transparent film) or occlusive dressings (hydrocolloids or hydrogels) to cover a wound so necrotic tissue is broken down by phagocytic processes with the use of moisture-retaining dressings
4- Sharp Debridement
Active debridement with sharp blades to remove necrotic wound
List 4 ways to treat pressure ulcer 🔑🔑 EXAM 2021
1- NUTRITION
- Appetite stimulants or high caloric diet
- Increase protein intake
1. 2 to 1.5 gm/kg/day for stages 1 to 2
1. 5 to 2.0 gm/kg/day for stages 3 to 4 - Vitamin C 1 g/day
2- POSITIONING
- Eliminate direct pressure to the wound
- Use pneumatic (air) mattress
3- WOUND CARE
- Stage 1 and 2: Isotonic saline, Protecting or absorbent dressing, Wound vacuum-assisted therapy (VAC) system
- Stage 3 injuries may require surgical intervention (debridement, muscle/skin flaps)
- Stage 4 pressure injuries almost always require surgery.
If pressure ulcer is not healing, what is your initial thoughts?
- Osteomyelitis → Xray and bone biopsy or bone scan
- Malnutrition → High protein 2g/kg (High albumin diet)
