Ch. 61 Pressure Ulcer

Question 1

How pressure causes ulcer?

Answer 1

By tissue ischemia.
Tissue get compressed between bony prominence and external surface, thus capillaries are compressed and blood flow is obrstucoted. Leads to perfusion injury, infarction and tissue necrosis.

Question 2

What are the measure to prevent pressure ulcer?

Answer 2

• Distribution of pressure across weight bearing surface.
• Pressure reducing support.
• Frequent pressure relief
• Minimize her force

Question 3

Assessing pressure ulcer?

Answer 3

1. Anatomical location
2. Size
3. Stage
4. Tissue quality
5. Exudate
6. Margins / surrounding tissue

Question 4

Which areas in the body are at higher risk of developing pressure ulcer?

Answer 4

1. Sacrum
2. Coccyx
3. Ischia
4. Trochanter
5. Malleoli
6. Heel

Question 5

Whats the difference between sacral and coccygeal ulcer?

Answer 5

Sacral : flat supine position

Coccyx : semi reclined or slouched posture

Question 6

In sitting position which body area is affected and prone to develop pressure ulcer?

Answer 6

Posterior to greater trochanter specially in wheelchair whit sling seat that is overstretched.

Question 7

Stages of pressure ulcer

Answer 7

Stage 1 non blench able erythema, intact skin
Stage 2 partial thickness skin loss, abrasion, blister, shallow center
Stage 3 full thickness skin loss, but not extending beyond fascia
Stage 4 full thickness skin loss, extending fascia and adjacent structures (bone, tendon, muscle necrosis)

Question 8

Treatment of pressure ulcer

Answer 8

1. Prevention
2. Treat underlying cause
3. Debridement
4. Moist environment

Question 9

How to diagnose osteomyelitis in pressure ulcer?

Answer 9

1. Bone biopsy > C/S for ABx
2. X-ray late findings
3. Bone scan: false +ve
4. MRI