Chapter 29 Pressure Ulcers Flashcards
The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure or pressure combined with shear and/or friction.”
The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure or pressure combined with shear and/or friction.”
Secondary factors of Pressure Ulcers include Immobility, Diminished sensation or mental status, Advanced age, Incontinence (leading to skin maceration), Elevated tissue temperatures, Circulatory deficiencies, Anemia, Nutritional deficits.
Secondary factors of Pressure Ulcers include Immobility, Diminished sensation or mental status, Advanced age, Incontinence (leading to skin maceration), Elevated tissue temperatures, Circulatory deficiencies, Anemia, Nutritional deficits.
Bony prominences are particularly at risk; _________ is more sensitive to breakdown from pressure than skin. Ulcers are commonly staged according to NPUAP guidelines as follows:
Stage I – Intact _________ with _________ erythema not resolved within _________ minutes. Warmth, edema, induration, or discoloration may be indicators of stage I ulcers in patients with darker skin.
Stage II – Partial-thickness epidermal or _________ skin loss. These may appear as _________ with erythema.
Stage III – Full-thickness skin loss and _________ involvement, but not through the underlying fascia.
Stage IV – Full-thickness skin loss with involvement of muscle, tendon, bone, or joint.
Bony prominences are particularly at risk; muscle is more sensitive to breakdown from pressure than skin. Ulcers are commonly staged according to NPUAP guidelines as follows:
Stage I – Intact epidermis with nonblanchable erythema not resolved within 30 minutes. Warmth, edema, induration, or discoloration may be indicators of stage I ulcers in patients with darker skin.
Stage II – Partial-thickness epidermal or dermal skin loss. These may appear as blisters with erythema.
Stage III – Full-thickness skin loss and subcutaneous involvement, but not through the underlying fascia.
Stage IV – Full-thickness skin loss with involvement of muscle, tendon, bone, or joint.
An ulcer with slough or necrotic tissue is deemed _________.
An ulcer with slough or necrotic tissue is deemed unstageable.
Pressure ulcer prevention should include appropriate seating/bed equipment, proper positioning, and education about pressure relief (i.e., ________ ________ every 15 to 20 min for ≥30 seconds while sitting; turning in bed every ________ hours).
Pressure ulcer prevention should include appropriate seating/bed equipment, proper positioning, and education about pressure relief (i.e., weight shifting every 15 to 20 min for ≥30 seconds while sitting; turning in bed q2h).
Treatment of pressure ulcers includes addressing the etiologic factors, treatment of infections, debridement of necrotic tissue (sharp, mechanical, enzymatic, or autolytic), regular wound cleansing, and use of appropriate wound dressings. A trial of topical antibiotics (e.g., ________) may be helpful in wounds not healing with optimal debridement and cleansing. Wound cultures are not generally thought to be helpful because most wounds are colonized with bacteria. Systemic antibiotics should be reserved for cases with evidence of ________, ________, or systemic infection. Modalities such as ________ light, laser radiation, US, hyperbaric O2, and electrical stimulation may be helpful in accelerating wound repair, although only ________ has sufficient supportive evidence to receive endorsement by the AHCPR (now the AHRQ). Surgical flaps may expedite the healing of noninfected deep ulcers by filling the void with well-vascularized healthy tissue (they do not provide a “cushion”).
Treatment of pressure ulcers includes addressing the etiologic factors, treatment of infections, debridement of necrotic tissue (sharp, mechanical, enzymatic, or autolytic), regular wound cleansing, and use of appropriate wound dressings. A trial of topical antibiotics (e.g., silver sulfadiazine) may be helpful in wounds not healing with optimal debridement and cleansing. Wound cultures are not generally thought to be helpful because most wounds are colonized with bacteria. Systemic antibiotics should be reserved for cases with evidence of osteomyelitis, cellulitis, or systemic infection. Modalities such as UV light, laser radiation, US, hyperbaric O2, and electrical stimulation may be helpful in accelerating wound repair, although only E-stim has sufficient supportive evidence to receive endorsement by the AHCPR (now the AHRQ). Surgical flaps may expedite the healing of noninfected deep ulcers by filling the void with well-vascularized healthy tissue (they do not provide a “cushion”).
