Chapter 88 Pressure Sores Flashcards
What is the etiology of pressure sores?
Tissue ischemia developing from pressure over a bony prominence, pressure exceeds blood pressure to that area
What are the risk factors of pressure sore development?
Increased age, SCI, spasticity, decreased skin sensation, paraplegia, quadriplegia, prolonged immobilization, bowel or bladder incontinence, (malnutrition is not a risk factor)
What are the most common sites of pressure sores?
Sacrum, ischium, greater trochanter
What are the stages of pressure sores?
Stages I-IV
Define: Suspected deep tissue injury
areas of purple or maroon discoloration with intact skin or blistering in the setting of excessive pressure and shear
Define: Stage I Ulcer
intact skin with non-blanching erythema; reversible; often heal without surgical intervention
Define: Stage II Ulcer
partial thickness loss of dermis; reversible; often heal without surgical intervention
Define: Stage III Ulcer
Full thickness skin loss with visible subcutaneous fat, which may extend to the deep fascia. There may be slough or undermining/tunneling
Define: Stage IV ulcer
full thickness tissue loss beyond the deep fascia with exposed bone, tendon or muscle
Define: unstageable wound
Excessive slough or eschar prevents accurate measurement of wound depth
What infections are commonly associated with pressure ulcers?
UTI, Pneumonia (usually the cause of fever in patients with SCI and pressure sores)
What laboratory tests are helpful in the diagnosis of osteomyelitis?
WBC (non-specific), ESR >120 mm/hr (more specific)
What radiologic test is most helpful in the diagnosis of osteomyelitis in a pressure sore?
None - MRI, CT, bone scan, XR
What is the gold standard for osteomyelitis diagnosis?
Bone biopsy and culture
What are the most common bacteria associated with pressure sores?
Staph aureus, proteus mirabilis, pseudomonas, bacteroides fragilis; polymicrobial