LO6 Pressure ulcers

Question 1

What is the definition of a pressure ulcer?

Answer 1

Areas of tissue necrosis over a bony prominence

Question 2

What are the high risk areas for development of pressure ulcers?

Answer 2

Hips, sacrum, buttocks, knees, medial and lateral malleolus, heels and toes

Question 3

What are the 4 main mechanisms for pressure ulcer development?

Answer 3

Extended periods of pressure, Shearing forces, Friction, Moisture (i.e. incontinence, sweat)

Question 4

What is the risk assessment tool used to measure susceptibility to pressure sore development?

Answer 4

Waterlow risk assessment

Question 5

What does the Waterlow risk assessment take into account?

Answer 5

BMI, Skin type, Sex and Age, MUST score, Continence, Mobility, Tissue malnutrition, Neurological deficit, Major surgery/Trauma.

Question 6

What is the pathophysiology of pressure ulcer development?

Answer 6

PUs result from continuous low level pressure gretaer than 32mmHg (this is enough to impede capillary arterial blood flow and capillary venous flow). The superficial dermis can tolerate ischaemia for 2-8 hours but the underlying tissue can only tolerate it for >2 hours. This means that by the time the skin has broken there may already be significant harm.

Question 7

What are the four stages of pressure ulcer grading?

Answer 7

0- Skin hyperaemia, 1- non-blanching erythema, 2- Broken skin or blistering, 3- Ulcer down to subcutaneous flat, 4- Ulcer down to connective tissue (V. difficult to heal)

Question 8

Who is involved in the care of pressure ulcers?

Answer 8

Specialist nurse at the tissue viability team

Question 9

What are the mechanisms for treatment of a pressure ulcer?

Answer 9

Pressure relieving equipment (mattress, cushion. Alternatively, there can be negative pressure (VAC dressings); maggot therapy; plastic therapy

Question 10

What are the management steps if there are signs of infection?

Answer 10

Debridement of the ulcer, sterile dressing and systemic antibiotics