Pressure sore

Question 1

What are pressure sores?

Answer 1

“Damage to the skin, usually over a bony prominence, as a result of pressure”
- Constant pressure limits blood flow to the skin leading to tissue damage
- Very common in hospitals and in the elderly population

Question 2

What are the risk factors for pressure sores?

Answer 2

Risk Factors → immobility, recent surgery or intensive care stay, diabetes, malnutrition

Question 3

What scoring system is used to screen for patients at risk of pressure ulcer?

Answer 3

Waterlow Score → used to screen for patients who are at risk of developing pressure ulcers. Takes into account BMI, nutritional status, skin type, mobility and continence.

Question 4

What are the presenting symptoms/ signs of a pressure sore?

Answer 4

1. Location → over bony prominences, typically sacrum or heel
2. Focal area of non-blanchable erythema
3. Evidence of decreased skin perfusion (increased CRT-cap refill time)
4. Painful (unlike neuropathic ulcers which are painless)
5. Signs of wound infection → purulent drainage, foul smell

Question 5

What are the different stages of a pressure sore?

Answer 5

1. Stage 1 ⇒ nonblanchable erythema of intact skin.
2. Stage 2 ⇒ loss of dermis +/- epidermis. Superficial ulcer.
3. Stage 3 ⇒ loss of all skin layers (full thickness).
4. Stage 4 ⇒ extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures

Question 6

What investigations are used to diagnose/ monitor a pressure sore?

Answer 6

Mainly a clinical diagnosis
- Evaluate for predisposing factors → blood glucose, HbA1C, serum albumin (assess malnutrition)
- Check for infection → leukocytosis and increased CRP

Question 7

How are pressure sores managed?

Answer 7

1. Pressure relief over affected area
2. Frequent position changes (every 2 hrs) for immobile patients
3. Moist wound environment (encourages ulcer healing)
4. Analgesia (paracetamol, ibruprofen)
5. Ensure good Nutrition
6. Wound Management → cleaning & dressings
7. Stage 3 or 4 → Debridement of necrotic tissue (if not suitable for surgery) or Surgical debridement and reconstruction with flap formation (if suitable for surgery)W

Question 8

What complications can arise from a pressure sore?

Answer 8

1. sepsis, cellulitis, osteomyelitis → if pressure ulcer becomes infected, infection can spread → all can be treated with systemic antibiotics

Question 9

Describe the prognosis of pressure sores?

Answer 9

good, as long as appropriate treatment and wound care is provided promptly