pressure sores Flashcards
where are pressure sores likely to occur?
Sacrum!!!!
Bony prominences (eg. greater trochanter, ischium)
Why do pressure sores occur?
causes?
Pressure - MC
Increased friction
shearing
moisture - ischemia - if >2hr = necrosis
what score do we use to assess the severity of pressure sores?
WATERLOW score
What does the Waterlow score assess?
stratified risk of pressure sores
Waterlow score:
>10?
>15?
>20?
what is taken into account with these scores?
> 10 = risk
15 = high
20 = very high
BMI, Sex, age, mobility, diet, meds
Waterlow score:
what do the scores 1-4 mean?
- Non blanching erythema, no mucosal tear
- Mucosal breach
- Full thickness skin involvement
- Bone/Joint involvement
Dx of pressure sores?
what other tests/investigations are done?
Bloods
MC+S (Incl site swab)
Tx of pressure sores?
prevention
repositioning
barrier cream
Tx for pressure sores?
1+2 Waterlow score
pain ladder
consider IV flucoxacillin (if cellulitis suspected)
Tx for pressure sores?
3+4 Waterlow score
Wound dressing
surgical debridement (+ Tx for 1+2)
RF for pressure sores?
Immobility
Old age
+ vascular disease (icl DM)
+ Confusion
+ poor nutrition/dehydration
What is the definition of malnutrition?
Nutritional deficit with functional effects
What are some causes of malnutrition?
common with increase age
Eating disorders
Malabsorption (eg. Coeliacs)
Poor diet
dysphagia
cancer
what screening tool is used for malnutrition?
MUST tool
What 3 things does the MUST tool look at?
BMI
<18.5 = 2 pts
18.5-20 = 1pt
Unintentional weight loss
5-10% = 1pt
Not ate properly in 5 days = 2pts
MUST screening tool
what do these scores mean and what happens?
0?
1?
>2?
0 = no action, advice (mild-none)
1 = observe (mod)
> 2 dietician input (severe)
Sx of malnutrition?
Anemia Sx (fatigue, angular stomatitis, glossitis)
Poor wound healing
Dehydration
Low libido
Constipation
Low urine output
Dx of malnutrition?
Bloods
lying/standing BP
ECG (Low K+)
Conservative Tx of malnutrition?
High calorie intake
Fortisips
Dietician Tx of malnutrition?
Assess swallowing (dysphagia scale)
Monitor electrolytes if re feeding (referring syndrome)
Advice on diet
What feeding tools can we use?
NG
NJ
PEG
PEJ
When is NG + NJ feeding used?
shorter term 30-60d
When is PEG feeding used, on what Px?
What risk does PEG feeding have?
Dementia
MND
Risk of aspiration pneumonia
what organisms can grow from aspiration pneumonia?
Tx?
S.Pneumo, S.aureus, pseudomonas
Tx = IV Cephalosporin or IV Metronidazole
When is PEJ feeding used?
If upper GI surgery, pancreatitis
If no enteric feeding is possible, what can be used to feed?
PICC feed
eg. GI obstruction
Complications of malnutrition?
Osteoporosis
Falls (high frailty)
Referring syndrome
CV = Bradycardia, ECG changes, postural hypo
What is the definition of osteoporosis?
T>-2.5 on DEXA
Fragility fractures due to low BMD
Selective destruction of horizontal trabeculae
-Low BMD
Ratio of mineral:bone = normal
Who suffers from osteoporosis?
M + F fraction?
world wide?
1 in 3 F
1 in 5 M
Over 50 world wide
(20% + >50y in UK)
Caucasian F
acronym for causes of osteoporosis?
SHATTERED
What does SHATTERED stand for?
Steroids
HyperT4
Alcohol
Thin
Testosterone Low
Estrogen Low
Renal/liver issues
Erosive bone disease (RA)
Drugs (Methotrexate, Li, Warfarin)
DMT1
Sx of osteoporosis?
Pathological fractures:
-Colles (fall on outstretched hand)
-Neck of Femur (NOF) - external rotation + shortened leg
-Vertebral crush (widow stoop)
-Hip fracture
Dx of osteoporosis?
1st and GS
Bloods (harm, U+E, Bone profile, LFT)
1. XRAY - fracture
GS. DEXA scan
What is a DEXA scan and Z score?
DEXA:
Compares BMD to healthy 30y Px
Z score:
Someone average of same demographic
what are the 3 levels of the scores of a DEXA scan and what do they mean?
0 - (-1) = normal
(-1) - (-2.5) = Osteopenia
> -2.5 = osteoporotic
What score do we use to stratify the risk of a fracture?
FRAX score
What does the FRAX score stratify?
10y fracture risk in 40-90y based on certain factors eg. PMHx, SHx, sex, age
what does each FRAX score mean and Tx?
<10%?
10-19%?
>20%?
<10% = low risk, DEXA in 5y/follow up
10-19% = Moderate risk, offer DEXA and consider Tx
>20% = high risk, do DEXA + Give tx
What is conservative Tx for osteoporosis?
High dietary Ca2+ (milk, dairy)
Sunlight exposure (Vit D)
Ca2+ supps (ADCAL D3)
What is first line medical Tx for osteoporosis?
examples? doses?
Bisphosphonates
eg.
PO Alendronate 70mg Once a week
IV Zolendronate 5mg yearly
How do bisphosphonates work?
Inhibit osteoclasts
How should alendronate be taken?
Take on empty stomach
First thing in morning
Stay sat up 30 mins after
take with water
what are some SE of alendronate?
GI (GORD, Oesophagitis)
MRONJ (Medication related osteonecrosis of jaw)
what is second line medical Tx for osteoporosis?
How is it given?
How does it work?
Denosumab (mAB)
2x yearly SC injections
Inhibit RANK-L
What are some third line medical Tx for osteoporosis?
How do they work?
Raloxifene - Oestrogen modulator (oest-agonist at bone, inhibits at endometrium)
Teriparatide - synthetic PTH
HRT
