Pressure Sores Flashcards
Define pressure sores
Pressure sores are lesions caused by prolonged pressure on an area of skin leading to reduced blood supply to the area.
Often occur over bony prominence e.g sacrum.
Why do pressure sores cause health problems? (complications)
Pain and irritation to patient
Severe - skin infections (flesh-eating), osteomyelitis and sepsis
Can prevent at later stages in patient who struggle to communicate this to staff (learning disability)
MSK deformity if underlying muscles and joints affected.
Long standing = Marjolins ulcers = type of squamous cell carcinoma.
What are the main risk factors for pressure sores?
Significantly limited mobility (spinal cord injury)
Significant sensation loss (diabetes)
Previous or current pressure ulcer
Nutritional deficiency
Inability to reposition themselves
Significant cognitive impairment
Foaecal or urinary incontinence.
Age - skin thinner, less elastic and more fragile
What are the different stages of a pressure sore?
Stage 1
Stage 2
Stage 3
Stage 4
Unstageable - tends to be a 3 or four with slough obscuring the extent of tissue loss.
What are the features of a stage 1 pressure sore?
Non-blanch-ble erythema of intact skin
Can resolved in 2-3days with care
What are the features of a stage 2 pressure sore?
Partial thickness skin loss with exposed dermis
Adipose tissue and deeper tissues are not visible
Can resolved in 3d to 3w with care
What are the features of a stage 3 pressure sore?
Full-thickness skin loss
Adipose tissue visible and deeper tissues may be visible depending on site of injury
Fascia, muscle, tendon, ligament, cartilage and bone are not exposed
Can resolved in 1-4months with care
What are the features of a stage 4 pressure injury?
Full thickness skin and tissue loss.
Exposed fascia, muscle, tendon, ligament, cartilage or bone
Can resolve in 3months to many years with care.
How do we prevent pressure sores?
Documented risk assessment in hospital or care home
If high risk - thorough assessment for an damage
Encourage or assist regular repositioning - hourly on chairs, 2hrs on beds
Involve dieticiants to assess nutrition - may need supplements
OT - assess bed and mattress may need a pressure redistributing mattress.
Good hygiene - mild soap and warm water, clean and dry
How should pressure sores be treated?
Document and classify area of damage
Contact tissue viability nurse for regular input on management
Contact dietician and OT for assessment - may need nutritional supplements or pressure redistributing mattress.
If severe consider wound debridement
If infection -> swab and antibiotics
Keep wound dressed with warm and moist dressing to encourage healing.
What are some common areas for pressure sores to occur?
Sacrum
Coccyx
Heels
Hips
What is the underlying pathophysiology of a pressure sore?
Key cause: unrelieved pressure and shearing forces
External pressure exceeds capillary closing pressure - leads to occlusion of bv and ischemia in affected area.
Tissue is deprived of oxygen and nutrients leading to cell death and necrosis.
When pressure is relieved reperfusion occurs.
Sudden return of blood causes oxidative stress and inflammation.
Continous tissue distortion can damage cells directly - further disrupting blood flow
What investigations should be done for a pressure sore?
Wound swab - micro for infection - use Levine technique
Bloods - FBC, U&Es, CRP and albumin
Tissue biopsy - if malignancy or vasculitis is suspected within a chronic non-healing ulver - for histo
Radiological imaging - if deep or ungradeable identify involved structures and potential osteomyelitis.
What are the key differential diagnosis for a pressure sore?
Diabetic ulcer - punched out on plantar foot in diabetics
Venous stasis - gaiter region, irregular borders, with signs of CVI such as oedema, hyperpigmentation or lipodermatosclerosis
Ischaemic ulcers - tips of toes/latera ankle (regions with poor blood supply), signs of PAD.
