Pressure sores Flashcards
Wound healing, Leg ulcers, sores
What are pressure sores?
Skin damage from pressure, in four stages:
(1) Redness
(2) Blisters
(3) Deep ulcers
(4) Tissue damage to fat, muscle, or bone
What are the stages of wound healing?
- Inflammation
- proliferation/remodelling
- tissue remodelling
What are the stages for pressure ulcers?
Stage 1
= Redness, no broken skin
Stage 2
= Partial-thickness loss of skin, possibly blistered
Stage 3
= Full-thickness skin loss, exposing subcutaneous fat
Stage 4
= Full-thickness loss with exposed bone, tendon, or muscle
A 75-year-old woman with a history of advanced Parkinson’s disease and type 2 diabetes mellitus is admitted to the hospital due to pneumonia. She is bedridden, has a BMI of 17, and is receiving minimal nutrition due to swallowing difficulties. After 10 days in the hospital, she develops a painful ulcer on her sacrum. On examination, the ulcer is 3 cm in diameter with exposed muscle tissue and surrounding erythema. The ulcer is malodorous, and there is minimal serous discharge with no necrotic tissue.
What is the most appropriate initial management step?
Regular repositioning and use of pressure-relieving devices
A 75-year-old male patient is admitted to the hospital following a stroke that has left him bedbound. On day 10 of his hospitalisation, the nursing staff notes a sore on his sacral area.
Upon examination, the sore appears as a shallow abrasion with loss of the top skin layer and a red wound bed. There is no slough, tunnelling, or undermining present.
What grade of pressure ulcer is described here?
Grade 2
An 81-year-old lady is on the geriatrics ward recovering from an acute ischaemic stroke five days ago. She currently still experiences considerable weakness in her left upper and lower limbs and has not been able to mobilise much since admission. Today, she complains of a stinging pain localised to her lower back.
On examination, an ulcer in the sacral area is seen. Some subcutaneous fat is visible, but no fascia, bone, or tendons are seen.
What is the most accurate stage of this ulcer based on the description above?
Grade 3
A 68-year-old female patient with diabetes and limited mobility is brought to the clinic by her caregiver who is concerned about a sore on the patient’s heel. The lesion is diagnosed as a Grade 3 pressure ulcer.
Which scoring system is used to screen patients at risk of developing a pressure ulcer?
Waterlow Score
Grade 4 pressure ulcer, what investigation is needed
MRI
What is a chronic leg ulcer?
An open lesion between the knee and ankle lasting >4 weeks
What causes arterial ulcers?
Insufficient blood supply due to peripheral vascular disease
What causes venous ulcers?
- Venous stasis
- Incompetent valves
- Increased pressure
- Poor healing
What is the most common leg ulcer?
venous
Where do venous ulcers occur and what do they look like?
Occur in the gaiter area, medial/lateral malleoli
They’re shallow, exudative, warm, with signs of venous insufficiency
Where do arterial ulcers occur and what do they look like?
Occur mostly on the foot.
they’re deep, punched-out, cold, white, shiny skin
What test helps diagnose arterial disease?
ABPI (Ankle-Brachial Pressure Index)
When should a wound swab be taken?
If the ulcer is painful, exudative, malodorous, or enlarging
What are the differences in how you managed arterial and venous ulcers, if any?
To manage arterial ulcers, you need to reduce risk factors (BP control, statins, antiplatelets) and do not do compression
Whereas to manage venous ulcers, you need to do compression bandaging, pain control, debridement, and elevate the leg
What is a diabetic ulcer like?
Usually painless and is found on a pressure point eg, under the toes or on the heel
A 68-year-old man presents to his General Practitioner with a sore above his right ankle He mentions that this sore has been present for the last 3 days and is not painful. He has a past medical history of diabetes which is treated with metformin and hypertension managed with amlodipine. On examination the lesion is large, shallow and oozing. The GP also notes hardening of the skin on the lower legs.
Given the likely diagnosis, what is the most appropriate management option?
Compression
What does a Stage 2 ulcer look like
Stage 2 pressure ulcers are partial thickness ulcers involving the epidermis and dermis, but sparing subcutaneous tissue
What does the Waterlow Score consist of ?
Factors such as
(1) mobility
(2) skin condition
(3) nutrition
(4) incontinence
What’s another name for a pressure sore?
Decubitus ulcer
A 92-year-old lady is being visited by the district nurses. She has developed a grade 2 pressure ulcer on her right buttock, over which she is quite tender. On examination, her temperature is 36.5ºC, there are no signs of cellulitis, and there is no exudate. The area around the ulcer is erythematous but is not warm to touch.
Given her presentation what is the most appropriate management of this patient?
Wound dressing, Analgesia, Nutritional assessment
An elderly, frail woman is admitted to the local nursing home after suffering a stroke. What is the most appropriate way to assess her risk of developing a pressure sore?
Waterlow score
