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PMR Canadian Flash Cards > Pressure Ulcer > Flashcards

Pressure Ulcer Flashcards

1
Q

What are the three phases of wound healing?

A

“1. inflammatory phase

  1. proliferative phase
  2. remodeling phase

Toronto Best Practice in LTC Initiative March 2006”

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2
Q

“What are common locations of pressure ulcers?

Red book”

A

“Supine: occiput, shoulders/scapula, elbows, Sacrum, heel (calcaneus)
Side lying: ear, shoulder, greater trochanter, knee, lateral malleolus
Sitting: scapulae, sacrum, Coccyx, ischial tuberosities, heel, ball of feet/ Pediatrics: occiput due to heavy head”

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3
Q

Describe 3 different mechanisms of developing a pressure ulcer.

A

“1. Ischemia – lack of blood supply to the tissue, Increased local O2 consumption, Hyperemia of surrounding tissue

  1. Pressure – prolonged pressure over bony prominence exceeding supracapillary pressure (70 mmHg) continuously for 2 hrs results in the occlusion of the microvessels of the dermis with subsequent tissue ischemia.
  2. Friction removes corpus striatum and separates the epidermis immediately above the basal cells
  3. Shear forces under the skin

Ref:
EK: probably shear, friction, and pressure”

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4
Q

List 5 common causes or risk factors of pressure ulcers

A 
"Ref: Tan pg 466 – 3 categories:
BIOMECHANICAL:
1. pressure.
2. shear/positioning.
3. friction.
4. temperature (perspiration and increased metaboli demand).
5. moisture (bowel/bladder incontinence) causing maceration.
6. immobility.
7. muscle atrophy.
BIOCHEMICAL:
7. poor nutrition (nitrogen, vitamins, protein).
8. anemia.
9. HO.
10. poor circulation (decreased venous return).
MEDICAL:
11. trauma.
12. illness/disease.
13. spasticity.
14. contractures.
15. decreased sensation (DM neuropathy, SCI).
16. psychosocial stress/depression.

SCI medicine textbook pg 569 – 3 categories:
EXTERNAL FACTORS, INTERNAL FACTORS, and BEHAVIOURAL FACTORS.
17. smoking/PVD.
18. alcohol use.
19. medication use (eg. Sedating).”

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5
Q

List the stages of pressure ulcers

A

“1: non-blanchable redness (epidermis intact)
2: partial thickness skin loss (or blister)
3: Full thickness skin loss
4: Full thickness tissue loss
Unstageable/unclassified (depth unknown, but full thickness)
Suspected deep tissue injury – depth unknown, Intact skin but under skin is purple,

NPUAP 2007 updated

  1. skin intact
  2. down to dermis
  3. down to fat
  4. past fascia to bone, muscle, tendon”
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6
Q

List 4 important aspects of preparing the wound bed to facilitate healing.

A

“Acronym: TIME

  1. tissue: debride non-viable and deficient areas
  2. Infection/inflammation: treat if present
  3. Moisture: maintain proper moisture balance (ie. Just right)
  4. Edge of wounds: non-advancing/undermining, treat

Schultz GS, Sibbald RG, Falanga V et al, Wound Rep Reg (2003); 11:1-28”

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7
Q

List 6 investigations to consider performing for pressure ulcers.

A

“1. albumin/pre-albumin (assesses nutrition).

  1. bone scan, XR, MRI, CT (r/o osteomyelitis).
  2. swab and culture of ulcer (r/o infection).
  3. pressure mapping.
  4. MRI – image soft tissue defect.
  5. CBC, blood cultures (if suspect systemic infection).
  6. ABI or toe pressures
  7. ESR/CRP

Gevan answer.”

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8
Q

List 6 general methods of debriding a wound.

A 
"1. surgical (ie. Surgeon). 
2. sharp (clinician). 
3. enzymatic. 
4. autolytic. 
5. mechanical. 
6. biologic.  
Acronym: BEAMSS  
Ref: www.viha.ca/NR/rdonlyres/469C9208-E310-4B5D-9FF8-4A7DE7EAAEDE/0/DebridementMethods.pdf  "
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9
Q

List 4 general principles in managing the wound bed a pressure ulcer.

A

“TIME Principle.

  1. Tissue: is it viable? May need debridement.
  2. Infection/inflammation: treat if present.
  3. moisture balance: needs to be ‘just right’.
  4. Edge of wound: monitor for non-advancing or undermined edges.

Ref: Schultz GS, Sibbald RG, Falanga V et al, Wound Rep Reg (2003); 11:1-28”

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10
Q

List 6 complications of pressure ulcers.

A

“1. bacteremia.

  1. osteomyelitis.
  2. septic arthritis.
  3. advancing cellulitis.
  4. endocarditis.
  5. amyloidosis.
  6. anemia.
  7. squamous cell carcinoma.
  8. fistula to bowel/bladder from ulcer.
  9. HO formation.
  10. maggot infestation.

Ref: Braddom pg 1329.”

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11
Q

What is the incidence and prevalence of pressure ulcers in persons with SCI?

A

“1. Annual incidence: 20-31%.
2. Prevalence: 14-46%.
3. during acute phase: ~34%.
Ref: http://www.scireproject.com/case-studies/case-2-mr-d-j/pressure-ulcers”

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12
Q

List 10 methods available for treating pressure ulcers in persons with SCI.

A

“TREATMENTS WITH EVIDENCE:
1. adjustments in up time (ie. In chair).
2. change wheelchair cushion.
3. nutritional assessment and correction of nutritional deficiencies.
4. assessment and tx of potential factors contributing to non-healing (eg. Thyroid disease, hypotestosterone, smoking cessation).
5. electrical stimulation (stage 3/4 ulcers, L1 – 2 RCTs).
6. laser treatment (L1 – no added benefit to standard wound care alone).
7. ultrasound/ultraviolet light (L1 – decreased wound healing time).
8. non-thermal pulsed electromagnetic energy (L1 – accelerates healing, stage 3/4).
9. topical negative pressure therapy (L4).
10. normothermic dressing.
11. recombinant human erythropoetin.
12. anabolic steroid agents (L4 – oxandrolone healing stage 3/4).
13. specific dressings.
14. maggot therapy.
Ref: http://www.scireproject.com/case-studies/case-2-mr-d-j/pressure-ulcers/treatment-options

OTHER:

  1. change mattress surface.
  2. rotate patient in bed frequently (ie q2hours).
  3. surgery – debridement, flap procedures, etc.”
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13
Q

What is pressure mapping?

A

“1. process of measuring interface pressure between the user and the support surface (eg. Cushion).
2. P = F/A. Hence, interface pressure is defined as the pressure that occurs at the interface between the body and the support surface.
Ref: http://www.scireproject.com/case-studies/case-2-mr-d-j/pressure-ulcers/seating-assessment-and-selection/pressure-mapping”

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14
Q

List 5 variables or issues affecting the usefulness of pressure mapping.

A

“Pressure mapping on its own cannot predict risk of developing pressure ulcers for a variety of reasons:

  1. EXTRINSIC FACTORS: moisture, friction, shear.
  2. INTRINSIC: nutrition, age, arterial pressure.
  3. PATIENT ISSUES: weight, muscle tone, body fat content.
  4. Time patient spends in chair.
  5. variability of data output affected by: material properties of pressure transducer, soft tissue, and support surface.
  6. No standard methodological guidelines exist for pressure measurement.
  7. data from pressure mapping in non-disabled subjects cannot be generalized to SCI patients – significant differences between the two groups.
    Ref: http://www.scireproject.com/case-studies/case-2-mr-d-j/pressure-ulcers/seating-assessment-and-selection/pressure-mapping

Note: Dr. C Ho states despite limitations, pressure mapping good for ‘biofeedback’, so patient can see what positions have greater pressure, and to educate patient about pressure spots.”

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15
Q

What is the normal transcutaneous O2 partial pressure (TcPO2) as measured on the bottom of the foot ?

A

“Measurement taken at the dorsum of the foot.

Normal Range: 45-95 mmHg.
Mean: 70 mmHg.
Minimum value needed to heal: > 40 mmHg.

Note: Good non-invasive test to predict likelihood of healing of residual limb after amputation.
Ref: Journal of Bone and Joint Surgery vol 65-B, no 1, January 1983 (Dowd et al).”

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PMR Canadian Flash Cards (9 decks)

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