Pressure ulcers

Question 1

Aetiology of pressure sores:

a) Direct cause
b) Risk factors

Answer 1

a) Pressure and/or shearing friction force over a bony prominence
b) Dementia, CVD, diabetes, malignancy, hip fracture, recent surgery, immobility, DVT, PD, sensory impairment, poor nutrition, infection

Question 2

Grading pressure ulcers (1 - 4)

- why might it be ungradeable?

Answer 2

Grade 1: non-blanchable erythema, skin intact
Grade 2: partial thickness (epidermis +/- dermis) skin loss, presenting as blister/abration
Grade 3: full thickness (damage to SC fat)
Grade 4: damage to underlying muscle, bone or other structures
Ungradeable: covered by slough so cannot determine thickness

Question 3

Pressure ulcer: management

Answer 3

Pressure redistribution (repositioning, pressure relieving supports e.g. foam mattress)
Good nutrition
Appropriate wound management - cleaning, debridement (hydrogels), dressing, antibiotics if clinically infected

Question 4

Wound management: principles

a) Ideal dressing
b) Prior to dressing…?
c) Debridement

Answer 4

a) Easy to apply and remove, have low allergenic potential, be sterile and impermeable to micro-organisms, provide a moist environment but remove excess exudate
b) Excess loose slough and exudate should be removed. Clean wound
c) Autolytic, Debrisoft, hydrogels, surgical

Question 5

Pressure ulcer: prevention

- Mnemonic: PRESSURE

Answer 5

• P - Positioning
• R - Repositioning and transferring
• E - Eliminate excess moisture (due to incontinence, perspiration or wound drainage)
• S - Skin care (cleaning, dressing, emollients)
• S - Sheepskins and supports (e.g. moon boots)
• U - Underlying risk factors reduce (e.g. poor nutrition)
• R - Redistribution equipment (e.g. mattresses)
• E - Education and training (e.g. mobility, positioning, skin care, etc.)