Pressure Ulcers

Question 1

What are pressure ulcers? Where do they occur

Answer 1

Breaks in the skin that develop in patients unable to move part of their body due to illness paralysis or advancing age

External pressure on the skin causes occlusion of the capillaries and tissue compression - reduced oxygen and nutrients

They typically develop over bony prominences such as sacrum or heel

Question 2

What are risk factors for pressure ulcers?

Answer 2

Malnourishment
Incontinence
Lack of mobility
Pain - leads to a reduction in mobility
Sensory impairment - peripheral neuroapthy
Obesity
PVD

Question 3

What score for risk fo pressure ulcers?

Answer 3

Waterlow score

Question 4

What are grades of pressure ulcers

Answer 4

1: non-blanching erythema of intact skin
2: partial thickness skin loss involving epidermis, dermis or both
3: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to underlying fascia
4: Extensive destruction, tissue necrosis or damage to muscle, bone or supporting structure with or without full thickness skin loss

Question 5

What is management for pressure ulcers?

Answer 5

Moist wound environment:
Hydrocolloid dressings and hydrogels
No soap as dries the wound

Decision to use systemic antibiotics should be taken on clinical basis - evidence of surrounding cellulitis
No routing wound swabs

Tissue viability nurse referral

Surgical debridement

Question 6

How to prevent pressure ulcers?

Answer 6

Support surface - pressure redistributing support surface - matresses and cushions

Skin assessment: skin must be regularly assessed

Keep moving: repositioning regime must be identified

Incontinence and moisture: Conitnence assessment before implementing appropraite managment - skin constantly moist with urine, faeces or sweat will carry risk of ulceration

Nutrition and hydration:
Greater risk if malnourished and dehydrated