Pressure ulcers

Question 1

What factors predispose to the development of pressure ulcers?

Answer 1

Malnourishment
Incontinence
Lack of mobility
Pain - leads to reduction in mobility

Question 2

What is used to screen for patients who are at risk of developing pressure areas?

Answer 2

The Waterlow Score

Question 3

How are pressure ulcers graded?

Answer 3

Using the European Pressure Ulcer Advisory Panel classification system:

Grade 1 = Non-blanching erythema of intact skin. Discolouration of skin, warmth, oedema, induration or hardness may also be used as indicators, particularly in darker skin patients.

Grade 2 = Partial thickness skin loss involving the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion or blister

Grade 3 = Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia

Grade 4 = Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structure with or without full thickness skin loss

Question 4

What is the management of pressure ulcers?

Answer 4

A moist wound environment encourages ulcer healing - can use hydrocolloid dressings and hydrogels, NOT soaps as this dries the wound

Don’t need to do wound swabs routinely as majority are colonised with bacteria
Use of systemic abx should be taken on clinical basis

Consider referral to tissue viability nurse

Surgical debridement may be beneficial for selected wounds