Pressure Ulcers- lecture 8

Question 1

Pressure Ulcers

Answer 1

lesion caused by unrelieved pressure that results in damage to underlying tissue

Question 2

Overall prevalence of pressure ulcers?

Answer 2

26%

Question 3

Prevalence/incidence of pressure ulcers in acute care?

Answer 3

25%, 14%

Question 4

Prevalence/ incidence of pressure ulcers in non acute care?

Answer 4

30%, 11%

Question 5

Prevalence of pressure ulcers in LTC?

Answer 5

36.*% and 53.2%

Question 6

Incidence of pressure ulcers in LTC?

Answer 6

11.7% and 11.6%

Question 7

Causes of PU?

Answer 7

intensity of pressure, duration of pressure, tissue tolerance

Question 8

What is included in tissue tolerance?

Answer 8

LBW, malnutrition, moisture affects tolerance (incontinent individuals are 5 times more likely to develop skin breakdown)

Question 9

Dynamics of pressure

Answer 9

sustained pressure (>/= 32 mmHg) - capillary obstruction-capillary collapse=capillary thrombosis-local ischemia (inadequate supply to organ)-edema-hypoxia (low oxygen to tissue)-unrelieved pressure-tissue acidosis-necrosis

Question 10

Pressure Ulcer Stages

Answer 10

1. non blanchable erythema
2. partial thickness skin loss (abrasion/ blister)
3. full thickness skin involving subcutaneous tissue but not through fascia
4. full thickness skin loss, extensive necrosis or damage to muscle, bone or supporting structures
5. necrotic tissue covering wound base, unstageable

Question 11

Stage 1

Answer 11

skin temp (warmth or coolness), tissue consistency (firm or boggy), sensation (pain or itching), persistent redness (lightly pigmented), persistent red, blue, or purple hues (darker skin tones)

Question 12

Stage 2

Answer 12

distinct break in skin or blister, may extend into the dermis, shallow, minimal drainage, shallow, minimal drainage, painful

Question 13

Stage 3

Answer 13

extends into sub layer, not through fascia, deep crater with drainage, may not be painful, healing may take weeks, monitor for infection

Question 14

Stage 4

Answer 14

penetrates through sub later into underlying fascia, muscle, tendon, cartilage, bone, undermining sinus tracts, risk of infection, septicemia and osteomyelitis, life threatening, aggressive treatment can take months

Question 15

Risk factors of PU

Answer 15

Age, nutritional status, anemia, obesity, diabetes, pressure, incontinence

Question 16

Nutritional Assessment of PU

Answer 16

CBC, iron, preabulmin,albumin, trasnferrin, hemoglobin, BUN, creatine, fasting blood glucose, glycosylated hemoglobin, thyroid function

Question 17

Healing- hemostasis

Answer 17

epinehprine to minimize bleeding

Question 18

Healing - inflammation

Answer 18

Vit c, E, selenium, arginine, cysteine, methionine

Question 19

Proliferation

Answer 19

Vits A, c, thiamin, zinc, panthothenic acid

Question 20

Maturation and remodeling

Answer 20

vit A, zinc, copper, manganese

Question 21

Key nutrients in wound healing

Answer 21

protein, iron, zinc, vit a,c , water, calories

Question 22

Why are energy and protein needs elevated?

Answer 22

increased metabolic rate, enhanced glycogen and protein store breakdown

Question 23

precautions and contraindications to supplementation

Answer 23

renal, haptic function, renal stone development, pancreatic disease, GI distress