Pressure Ulcers vs Neuro Ulcers

Question 1

Pressure Ulcer Overview

Answer 1

• also called a Decubitus Ulcer
• Results from sustained or prolonged pressure on tissue at levels greater than that of papillary pressure
• Skin covering bony prominences is particularity susceptible to localized ischemia and tissue necrosis due to pressure
• Most present in SNF facilities, acute care, and home health
• Common areas are sacrum, ischial tuberosities, buttocks, and back of head

Question 2

Pressure Ulcer Causes

Answer 2

• Shearing forces
• Moisture
• Heat
• Friction
• Medications
• Muscle atrophy
• Malnutrition
• Debilitating medical conditions (anything that makes the patient more sedentary)

Question 3

Pressure Ulcer Stages

Answer 3

• Stage 1 = non-blanching erythema, intact epidermis
• Stage 2 = partial thickness ulcer involving epidermis and dermis
• Stage 3 = full thickness ulcer extending through dermis into subcutaneous tissue (subcutaneous tissue is yellow)
• Stage 4 = deep tissue destruction extending through fascia and may involve bone, muscle, and tendons
• Side note — once a pressure ulcer is staged, the name/label assigned does NOT change (even when it heals)

Question 4

Braden Scale

Answer 4

• Pressure ulcer scale
• Severe risk = total score of 9
• High risk = total score 10-12
• Moderate risk = total score 13-14
• Mild risk = total score of 15-18

Question 5

Pressure Ulcer Precautions

Answer 5

• Reposition every 2 hours in BED*
• Reposition every 15-20 minutes in SITTING*
• Manage excess moisture
• Off load with pressure relieving devices
• Inspect skin daily
• Limit shear, traction, and friction forces over fragile skin

Question 6

Pressure Ulcer Treatment

Answer 6

• Pressure relief techniques — standing up, changing positions, etc
• Patient educations — eating correctly, checking skin, etc
• Aid in prevention of pressure ulcers through patient education

Question 7

Neuropathic Ulcer Definition

Answer 7

• Secondary complication associated with combination of ischemia and neuropathy
• Often associated with DM or peripheral neuropathy (pain and neuro sx from nerve damage, often in hands/feet)

Question 8

Neuropathic Ulcer Characteristics

Answer 8

• Foot is susceptible
• Well defined oval or circle, calloused rim, cracked periwound
• No pain
• Low exudate
• Diminished or absent pedal pulses
• Decreased skin temperature
• Dry, inelastic, shiny skin
• Loss of protective sensation (5.07 monofilament)

Question 9

Neuropathic Ulcer Stages (WAGNER SCALE)

Answer 9

• Stage 0 = no open lesion, may possess pre-ulcerative lesion, healed ulcers, bony deformity
• Stage 1 = superficial ulcer not involving subcutaneous tissue
• Stage 2 = deep ulcer with penetration through subcutaneous tissue, potentially exposed bone, tendon, or joint capsule
• Stage 3 = deep ulcer with osteitis, abscess, or osteomyelitis (bone infection)
• Stage 4 = gangrene of digit
• Stage 5 = gangrene of foot requiring disarticulation

Question 10

Neuropathic Ulcer Precautions

Answer 10

• Limb protection
• Risk reduction education
• Inspect legs and feet daily
• Inspect footwear for debris prior to donning
• Wear appropriately sized off-loading footwear with clean cushioned seamless socks

Question 11

Neuropathic Ulcer Treatment

Answer 11

• Prevention and management
• Activities — gait, posture, and foot off-loading education and training
• Patient education on basic diabetic foot care