ulcers Flashcards
this leads to distortion/damage to blood vessels, usually at a deep tissue level
Shear force
this is a risk factor for pressure injury
low diastolic BP - takes less pressure in order to impede circulation
patient should turn how often when lying down?
2 hours
patient should shift how often when sitting up
15 minutes
this stage of pressure injury is not yet an open wound, and has nonblanchable erythema & may be “boggy”
stage 1
This stage of pressure ulcer are superficial - partial thickness. include epidermis, sometimes part of dermis and includes blisters
stage II
these are deep ulcers, with extensive necrosis. they are full thickness with dermis and subcutaneous tissue involved - extend to BUT not through subctuaneous fascia
stage III
full thickness ulcer. deep ulceration, may have undermining
involves epidermis, dermis, subcutaneous tissue through fascia to muscle, tendon, joint capsule, and sometimes bone
stage IV
this pressure ulcer has high risk of osteomyelitis
stage IV
Can a stage IV ulcer reverse to a stage II ulcer?
NO no reversal omg
this scale is rated 0 to 7 based on observation of ulcer
sessing scale
this allows clinician to chart progress by subtracting score at reassessment from score initial evaluation
sessing scale
this scale ranges from score 8 to 34
PUSH - pressure ulcer scale for healing
this type of debridement method removes nectrotic tissue only, leaves uninvolved skin intact
selective
this debridement method goes from wet to dry
non-selective