Advanced Clinical Solutions Pressure Ulcer Carilex Medical Group 1
Advanced Clinical Solutions Contents About Pressure Ulcer! 2 Stages of Pressure Ulcer! 5 Reference! 7 Carilex Medical Group 1
About Pressure Ulcer Definition Pressure ulcers, also called decubitus ulcers (the term Decubitus comes from the Latin term to lie down ). or bedsores, are the end results of constant skin pressure. The National Pressure Ulcer Advisory Panel (NPUAP) has redefined the definition of a pressure ulcer instead the original in 2007. The definition by NPUAP is: A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated. Pressure ulcer are a common, life-threatening, expensive problem for patients. Pressure ulcers have been estimated to be responsible for 60,000 deaths per year in the United States. 4% to 14% of hospitalized patients and 8.9% in long-term care facilities patients develop pressure ulcers. In 1989, the NPUAP set a national goal for the ensuing decade of reducing the incidence of pressure ulcers by 50%. To reach this goal, NPUAP has promoted an active program that aimed to improve clinical practice on pressure ulcers through education, research, and public policy. As a responsible anti-decubitus mattress provider, we expect to continue to provide our safe, high quality, and reliable products doing our best for the prevention and treatment of pressure ulcer. Etiology Unrelieved pressure on the skin squeezes tiny blood vessels, which supply the skin with nutrients and oxygen. When skin is starved of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms.
In animal studies, 60 mmhg pressure applied to the skin for one hour produces histologically identifiable injuries such as venous thrombosis, muscle degeneration, and tissue necrosis. The average human being exerts 60 to 70 mmhg pressure on such body areas as the sacrum, occiput and heels while lying in bed or on the ischia while sitting in a chair. Decubitus ulcers are caused by pressure exerted on the subcutaneous tissue and skin when compressed between the weight of the body and a mattress or chair. The pressure affects capillary perfusion and interrupts the blood supply, producing ischemia and preventing the removal of cellular waste. When the pressure is unrelieved, cell necrosis may occur. Healthy people, however, regularly shift their body weight, even while asleep. Sitting in one position causes pain in areas of increased pressure, thus stimulating movement. Patients unable to sense pain or to shift their body weight, such as paraplegics os bedridden individuals, develop prolonged elevated tissue pressure and, eventually, necrosis. Muscle tissue is more sensitive to ischemia than the overlying skin. That s why the necrotic area is always wider and deeper than it appears on first inspection. Other factors cause pressure ulcers too. If a person slide down in the bed or chiar, blood vessels can stretch or bend and cause pressure ulcers. Even slight rubbing or friction on the skin may cause minor pressure ulcer. Where Pressure Ulcers Form Pressure ulcer from where bone causes the greatest force on the skin and the tissue and squeezes them again an outside surface, such as, other body parts, a mattress, or a chair. For persons who must stay in beds they easily develop increased pressure over bony prominences. Most commonly pressure sores occur on the lower half of the body, particularly over the sacrum (43%), greater trochanter (12%),heel (1i%), ischial tuberosities(5%),and lateral malleoli (6%)(Peterson, 1976); other common sites are the back of the head(occiput), behind the ear, the scapular spines(shoulder), the iliac crest, anterior knees and the elbow. For Patients in sitting position, i.e., in chair or wheelchairs, are at risk for developing pressure ulcers over the knees, ankles, should blades, back of the head, and spine. These areas are not covered by pads of fat that normally cushion blood vessels. When blood vessels are compressed and blood flow is reduced, oxygen supply diminishes, skin breaks down, the tissues beneath are destroyed and pressure ulcers occur. Pressure ulcers are also likely to occur if an area is continually moist or not kept clean, such as perineum, therefore, it is very important to keep the body dry and clear when caring the incontinent and bedridden patients. Nevers normally tell the body when to move to relieve pressure on the skin. Persons in bed who are unable to move may get pressure ulcers after as little as one to two hours. Persons who sit in chairs and cannot move can get pressure ulcers in even less time since the pressure on the skin is greater.
F Pressure areas in common res-ng posi-ons: A, Fowler's; B, supine; C, prone; and D, side- lying.
Stages of Pressure Ulcer Pressure Ulcers are stages the following system : From NPUAP 2007 Category Definition Diagram Stage Ⅲ Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Further Description: The depth of a Stage Ⅲ pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and Stage Ⅲ ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Stage Ⅲ pressure ulcers. Bone/tendon in not visible or directly palpable. Stage Ⅳ Full-thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling. Further Description: The depth of a Stage Ⅳ pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers ca be shallow. Stage Ⅳ ulcers can extend into muscle and/or supporting structures (for example, fascia, tendon, or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable. Unstageable Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/ or eschar (tan, brown, or black) in the wound bed. Further Description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as the body s natural (biological) cover and should not be removed.
Category Definition Diagram (Suspected) Deep Tissue Injury Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy,boggy, warmer or cooler as compared to adjacent tissue. Further Description: Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid, exposing additional layers of tissue even with optimal treatment. Stage Ⅰ Intack skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Further Description: The area may be painful, firm,soft, warmer or cooler as compared to adjacent tissue. Stage Ⅰ may be difficult to detect in individuals with dark skin tones. May indicate at risk persons (a heralding sign of risk). Stage Ⅱ Partial-thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Further Description: Presents as a shiny or dry shallow ulcer without slough or bruising* This stage should not be used to describe skin tears, tape burns,perineal dermatitis, maceration or denudement. *Bruising indicated suspected deep tissus injury. This staging system should be used only to describe pressure ulcers. Wound from other causes, such as arterial, venous, diabetic foot, skin tears, tape burns, perineal dermatitis, maceration, or denudement should not be staged using this system. Other staging systems exist for some of these conditions and should be used instead.
REFERENCE 1. Cudding, janet et al., (2011). Pressure ulcers in America Prevalence, incidence, and implications for the future. Advances in Skin & Wound care: The Journal for prevention and Healing. 14(4):208-215 2. Joyce, B., et al., (2007). National Pressure Ulcer Advisory Panel s Updated Pressure Ulcer Staging System. Dermatology Nursing, 19(4):343-349