Pressure SoresAndre SookdarClass of 2013
Objectives• Definition• Epidemiology• Pathogenesis• Risk Factors• Stage & Risk Assessment• Prevention• Management
Definition• A Pressure sore is a localized injury tothe skin or underlying tissue as a resultof unrelieved pressure.• Decu...
Epidemiology• Between 1-3 million US affected• 11 - 18% nursing home residents (2004)• 9 - 60% hospital• 3 - 18% home• Hea...
PathogenesisTraditional Theory• Prolonged Pressure• Friction• Shearing Forces• Moisture
Pathogenesis• Pressure: When external pressures aregreater than capillary pressure (12-32mmHg) ischaemia results• Intermit...
Pathogenesis• Shearing Forces: When the patient israised at an angle > 30˚, shearingforces occur between the deep fasciaan...
Pathogenesis
Pathogenesis• Impairment in lymphathic flow increase in metabolic waste products• Reperfusion injury• Deformation of tiss...
Common Sites• Commonly occurs at bonyprominences, e.g. sacrum, greatertrochanters, heels, ischial tuberosities• 95% occur ...
Intrinsic Risk FactorsLimited Mobility• Spinal cord injury• CVA• Parkinson Disease• Alzheimer Disease• Pain• Fractures• Po...
Intrinsic Risk FactorsPoor Nutrition• Anorexia• Dehydration• Poor dentition• Poverty or lack of access to food• Dietary Re...
Intrinsic Risk FactorsCo-morbidities• Diabetes• Depression• Peripheral VascularDisease• Decreased painsensation• Immunodef...
Intrinsic Risk FactorsAging skin• Loss of elasticity• Decreased cutaneous blood flow• Changes in dermal pH• Flattening of ...
Extrinsic Risk Factors• Pressure from external surface e.g.bed, chair• Friction from being unable to move well• Shear forc...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 1 – Intact skin with non-blanchableredn...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 2 – Partial thickness skin loss,present...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 3 – Full thickness skin loss. Fat maybe...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 4 – Full-thickness tissue loss withexpo...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Unstageable – Full thickness tissue loss inwh...
National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Suspected Deep Tissue Injury – Purpleor maroo...
Risk Assessment and Evaluation• Braden Scale• Push Tool
Braden Scale• Sensory Perception 1-4• Moisture 1-4• Physical Activity 1-4• Mobility 1-4• Nutrition 1-4• Friction & Shear 1...
PUSH Tool
PreventionAims• Reduce Pressure and Shearing effects• Reduce Moisture• General Skin Care• Nutrition• Co-morbidities• Invol...
Prevention• Daily skin inspection• Bathing and skin cleaning frequency• Moisturize skin; avoid hot water or harshsolutions...
Prevention• Practice proper positioning, transferring andturning techniques to avoid friction and shearingforces; lift don...
Prevention• Use adjunct devices (air mattresses, limbpadding) where necessary• Use pillows or padding to avoid bonypromine...
How might the Leg Ulcer andThumb Bruises be related?
Management• Based on Staging and Investigation• Wound swabs and cultures usuallyshow mixed growth• Blood – CBC, CRP, ESR, ...
Management - AAFP
DressingsDressing Type Description Indication Brand NamesTransparent Film Adhesive, semi-permeable, allowsvaporizationStag...
Management• Clean, barrier• Antibiotic where appropriate• Debride necrotic tissue
Complications• Sepsis, cellulitis, endocarditis, meningitis• Fistula formation• Osteomyelitis, septic arthritis• Sinus tra...
Conclusion• Risk• Prevention• Identify early• Manage
The EndThank You
References• www.aafp.org• Sussman C, Bates-jensen B. Wound Care:A Collaborative Practice Manual for HealthProfessionals 4t...
Pressure sores presentation
Pressure sores presentation
Pressure sores presentation
Pressure sores presentation
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Pressure sores presentation

Published on: Mar 4, 2016
Published in: Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Pressure sores presentation

  • 1. Pressure SoresAndre SookdarClass of 2013
  • 2. Objectives• Definition• Epidemiology• Pathogenesis• Risk Factors• Stage & Risk Assessment• Prevention• Management
  • 3. Definition• A Pressure sore is a localized injury tothe skin or underlying tissue as a resultof unrelieved pressure.• Decubitus Ulcer, bedsore
  • 4. Epidemiology• Between 1-3 million US affected• 11 - 18% nursing home residents (2004)• 9 - 60% hospital• 3 - 18% home• Health care expenditure $5 Billion US/year• 1.4 – 2.1 Billion pounds (UK)/year• More than 17,000 lawsuits annually• The longer the patient stays in a hospitalor nursing home the greater the risk
  • 5. PathogenesisTraditional Theory• Prolonged Pressure• Friction• Shearing Forces• Moisture
  • 6. Pathogenesis• Pressure: When external pressures aregreater than capillary pressure (12-32mmHg) ischaemia results• Intermittent pressure relief helps preventulcer formation• Friction: Compromise of the protectivestratum corneum decreases the pressurerequired for ischaemia• The loss of the skin’s ability to act as abarrier further enhances ulcer formation
  • 7. Pathogenesis• Shearing Forces: When the patient israised at an angle > 30˚, shearingforces occur between the deep fasciaand the outer skin• Moisture: Chronic moist environment(incontinence, perspiration) leads totissue damage and ulcer formation
  • 8. Pathogenesis
  • 9. Pathogenesis• Impairment in lymphathic flow increase in metabolic waste products• Reperfusion injury• Deformation of tissue cells
  • 10. Common Sites• Commonly occurs at bonyprominences, e.g. sacrum, greatertrochanters, heels, ischial tuberosities• 95% occur on the caudal aspect of thebody; 65% in the pelvic area, 30% onthe lower limbs
  • 11. Intrinsic Risk FactorsLimited Mobility• Spinal cord injury• CVA• Parkinson Disease• Alzheimer Disease• Pain• Fractures• Postsurgical• Coma or sedation• Arthropathy
  • 12. Intrinsic Risk FactorsPoor Nutrition• Anorexia• Dehydration• Poor dentition• Poverty or lack of access to food• Dietary Restriction
  • 13. Intrinsic Risk FactorsCo-morbidities• Diabetes• Depression• Peripheral VascularDisease• Decreased painsensation• Immunodeficiency• Corticosteroideffects• Congestive heartfailure• Malignancies• Renal Disease• COPD• Dementia
  • 14. Intrinsic Risk FactorsAging skin• Loss of elasticity• Decreased cutaneous blood flow• Changes in dermal pH• Flattening of rete ridges• Loss of subcutaneous fat• Decreased dermal-epidermal bloodflow
  • 15. Extrinsic Risk Factors• Pressure from external surface e.g.bed, chair• Friction from being unable to move well• Shear forces form involuntarymovement• Moisture – bowel or bladderincontinence, perspiration, wounddrainage
  • 16. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 1 – Intact skin with non-blanchableredness of a localized area, usually over abony prominence. The area may be painful,firm, soft, warmer or cooler than adjacenttissue.
  • 17. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 2 – Partial thickness skin loss,presenting as a shallow open ulcer with ared-pink wound bed without slough. May alsopresent as an intact or open serum-filledblister. Includes tears, tape burns,maceration or excoriation
  • 18. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 3 – Full thickness skin loss. Fat maybe visible but bone, tendon or muscle tissueare not. Slough may be present.
  • 19. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Stage 4 – Full-thickness tissue loss withexposed bone, tendon or muscle. Slough oreschar may be present.
  • 20. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Unstageable – Full thickness tissue loss inwhich the base of the ulcer is covered byslough or eschar. Until enough of the base isexposed, the true depth and stage cannot bedetermined.
  • 21. National Pressure Ulcer Advisory PanelPressure Ulcer Staging Classification• Suspected Deep Tissue Injury – Purpleor maroon discoloured intact skin or blood-filled blister due to damaged underlying softtissue from pressure or shearing forces. Thearea may be painful, firm, mushy, boggy,wormer or cooler than surrounding tissue
  • 22. Risk Assessment and Evaluation• Braden Scale• Push Tool
  • 23. Braden Scale• Sensory Perception 1-4• Moisture 1-4• Physical Activity 1-4• Mobility 1-4• Nutrition 1-4• Friction & Shear 1-3• Score 18+ Low risk• 15-18 Mild risk, 13-14 Moderate risk, 10-12 High risk, below 10 Very High Risk
  • 24. PUSH Tool
  • 25. PreventionAims• Reduce Pressure and Shearing effects• Reduce Moisture• General Skin Care• Nutrition• Co-morbidities• Involve patient, family, caregivers
  • 26. Prevention• Daily skin inspection• Bathing and skin cleaning frequency• Moisturize skin; avoid hot water or harshsolutions• Assess and treat incontinence; use topicalbarriers or absorbent padding when needed• Proper re-positioning frequently; q2hrly forthose bed-bound, q1hrly for those inwheelchairs; self re-positioning every 15minutes for those in wheelchairs• Avoid manipulating bony prominences
  • 27. Prevention• Practice proper positioning, transferring andturning techniques to avoid friction and shearingforces; lift don’t shift• Use dry lubricants (cornstarch) or protectivecoverings to reduce friction injury• Institute a rehabilitation program to maintain orimprove mobility/activity status• Consider nutritional supplementation/support fornutritionally compromised persons
  • 28. Prevention• Use adjunct devices (air mattresses, limbpadding) where necessary• Use pillows or padding to avoid bonyprominences such as knees from havingdirect contact• Elevate the head of the bed no more than30˚ unless absolutely necessary• Monitor and document interventions andoutcomes• Have a fixed repositioning schedule
  • 29. How might the Leg Ulcer andThumb Bruises be related?
  • 30. Management• Based on Staging and Investigation• Wound swabs and cultures usuallyshow mixed growth• Blood – CBC, CRP, ESR, SerumProtein/Albumin• MRI• X-Rays• Ultrasound• Tissue Biopsy – suspect malignancy
  • 31. Management - AAFP
  • 32. DressingsDressing Type Description Indication Brand NamesTransparent Film Adhesive, semi-permeable, allowsvaporizationStage I and II withlight or noexudatesOpsite, TegadermHydrogel Water/Glycerinbased gels ongauze or dressingsStage II, III, IV;deep ulcers;necrosis & sloughAcryderm, Flexigel,IntrasiteAlginate From Seaweed Stage III, IV withmoderate to heavyexudateAlgicell, Algisite,TegagenFoam Moist, thermalInsulationStage II to IV withvarying drainageHydrocell,PolydermHydrocolloid Occlusive orsemiocclusive;gelatin and pectinStage II to IV withsough and necrosisDermafilm,TegadermMoistened Gauze Gauze in saline Stage III to IV
  • 33. Management• Clean, barrier• Antibiotic where appropriate• Debride necrotic tissue
  • 34. Complications• Sepsis, cellulitis, endocarditis, meningitis• Fistula formation• Osteomyelitis, septic arthritis• Sinus tracts• Squamous Cell Carcinoma (Marjolin’sulcer)• Amyloidosis• Drug resistant bacteria• Maggot infestation
  • 35. Conclusion• Risk• Prevention• Identify early• Manage
  • 36. The EndThank You
  • 37. References• www.aafp.org• Sussman C, Bates-jensen B. Wound Care:A Collaborative Practice Manual for HealthProfessionals 4th Ed Lippincott Williams &Wilkins 2012• Falabella A, Kirsner R.S. Wound HealingTaylor & Francis Group 2005• Ruiz J.G. Pressure Ulcers University ofMiami Grand Rounds Presentation

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