Pressure sores

What are they

How do you prevent them

How do you treat them

How can pressure ulcers develop

• Normally the skin is kept healthy by blood which is supplied through tiny blood vessels called capillaries.

• In some places large bones lie close to the skin especially at the shoulders,elbows,heels,hips and buttocks.

• When a person is lying/sitting down the skin gets compressed between the bones and the surface. This impedes the blood supply to the area of skin Then there is a risk of bedsores also known as decubitus ulcers

Factors

Unrelievedpressure

Shearing force Extrinsic Friction

Repeated applicationOf force

Immobility Intrinsic Malnutrition

Altered consciousness incontinence

Debilitating concurrentillness

Advancing age

Shearing and friction

• Shearing force. This occurs when force or pressure is applied at an angle to the skin. The various skin layers move over one another causing tissue damage.

• Friction This occurs when the patient is slid over the sheet instead of being lifted.

Classification of pressure sores

Location of pressure sores

• Trunk 4%

• upper limbs 3%

• Sacrum 31%

• Trochanters 10%

• Buttocks 27%

• Lower limbs 5%

• Heels 20%

The prevention and management of pressure sores

• 1. Assess the patients risk of developing a pressure sore Using a valid assessment tool within two hours of admission.

• 2. Re-assess the risk whenever there is a change in the patients condition

• 3. Choose an appropriate patient support system.• 4. Devise a mobility turning system appropriate to the

patients risk. Keeping patient off damaged and high risk areas as much as possible.

• 5. Inspect high risk sites whenever repositioning patient, record treatment and healing.

• 6. Maintain skin integrity. Cleanse after patient is incontinent. Avoid using excessive soap and rubbing.

• 7. With the aid of the dietician assess the patients nutritional status and any special dietary requirements.

• 8.Alleviate the affects of other concurrent debilitating conditions if possible.

• 9. Don’t forget the importance of psychological support.

The results of pressure sores

• They can lead to:– 1. Pain– 2. Infection– 3. An increase in the nurses workload– 4.Extension to patients stay– 5. Health trust being sued– 6. Occasionally death.

Stage one. Wound healing time 0-6 days

• 1. Vasoconstriction and formation of a clot in severed blood vessels.

• 2.Vasodilatation around the wound causing redness and heat.

• 3. Escape of white corpuscles and fluid into the tissue around the wound causing swelling.

• 4. Clearance of any bacteria by the white corpuscles.

stage one cont.

• 5. Migration of Polymorphs and macrophages to the area.

• 6. Ingestion of cell debris and bacteria by the polymorphs and macrophages

• 7.Death of polymorphs and macrophages and creation of wound exudate.

• 8. Gradual drainage of exudate. Which shows that the first stage is over.

Stage two. The reconstruction proliferation stage.

Time 4-15 days

• 1. Macrophages stimulate the production of fibroblasts and capillary buds.

• 2. Fibroblasts manufacture collagen to form the framework which gives strength to the wound.

• 3. Formation of granulation tissue to reduce the size of the wound.

Stage two cont.

• 4. Contraction of granulation tissue to reduce the size of the wound.

• 5. Migration of epithelial cells across the wound.

• 6. Joining of epithelial cells to complete the reconstruction stage.

Stage three. Remodelling

• 1. Collagen fibres randomly laid down during the reconstruction stage rearrange themselves along the line of tension to increase the strength of the scar.

• 2. Extra capillary buds needed for healing gradually disappear so the scar changes colour from red to pink to white.

Dressings

• Alginates. I.e. Sorbasan, kaltostat.– Used for heavily discharging/exudating wounds

• Beads. I.e. Debrisan.– Used for exudating wounds and debridement.

• Charcoal. I.e. Carbonet.– Used for Malodorous wounds.

• Foams. I.e. Lyofoam, Allevyn.

– Used for Cavity wounds, moderately exudating wounds.

Dressings cont.

• Hydrocolloids. I.e. Granuflex.– Used for most wounds except heavily exudating

ones.

• Hydrogels. I.e. Sherisorb.– Used for necrotic wounds and most other

wounds.

• Enzymes. I.e. Varidase.– Used for hard black necrotic tissue.

• Films. I.e. Opsite, Bioclusive.– Used for small superficial/shallow wounds.