Etiology: (aka bed sores, pressure sores, decubitus/ Pressure injuries are caused when an excess of shear or force is applied to the skin, causing damage to the tissue.), epidemiology (An estimated 2.5 million pressure-induced injuries are treated each year in acute care facilities in the United States alone )* add more here and let me know source… pathophysiology (Pathophysiology.
Pressure: When soft tissues are compressed for prolonged periods between bony prominences and external surfaces, microvascular occlusion with tissue ischemia and hypoxia occurs.Constant pressure on the skin results from remaining in the same position for a prolonged period of time, preventing proper circulation from perfusing the tissue which in turn allows tissue breakdown.)
Clinical presentation: (biggest offenders are decubitus in the coccyx region and the gluteal cleft and the heels- skin feels “boggy”. THese areas are usually the most “dependent” in the lying and sitting positions.
Stage 1 will present as redness that is no longer blanchable/ now unblanchable but skin integrity isn’t broken.
Stage 2 the integrity of the skin is broken/ partial thickness.
Stage 3 possibly some exposed fat/ full thickness. Stage 4 may show bone/ full thickness/ tissue loss. U
nstageable is when it doesn’t fall into one of the previous four stages. will attach picture if able to include in infographic? Differential diagnosis, based on the patient’s complaint: Cellulitis, Osteomyelitis, Undernutrition, Pressure Ulcer, diabetic ulcer, venous ulcer, Warfarin Necrosis Diagnostic studies: Clinical evaluation and Nutritional assessment especially for wounds with stage 3 or 4 pressure ulcers.
Undernutrition requires further evaluation and treatment .Recommended tests include hematocrit, transferrin, prealbumin, albumin, and total and CD4+ lymphocyte counts. If suspected Osteomyelitis we should check CBC,blood cultures, ESR or C-reactive protein.
Bone biopsy might be necessary if osteomyelitis is suspected. MRI can help determine the extent of pressure ulcer.
Pharmacologic & Non-pharmacologic management plan as appropriate: non-pharmacological: support surfaces, nutrition,electrotherapy, repositioning, adjunctive therapy (ultrasound, laser, electromagnetic, light, shock wave, hydrotherapy, radiofrequency, or vibration therapy) to increase the rates of PU healing in older patients.
Pharmacological: reducing pressure on the affected skin, caring for wounds, controlling pain with NSAIDs or topical pain medications, preventing infection and maintaining good nutrition. Cleaning. If the affected skin isn’t broken, wash it with a gentle cleanser and pat dry.
Clean open sores with water or a saltwater (saline) solution each time the dressing is changed. Putting on a bandage. A bandage speeds healing by keeping the wound moist. It also creates a barrier against infection and keeps skin around it dry. Bandage choices include films, gauzes, gels, foams and treated coverings. You might need a combination of dressings. remove and debride any damaged tissue.
Pertinent patient education regarding disease prevention and health maintenance: Patients who are immobile need pressure points to be relieved by changing body position at least every two hours.
Patients on a wheelchair should shift their weight at least every 10-15 minutes. In addition, patients at risk should keep their skin clean, warm, and dry. Eating a well balanced diet and drinking enough fluids is also important to keep blood flowing properly.
Exercise or range of motion to extremities should also be done to promote circulation. Smoking and secondhand smoke should be avoided as well. Patient counseling (avoid clothing with thick seams, buttons, zippers, tight clothing, keep clothes from bunching up or wrinkling, keep skin clean and moisturized, try to get out of bed as often as possible and move/change positions at least every 2 hrs, offload pressure with pillows) Pertinent ethical, psychosocial, cultural, and behavioral health care issues to be included as appropriate (ethical- nurses not regularly changing pt position as indicated. psychosocial- patient lacks will to move positions regularly. cultural-pt are not able to effectively communicate pain. behav health- pt may have behavioral health problems that complicate care) *PLEASE try to find better answers to this last question- and share sources..thank you
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