Pressure Sore/Ulcer

(Bed Sore, Decubitis Ulcer)

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Definition

-  Areas of damaged skin & underlying tissue caused by unrelieved pressure or friction

 

Features

-  Largely preventable problem

-  Common sites

-  Heels

-  Elbows

-  Sacrum

-  Occiput

 

Classification

-  Grade 1: skin discoloration, usually red, blue, purple or black

-  Grade 2: skin loss or damage involving mose superficial layers

-  Grade 3: necrosis or damage to skin patch, limited to skin

-  Grade 4: necrosis or damage to skin patch & underlying structures (tendon, joint, bone, muscle)

 

Risk Factors

-  Elderly (thinner more delicate skin)

-  Immobilisation

-  DM

-  Neuropathy

-  PVD

-  Incontinence

-  Malnutrition

-  Dementia

 

Associated S/S

-  Discharge

 

Complications

-  Sepsis

-  Cellulitis

-  Osteomyleitis

-  Myositis

-  Abscess

 

Ix

-  +/- FBE

-  +/- CRP

-  +/- wound swab MCS

-  +/- BC

-  +/- Vascular studies

-  Venous +/- arterial doppler

 

Prevention

-  Pressure care

-  Regular position changes

-  Bed bound change position every 2 hrs+

-  Pressure mattress

-  Personal hygiene

-  Regular review

-  Quit smoking

 

Mx

-  Dressings

-  +/- BD/TDS NS gauze dressings

-  +/- Hydrogel (debriding)

-  Debridement & washout

 

 

 

References

 

Better Health Channel: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pressure_sores?open