Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pressure Ulcers/Injuries (Conceptual Framework (the forces of pressure are…
Pressure Ulcers/Injuries
- Pressure Injury: The term “pressure injury” replaces “pressure ulcer” to more accurately describe pressure injuries to both intact and ulcerated skin
- A pressure injury: localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device; injury can present as intact skin or an open ulcer and may be painful; injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear
- most frequent type of expensive, avoidable side effects of care; affects approx of 25% of patients in acute care and 30% in long term care
Deep Tissue Pressure Injury:
- Purple or maroon localized intact skin or blood-filled blister due to damage to underlying soft tissue from pressure and/or shear
Medical Device Related Pressure Injury:
- result from the use of devices designed and applied for diagnostic or therapeutic purposes; the resultant pressure injury generally conforms to the pattern or shape of the device; injury should be staged using the staging system
Mucosal Membrane Pressure Injury:
- is found on mucous membranes with a history of a medical device in use at the location of the injury; due to the anatomy of the tissue these injuries cannot be staged
-
Tissue Damage Occurs when...
- Sustained pressure on an area supporting the body is high enough to close capillaries (capillary closing pressure)
- Normal capillary pressure ranges from 16 to 32 mm Hg
- The result is reduced blood supply and eventual death of skin & underlying muscles.
At Risk
CAN’T FEEL
- Spinal cord injury
- Spina bifida
- Peripheral neuropathy
CAN’T MOVE
- Arthritis
- Stroke
- Cognitive impairment
Conceptual Framework
-
- the forces of pressure are opposed by tissue tolerance (so any factors that increase pressure or decrease tissue tolerance will contribute to the development of a pressure ulcer or pressure injury)
Pressure --> 3 Factors
- Mobility (ability to change and control body position
- Activity (degree of physical activity (i.e. out of bed, chairfast, bedfast)
- Sensory Perception (ability to feel pressure related discomfort; ability to respond meaningfully to pressure related discomfort)
Tissue Tolerance (Extrinsic factors):
- Shearing force – pressure exerted on the skin when it adheres to the bed & the skin layers slide in the direction of body movement
- Friction – two surfaces rubbing against each other
- Excessive moisture
- Surgical procedure > 4 hours
Tissue Tolerance (Intrinsic Factors):
- Poor Nutrition
- Age: >70 years
- Co-morbidities
- Stress
- Previous history of Pressure Ulcer
- Smoking
-
-
Treatment
- Current Trend:
- Keep person off the pressure ulcer
- Use pressure reducing or relieving devices
- Keep a pressure ulcer slightly moist, rather than dry, to enhance re-epithelialization
- Control pain (affects between 12-100% of patients with pressure ulcers; under treated; increases as stage of ulcer increases)
- Turning (continue to turn every 2 hours, avoid affected area)
- Cleansing (clean ulcer with noncytotoxic solution that do not kill/damage cells especially fibroblasts; ex. these are cytotoxic (Dakin's solution (sodium hypochlorite), acetic acid, povidone iodine, hydrogen peroxide)
- Dressings:
- Stage I
Transparent film dressing, thin hydrocolloid dressing [protect skin]
- Stage II
Moist wound dressing, transparent film dressing, hydrocolloid dressing [promote re-epithelialization]
- Stage III & IV
Debridement, hydrogel, hydrocolloid, alginate, mesal [promote granulation tissue to fill in wound]
Controlling Pain:
3 types of chronic wound pain
- noncyclic acute pain: single or infrequent episodes (ex. debridement)
- cyclic acute pain: accompanies repetitive procedures (ex. dressing changes, repositioning)
- chronic wound pain: persistent pain occurring without external stimulation
Origin of Chronic Wound Pain:
- Nociceptive pain: occurs in response to tissue damage; usually resolves once damage is repaired; described as throbbing or aching; severity usually correlates with level of tissue damage
- Neuropathic pain: results from injury to nerve tissues or fibres; described as tingling or stinging in mild cases; described as stabbing or burning in more severe cases
