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Infected Stage Four Pressure Ulcer (Pathophysiology (Sustained pressure to…
Infected Stage Four Pressure Ulcer
Patient Mrs P
95 year old female, living in residential care, widowed, nil family members living in Auckland.
Presents: febrile, severely malnourished, increased pain during mobility, offensive discharge of sacral pressure ulcer.
Investigations preformed: wound swabs, blood tests, wound assessment, skin assessment, nutritional status, and glasgow coma scale.
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Was being treated in community for pressure ulcer, but has increased in size and offensive smelling.
Signs and Symptoms: T= Necrotic tissue + slough present. I= both inflammation and infection present (shown through offensive smell, febrile, redness of surrounding skin, increased pain). M= Copious yellow exudate. E= Red raised edges of wound.
Nursing interventions:
Regular two hourly turns in combination with alternating pressure mattress: to remove the underlying cause of injury to therefore reduce risk of further deterioration.
Keep surrounding skin dry and clean: moist environment increases risk of skin break down and infection.
Provide nutritional support: protein and calorie intake is essential in promoting good wound healing. It also reduces her risk of mortality as she is more equipped to fight infection.
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Maintain observations: to monitor signs of deterioration, therefore preventative actions can be put in place sooner for better results.
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Risk factors
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Dementia: Mrs P has sever dementia affecting her ability to obtain adequate nutritional supplies, mobilise and acknowledge when she needs to re-position herself resulting in an increased risk of pressure ulcer onset.
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Mrs P, is also bed-ridden due to her co-morbidities therefore increasing her risk of pressure are onset as she experiences sustained pressure in localised areas of her skin.
Pathophysiology
Sustained pressure to a localised area of skin, usually over a bony prominence, causing localised injury to skin.
Unless the sustained pressure is removed the wound gets increasingly bigger both in depth and width.
Prolonged pressure obstructs the blood flow, resulting in hypoxic tissue damage and reduced perfusion
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The ulceration creates a breakage in the skin, where the skin has lost its barrier function, therefore the wound becomes colonised with bacteria
If not monitored localised wound infection can occur and if not treated appropriately, systemic infection can occur resulting in possible multi-organ failure, sepsis and mortality
Age-related physiology
Due to the changes to skin associated with aging Mrs P is at a increased risk as her skin has undergone both intrinsic and extrinsic changes. Resulting in her being more susceptible.
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Reduced mobility to age-related co-morbidities have also resulted in Mrs Ps vulnerability to pressure ulcer onset.
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