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Pressure Ulcers. download, Reference: Carville, K. (2011). Wound Care…
Pressure Ulcers. 
General Factors
Co-morbidities: Type 2 diabetes
Factors which inhibit Elsie's healing: Old age, poor nutrition and obesity, decreased mobility, poly-pharmacy
Diabetes: uncontrolled blood sugar levels have adverse effects on wounds. Macrophages are responsible for ridding the wound bed of dead bacterias and foreign bodies while stimulating fibroblasts to increase collagen production. During inflammatory phase macrophage levels are reduced in diabetics. Due to a diabetics increased susceptibility to neuropathy, ischaemia and infection wound healing is furhter inhibited.
Age: as people get older a range of biological factors to contribute to a gradual deterioration of body organ function. Healing in elderly is inhibited by the greater incidence of co-morbidities and associated medications. Reduced mobility, financial resources and psychological status can all impact nutritional status and general health.
Inadequate nutrition: delays wound healing and increase the incidence of infection occurring. Malnutrition can be due to insufficient intake or malabsorption syndrome. Specific nutrients which enhance healing are amino acids - help revascularisation, fibroblastic, collagen synthesis and lymphatic formation. Cell energy from whole grains, sugar, honey and vegetables help phagocytic activity and energy is obtained from fats like butter. Cell membranes made from fatty linoleic acids regulate metabolism, circulation and inflammation. Vitamin C os essential for collagen synthesis and reduced infection risk. Vitamin A assists in epithelialisation and collagen synthesis. Vitamin B-complea
Local Factors to consider: Hydration of wound, Wound management practices, wound temperature, friction and sheer along with pressure, foreign bodies and presence f infection
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Intrinsic factors
Age: graducal deterioration as age increases effects body function and repair potential. Mobility may decrease along with access to nutrition resulting in decreased immunity and tissue turgor.
Immobility is a leading cause of localised pressure injuries due to occlusion of blood vessels causing pressure injuries. decreased movement also impairs blood flow and retards venous return causing oedema which compromises skin integrity and oxygenation.
Skin condition: impaired sensation, thermoregulation and protection of the skin decreases skin integrity.
Neuropathy reduces awareness of pain, pressure and sensitivity of the skin therefore is a significant factor causing ischaemia of tissue.
Adeqaute and balanced nutrition results in optimal health, increased immunity, and increased healing abilities. Malnutrition, dehydration or electrolyte imbalances increases risk of developing pressue ulcers.
Cachexia: reduces protective layers of adipose and muscle between bony prominences and skin contact with surfaces.
Tissue perfusion - caused by vasoconstriction, compression of blood vessels and diseases which reduce oxygenation of the blood or oedema all increases risk of pressure injury.
Pressure Ulcers are the result of trauma to the skin caused by pressure, sheer or friction and are a common problem the aging population, immobile or neurologically impaired individuals.
vascular and lymph vessels deliver nutrients and oxygen needed for cell metabolism and epidermal mitosis. This network also assists in temperature regulation and waste removal. When this network of tissues is damaged it is the result of excessive or sustained compression. compression of capillaries and microcirculation compromises the oxygen and nutrient supply to the skin and underlying tissues. this causes localised hypoxia, ischaemia, acidosis and necrosis.
Pressure ulcers occur when capillaries are compressed between bone and skin by an external surface or object for a long period. Therefore boney areas are at risk i.e. sacrum, spine, elbows.
Sheering force or friction refers too damage caused by sliding skin across surfaces which traumatises underlying tissues and blood vessels.
Extrinsic factors
Moisture: this impairs the tensile strength of skin when skin is excessively moist and becomes macerated. Ulceration develops when friction or sheering of the skin occurs in the presence of moisture. This moisture can be incontinence, wound exudate, dribbling or sweat.
Reference: Carville, K. (2011). Wound Care Manual (4th Ed.). Silver Chain Foundation.