$PRESSURE ULCER osms.it/pressure-ulcer PATHOLOGY & CAUSES ▪ Localized skin, underlying-tissue injury ▫ Caused by unrelieved pressure/pressure in combination with friction, shearing forces ▪ AKA bedsores/decubitus ▪ Blood ﬂow diminishes ▫ Pressure → ischemia → necrosis ▪ Bony prominences most commonly affected ▫ Sacrum, heels, hips, elbows RISK FACTORS ▪ Reduced mobility ▫ Chronic/acute disease (e.g. hip fracture, stroke, Parkinson disease) ▫ Central/peripheral neural damage, altered level of consciousness, advanced age ▪ Reduced perfusion ▫ Atherosclerosis, peripheral vascular disease, hypotension, smoking ▪ Factors affecting skin structure ▫ Malnutrition, protein deﬁciency, skin moisture (incontinence, sweating) ▪ Diabetes mellitus STAGING ▪ Stage I: nonblanchable erythema; skin intact, localized ▪ Stage II: partial thickness dermis loss; red wound bed; serum-ﬁlled blister; no skin sloughing ▪ Stage III: full thickness tissue loss; visible subcutaneous fat; raised wound edges (epibole); skin sloughs ▪ Stage IV: full thickness tissue loss; bone, muscle, tendon exposed; raised wound edges; skin sloughs/eschar formation 56 OSMOSIS.ORG ▪ Unstageable: if ﬁlled with sloughed skin, scabs; diagnosis difﬁcult ▪ Deep tissue injury: nonblanchable erythema, skin separation; no skin disruption COMPLICATIONS ▪ Bioﬁlm formation on wound → inﬂammation → delayed healing → wound dehiscence ▪ Wound, bone, joint infection; sepsis; ﬁstulas; gangrene ▪ Malignant transformation rare SIGNS & SYMPTOMS ▪ Ulceration (skin in contact with underlying surface) ▪ Fever, foul odor (if complicated by infection) ▪ May be painful DIAGNOSIS LAB RESULTS ▪ Swab culture ▫ May help determine treatment in healing-resistant ulcers OTHER DIAGNOSTICS ▪ Clinical presentation TREATMENT MEDICATIONS ▪ Topical sulfadiazine cream OTHER INTERVENTIONS ▪ Debridement of bioﬁlm, dressing replacement, negative pressure therapy$

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Pressure ulcer

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Integumentary system

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Pressure ulcer

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Pressure ulcer

Celebrate Doctors' Day with 50% off Osmosis! Sale ends March 31.

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AssessmentsPressure ulcer

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Pressure ulcer

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Pressure ulcer