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Pressure Ulcer Management

Pressure Ulcer Management. By Susan Yap, PT. Anatomy of the Skin. Epidermis Dermis Subcutaneous Tissue Fascia Muscle Tendon and Bone. Functions of the Skin. Protection Regulates Body Temperature Sensation. Effects of Aging on Skin. Dehydration Reduced Subcutaneous Fat

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Pressure Ulcer Management

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  1. Pressure Ulcer Management By Susan Yap, PT

  2. Anatomy of the Skin • Epidermis • Dermis • Subcutaneous Tissue • Fascia • Muscle Tendon and Bone

  3. Functions of the Skin • Protection • Regulates Body Temperature • Sensation

  4. Effects of Aging on Skin • Dehydration • Reduced Subcutaneous Fat • Decreased Vascularization • Decreased Elasticity

  5. Physiology of Wound Healing • Healing by primary intention- wound edges are brought together and sutured • Healing by secondary intention- wound edges are not brought together and must heal by granulation, contraction and epithelialization

  6. Phases of Wound Healing • Inflammatory Phase • Acute Phase = Vasoconstriction and clot formation • Followed by demolition phase • Chronic inflammation results in wound is overwhelmed by necrotic tissue • Characteristics: Edema, Erythema, Pain, Necrotic tissue and Exudate • Proliferative Phase • Granulation Tissue fills wound bed • Angiogenesis • Epidermal cells migrate across granulation tissue • Contraction of wound edges • Characteristics: Deep red granulation tissue, Transudate, Epithelialization occurring • Maturation Phase • Increase in tensile strength through collagen synthesis • Resulting scar tissue 70-80% as strong as original skin • Characteristics: Decrease vascularization, Increase tensile strength, Decrease size of scar

  7. Pressure Ulcer Any lesion cause by unrelieved pressure resulting in damage of underlying tissue ; usually over a bony prominence.

  8. Risk Assessment • Impaired circulation • Impaired Mobility • Predisposing Illness or medication that impair healing • Decrease mental status • Incontinence • Nutritional deficits • Patients with existing pressure ulcer • Non compliance

  9. Early Intervention • Team Effort • Address functional mobility and ROM • Continence training • Education • Positioning • Pressure relieving/reducing devices

  10. Mechanical Loading and Support Surfaces • Bed bound • Chair bound • Avoid positioning directly on the trochanters • Positioning devices to relieve all pressure from the heels and to prevent direct contact to bony prominences • Prevent sheer injury • Ring cushions should be avoided • Support surfaces

  11. Initial Evaluation • Holistic approach • Functional mobility and ROM • Nutritional status • Pain level • Psychosocial health • Common complications of pressure ulcer

  12. Wound Assessment • Etiology • Location • Size

  13. Pressure Ulcer • Stage I - Red non-blanchable • Stage II - Partial thickness skin loss • Stage III – Full thickness skin loss involving underlying subcutaneous tissue • Stage IV – Full thickness skin loss with extensive destruction damage to muscle bone

  14. Stage I

  15. Stage II

  16. Stage III

  17. Stage IV

  18. Viable Tissue • Granulation • Epithelialization

  19. Necrotic/Nonviable Tissue • Eschar • Slough

  20. Drainage/Exudate • Amount • Transudate/serous • Purulent

  21. Odor • Describe • Intensity • Result of autolytic debridement or dressing

  22. Developing Goals • Process Oriented • Measurable • Time Oriented

  23. Debridement • Mechanical • Sharp • Enzymatic • Autolytic

  24. Dressings • Cardinal rule keep ulcer tissue moist • Eliminate dead space by loosely packing • Control exudate • Cost effective • Time effective • Location of wound

  25. Things to remember • Communication with Physicians • Documentation • Risk Management • Education • Quality Improvement

  26. Thank You Email : susan_yap@hchd.tmc.edu

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