Skin, Wounds and Nutrition Part 2

1. Skin, Wounds and Nutrition Part 2

2. Pressure Ulcers Pressure Ulcer Definition (NPUAP)A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

3. Pressure Ulcer A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

4. Who Gets Pressure Ulcers? • People who are immobile for extended periods • Older adults • Paralyzed • Comatose

5. Pressure Ulcers Pathophysiology • Neuropathic: interruption of autonomic reflex and circulatory reflex • Shear: mechanical force on epidermis • Direct pressure: capillary closing pressure 32 mmHg • Maceration / contamination

6. Pressure  Inflammation  Edema  Small Vessel Thrombosis  Cell Death

7. Pressure Ulcers - Stages of Severity National Pressure Ulcer Advisory Panel Revised Definitions February 2007

8. Pressure Ulcer Suspected Deep Tissue Injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

9. Pressure Ulcer Stage I:Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

10. Pressure Ulcer Stage II:Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

13. Pressure Ulcer • Stage III:Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling

14. Pressure Ulcer • Stage IV:Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

16. Physical Condition Activity Nutritional Status Patient at Risk Mobility Mental Status Continence

17. Management - Prevention Recognize at risk • Mobility • Activity • Sensory perception • External apparatus

18. Prevention Strategy • Pressure relief • Clean, intact skin • Nutrition • Movement • Patient/family education

19. Management - Prevention Avoidance Pressure • Turning • Mattress overlay • Air/water bed • Air fluidized

23. The Enemies • Pressure • Friction/shear • Heat • Moisture

24. High Interface Pressure • Pinches off capillary blood vessels that transport oxygen and nutrients to tissue • Without blood flow, tissue quickly dies and decomposes, forming a pressure ulcer

25. Patient On the Back

26. Patient on the Side