Pressure Ulcer Management

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