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PRESSURE ULCER PRESENTED BY: DR. H. NAJARI ASSISTED PROFESSOR DEPARTMENT OF INFECTIOUS DISEASE QAZVIN UNIVERSITY OF MEDICAL SCIENCE DEFINITION • Pressure ulcer, also known as Pressure sores, Bedsores and Decubitus ulcers, are localized injuries to the skin and/or underling tissue that usually occur over a bony prominence • The most common sites are the skin overlying the sacrum, coccyx, heels or the hips • Elbows, knees, ankles, back of shoulders or cranium can be affected CONTRIBUTING FACTORS • Sustained pressure. pressure applied to soft tissue resulting in completely or partially obstructed to blood flow to the soft tissue • Shear is also a cause, as it can pull on blood vessels that feed the skin. Shear occur when two surfaces move in the opposite direction • Friction. Is the resistance to motion.it may occur when the skin is dragged across a surface. RISK FACTORS Comma & paralysis After surgery Poor health and weakness Bed rest and wheelchair use Difficult moving and inability to easily change position while seated or in bed RISK FACTORS • Age • Lack of sensory perception • Weight loss • Poor nutrition • Excess moisture or dryness • Bowel incontinence • Medical condition affecting blood flow • Smoking • Limited alertness • Muscle spasms STAGING Bedsores fall into one of 4 stage based on their severity management of patients are based on the staging STAGE I Non-broken skin Stage may be difficult to detect The skin appears red, non-blanchable The site is tender, painful, firm, soft, warm or cool STAGE II Epidermis and part dermis is damaged or lost The wound may be shallow & pinkish or red It look like a fluid-filled or a ruptured blister STAGE III Full thickness tissue loss The loss of skin usually exposes some fat The dead tissue ulcer looks crater-like The bottom of wound have some yellowish The damage may extend beyond the primary wound blew layers of healthy skin STAGE IV • Full thickness tissue loss with exposed bone, tendon or muscle • The bottom of the wound likely contains dead tissue that is yellowish or dark and crusty • The damage often extends beyond the primary wound layer of healthy skin UNSTAGEABLE • Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough • Yellow, brown, black or dead tissue is covered surface of ulcer • It is not possible to see how deep the wound is DEEP TISSUE INJURY • The skin is purple or maroon but the skin is not broken • A blood-filled blister is present • The area is painful, firm or mushy • The area is warm or cool compared with the surrounding skin • In people with darker skin, a shiny patch or a change in skin tone may develop COMPLICATIONS