DECUBITUS ULCER IN ENGLISH

                                                     

                                 DECUBITUS ULCER IN ENGLISH

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DECUBITUS ULCER-

Ø Decubitus ulcer or bed sore or pressure ulcer is a wound with a localized area of tissue necrosis. It is defined as injury to the tissue due to inadequate blood and oxygen supply caused by exposure to pressure. 

Ø The pressure causes ischemia, which is a temporary deficiency of blood supply to tissue or an organ.

Ø The unrelieved pressure or pressure in combination with shearing and/or friction results in localized damage. Later it causes tissue necrosis when the soft tissue and blood supply are compressed between a bony prominence and an external surface for a prolonged period of time. These sites are knon as pressure points.

CAUSES OF PRESSURE SORE-

Ø External Pressure- Pressure ulcers usually occur over bony prominences where body weight is distributed over a small area without much subcutaneous tissue to cushion damage to the skin. A pressure ulcer may form in as little as 1 to 2 hours if the patient has not moved or been repositioned to allow blood circulation to the areas.

Ø Friction-  Friction occurs when two surfaces rub against each other. The friction can damage superficial blood vessels directly under the skin. A patient who lies on wrinkled sheets is likely to sustain tissue damage as a result of friction. The skin over the elbows and heels often is injured due to friction when patients try to move up in bed with the use of their arms and feet.

Ø Shear- shear occurs when one layer of tissue slides over another layer due to slanting force. Shear separates the skin from underlying tissues. The small blood vessels and capillaries in the area are stretched and possibly tear, resulting in decreased circulation to the tissue cells under the skin. Shear is seen during fowler's positon when patient slips down due to gravity.

Ø Immobility- Patients who spend long periods of time in bed or seated without shifting their body weight properly are at great risk for development of a pressure ulcer.

Ø Nutrition-  Protein–calorie malnutrition predisposes a person to pressure ulcer formation because poorly nourished cells are damaged easily.

Ø Moisture-  Damp skin is also a risk factor for pressure ulcer development.  Primary sources of skin moisture include perspiration, urine, feces, and drainage from wounds. Prolonged moisture on the skin reduces the skin’s resistance to trauma, friction and shear

Ø Age- Older adults are at a greater risk for pressure ulcer formation because the aging skin is more susceptible to injury.

 

PRESSURE POINTS-

Ø During supine position- Occipital bone, scapula, vertebra, sacrum, coccyx and calcaneus bone.

Ø During prone position- Frontal bone, mandible, humerus,  Sternum, tuberosity of pelvis, patella and tibia bone

Ø During lateral position- Scapula, ribs, iliac crest,  greater trochanter of femur, lateral knee, lateral malleolus, medial malleolus

Ø During fowler’s position- Scapula and sacrum.

 

STAGING OF PRESSURE ULCERS-

           Stage I-

           In this stage the skin is intact but redness of a localized area usually over a bony prominence. The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue. Edema may be present.

           Stage II-

           In this stage the skin is damaged. skin loss includes the epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, a blister, or a shallow wound.

           Stage III-

           In this stage there is Full thickness skin loss. Subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. The depth of a stage III pressure ulcer varies with location of the wound. Slough may be present .

           Stage IV-

           In this stage there is Full thickness skin loss along  with full thickness subcutaneous tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. It often include undermining and tunneling.

WOUND CARE-

Ø The goal of wound care is to promote tissue repair and regeneration so that skin integrity is restored.

Ø Wounds can be treated by leaving them open to air

Ø If the scab is removed accidentally before healing is complete, re-injury occurs, and the new delicate cells are exposed.

Ø It can also be treated by closed wound care using dressings to keep the wound moist. A moist and sterile environment is best for wound healing.

Ø The presence of foreign matter and/or devitalized, injured, infected tissue in a wound may indicate the need for debridement to promote wound healing.

Ø Autolytic debridement uses occlusive dressings, such as hydrocolloids or transparent films, and uses the body’s own enzymes and defense mechanisms to loosen and liquefy necrotic tissue

Ø Attention should be given on prevention of bed sores.

 

PREVENTION OF PRESSURE ULCERS-

Ø Skin care is very important for the prevention of pressure ulcers.

Ø Daily inspection of pressures points for detection of signs of pressure sore is important.

Ø If signs of skin breakdown is seen, prompt treatment should be started.

Ø Always keep skin of the patient dry and clean.

Ø Position of the patient should be changed after every 2 hours to remove pressure from pressure points.

Ø Talcum powder or skin cream should be applied to the skin according to weather condition.

Ø Special attention should be given to unconscious or paralyzed patients to protect them from soiling with urine or stool.

Ø Provide soft smooth and wrinkle free beddings to the patient.

Ø Special mattress such as air or water mattress can be used to prevent pressure sore in high risk patients.

Ø Use special devices under pressure points such as pillo rings, extra cotton, air cushion etc.

Ø Provide health education to patient and relatives about causes and prevention of pressure ulcers.

Ø To improve blood circulation back care and skin care should be provided to high risk patients with circular motion massage on pressure points.