Questions and Answers
What is a common cause of pressure ulcers related to skin movement against surfaces?
Which of the following factors is NOT considered a high-risk characteristic for developing pressure ulcers?
Which stage of pressure ulcer is characterized by full-thickness skin loss with damage to muscle and possibly bone?
The Braden Scale includes multiple factors; however, which of the following is NOT one of them?
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What percentage of patients with pressure ulcers report some degree of pain associated with their condition?
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Which of the following is essential for preventing skin breakdown in patients at risk for pressure ulcers?
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What is the mortality rate for patients with pressure ulcers within one year after hospital discharge?
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Which of the following does NOT represent a common complication associated with pressure ulcers?
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Study Notes
Definition and Types
- Pressure ulcers, also known as decubitus ulcers, result from prolonged pressure, friction, or shear on the skin.
Causes and Manifestations
- Major causes include:
- Prolonged pressure on specific body areas
- Friction that damages the skin
- Shear forces that affect blood flow
High-Risk Areas
- Common sites for pressure ulcers typically include bony prominences:
- Heels
- Hips
- Sacrum/Coccyx
- Ischia
- Shoulders
High-Risk Clients
- Individuals at increased risk of developing pressure ulcers:
- Immobile patients
- Elderly individuals
- Individuals with incontinence
- Those with nutritional deficits
- Smokers
Braden Scale
- A tool for evaluating the risk of pressure ulcers based on:
- Sensory perception
- Moisture levels
- Activity level
- Mobility
- Nutrition
Pain and Complications
- Approximately 59% of individuals with pressure ulcers experience pain, with 45% finding it distressing or intolerable.
- Only 2% receive pain medication within 4 hours post-dressing change.
- Complications from pressure ulcers can include:
- Persistent pain
- Infection
- Mortality rates associated with pressure ulcers are severe:
- 40% of patients die within a year
- 60% die within one year after hospital discharge
Prevention and Care
- Essential preventive measures include:
- General skin care practices
- Regular skin assessments
- Utilizing proper surfaces to alleviate pressure
- Encouraging mobility
- Providing incontinence care
- Ensuring good nutrition
- Key factors to prevent skin breakdown:
- Adequate circulation
- Proper nutrition
- Effective skincare routines
Pressure Ulcer Staging
- The classification of pressure ulcers is as follows:
- Stage I: Non-blanchable erythema of intact skin.
- Stage II: Partial-thickness skin loss; ulcer appears as an abrasion, blister, or shallow crater.
- Stage III: Full-thickness skin loss with damage or necrosis of subcutaneous tissue; may extend to underlying fascia.
- Stage IV: Extensive full-thickness skin loss with damage to muscle, bone, or supporting structures; may include undermining and sinus tracts.
- Unstageable: Full-thickness tissue loss, where slough or eschar obscures the ulcer base.
Monitoring and Treatment
- Regular assessment of ulcer characteristics, including:
- Location
- Size
- Wound bed composition (granulation tissue, slough, necrotic tissue)
- Wound edges and drainage
- Signs and symptoms of infection and pain levels.
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Description
This quiz covers the definition, causes, and manifestations of pressure ulcers, also known as decubitus ulcers. It discusses high-risk areas and populations for developing these ulcers and introduces the Braden Scale for assessing risk. Test your knowledge on this important nursing topic.
