Tratamiento y apósitos para las UPP

Other Dressings

• Carbon activated dressing
• Interacts
• Reduces odor
• Easy application
• May be present with alginates and hydrocolloids

Alginate Dressing

• Highly absorbent seaweed dressings
• The dressing congeals when soaked in saline

Requirements for All Dressings

• Maintain humidity and temperature
• Biocompatible
• Protective against external agents
• Absorb exudates
• Selective for permeability of O2 and H2O
• Interaction with the UPP promotes healing

UPP Evaluation: Severity Index

• Evaluated every 14 days
• Calculated as I.G = (length + width) / 2 * Estadia

Steps to Treat UPP

• 1st: Assess the UPP to determine the clinical stage
• 2nd: Is there an infection?
• If yes (stages II, III, IV):
  • Perform a culture to check for infection
  • Debridement of necrotic tissue (enzymatic or surgical)
  • Treat the infection using antibiotic cream or silver (Ag)
  • Apply an absorbent dressing (carbon, alginate, gauze)
• Monitor every 15 days

UPP Stage I Treatment

• Use hyperoxygenated fatty acid + dressing with:
  • Polyurethane
  • Hydrocolloid
  • Hydrocellular
  • Polymeric

UPP Stage II Treatment

• Necrotic tissue chemical debridement + dressings using:
  • Enzymatic collagenase
  • Surgical hydrogel
  • Hydrofiber
  • Hydropholymer

UPP Stage III Treatment

• May present slough and necrotic exudate
• Debridement (surgical, enzymatic or surgical) + dressing of Hydrofiber or Hydropholymer

UPP Stage IV Treatment

• Very abundant exudate
• Debridement + highly absorbent dressing with:
  • Enzymatic
  • Surgical
  • Alginate Calcium
  • Hydrofiber
  • Hydrocellular
  • Hydropholymer

Scotts Used: UPP Treatment

• Red ulcer = inflamed
• Use sterile gauze with 0.9% physiological saline
• Manifest dressing
• Hydrogel
• Hydrocolloids
• Perform irrigation to remove exudate
• Incision with serous liquid + exudate
  • Sepsis: dressings are absorbent and hydrocolloid based
    • Use prontosan + topical antibiotic if possible
  • Necrotic tissue needs debridement which is enzymatic or surgical

Additional Information

• Test: place a dressing 3 cm beyond the wound surface
• If wound has exudate debride
• If no infection apply antibiotic
• Flictena = Blister < 0.5 cm
• Apohisis = solvent
• 3 brains (neurons): cerebrum, intestine and heart
• Test the opposition 3 cm above the surface zone periulceral.
• Test: if there is a lot of exudate, debride.
• Test: if there is no infection, don't use an antibiotic.

Areas Where UPP Appear

• Decubitus supine:
  • Occiput: back of the skull where the head rests
  • Scapula
  • Elbow
  • Sacrum
  • Heels
• Lateral decubitus:
  • Ear
  • Shoulder (acromion)
  • Ischion
  • Trochanter
  • External knee
  • Malleolus (external tibial)
• Decubitus prone:
  • Cheek, ear
  • Breasts (women)
  • Genitals (men)
  • Patellae
  • Toes
  • Iliac spine
• Sitting:
  • Omoplato
  • Elbow
  • Ischial region
  • Spinous processes of the spine
  • Popliteal region
  • Sacrum
  • Ischiatic tuberosity
• Change position every hour

Other Ulcers

• Iatrogenic Ulcers:
  • Mouth (endotracheal tube)
  • Nose (tubes, mask)
  • Urethral meatus (tube)
  • Wrists and feet (restraints)
• Neuropathic - Plantar Perforating Ulcer (associated with diabetes)
  • Motor neuropathy:
    • Foot muscle atrophy
    • Toe deformities
  • Sensory neuropathy:
    • Foot is insensitive

Wagner Classification of Neuropathic Ulcers

• 0: No lesion
• 1: Superficial ulcer
• 2: Deep ulcer
• 3: Deep ulcer with access
• 4: Limited gangrene
• 5: Extensive gangrene
• Vascular Ulcers
  • Venous Ulcers:
    • Poor venous return
      • Causes:
        • Post-phlebitic syndrome
        • Chronic edema
        • Static condition (stasis)
        • Poor function of the muscle pump in the calf.
      • Occur Between the knee and ankle, medial malleolus
      • Red or yellow with slough
      • Mild pain that is relieved by elevating the leg
      • Doppler Index Arm/Ankle assessment
      • Pulse is present
      • Compression dressings can be passive or active (elastic)
      • Compression stockings (40mm Hg)
  • Arterial Ulcers
    • Obstruction of arterial flow
      • Locations: Anterior and lateral aspect of Lower 1/3 of the leg, Malleoli and toe tips
      • Grey-yellow with necrosis
      • Severe pain
      • Pulse may be absent lower in the limb
      • Angiitic Ulcers: tip/end of toes

Risk Factors for the Development of Foot Ulcers

• Diabetes
• Obesity
• Older Adults
• Intermittent Claudication
  • Measure with a depa test
• Tension on the limbs
  • Perform a Sensory Assessment
  • Test tension (vascular or mixed)
  • Doppler test should be performed with each ulcer
• Use a wet compress on the wounds

Iatrogenic or YatrogeÌnic Ulcers

• Occurs when unintentionally harming someone

Neuropathic/Plantar Perforating Ulcer = Diabetic Foot:

Types of Neuropathy

• Motor damage: changes muscle of foot and causes deformities
• Sensory
• Insensitive foot that has color or smell
• Changes shape and does not reduce size

Additional Information

• With neuropathy there is no sweat (dry skin)
• Is there an infection?
  • No: Moisturize
• Use colloidal or hyperceratosis
• Yes: Perform debridement
• Clean with isotonic saline

Types of Diabetic Ulcers: Wagner Classification

• 0: No ulcer on the foot. At risk
• Calluses
• Toes in claw position
• Deformities, Metatarsal heads are prominant
• 1: Superficial ulcer
• 2 Deep ulcer - possibly into the bone
• 3 Ulcers may have undermining with severe odor, possible exposure to bone and tendom
• 4: Gangrene, limited portion of foot
• 5: Gangrene , Entire foot affected
• You can use infection with systemic symptoms and P.ais drug

Venous Ulcers

• Cause: Malfunction of the venous return or values.

Types of venous ulcers.

• Varicose-veins are visible & often have valvular insufficiency
• 2. Post phlebitis
• 3. Static: Can be bilateral, malfunction of the pump around the ankle

Phlebitis

• Inflammation of the Venous walls.

Stasis

• Stagnation.

Assessment

• Assess for drainage

Doppler

• Ankle index.
• Measures flow direction-an ITB with a brachial index

How to Measure Edema

• Patient should be lying down for 15 minutes
• Measure the pressure in the brachium with the 2 brachia
• Use the higher pressure
• Measure TAS dorsal of the tibia as well
• Use the highest pressure
• ITB: PAS & Alta ankle / PAS + Alta del brazo

ITB Values

• Greater than 1.3 = Normal

• Between 0.8 - 1.3 Is for Venous blood

• At 0.6-0.8 it's Micio

• Below 6 it's Pase, no measure the ITB blood/Brachial pressure

• Do not measure ITB in presence of:

  • Thrombosis
  • Cellutitis (infection)
  • Phlebitis
  • Arcus or Calcaneus

• Compression bandages

Types of Compression Bandages

• Type 1: Passive elastic bandage can be used
• Function controls the limb area
• Evacuates muscle
• Type 2: Active elastic is used and compressive also
• Use for one week
• Total of 90°
• Using the law of Laplace

Indications

• Medial compression with a 40mmH9 band
• Changes bandage every 6 months
• Two Careload will improve ulcers
• Use first debridement to treat infections
• 2nd, use of Pathe de la la and epifitos or Ceno

Prevention of Venous Ulcers

• Hygiene, hydraulic, exercice, lift feet
• Must be greater than 10-15cm
• Avoid hypertension and operations or blood

Arterial Ulcers

• Caused by a lack of sape.
• Obstruction of blood flow
• Types may be caused by AHTA after an ablation
• With hypertension I get active and it pushes through to the tissue
• Atherosclerosis can show
• Aleromas which is calcinous and grease formation
• Dispremo (Drop Foot) Pulso
• Mueledos & yente diedos

3. With Angiitis by smokers it causes

• Buerger's disease.
• It may give a pulse in Poplitea & Pulpejo dedos = yemas

Treatment for arterial ulcers

• DO NOT compress with bandages

Prevention

• Don't over do, don't be pressed to always move the limb to 10-15cm's always maintain the muscles.
• Use a Mix of Vicces in case of venora or arterial
• Use Paraones Dleer

Differentiation

• Venous Ulcers:
  • Large, superficial
  • tween tibia and medial malleolus
  • Exudative, Impaired pigmentation
  • Slightly painful
  • Improved with leg elevation above the heart (10-15 cm)
• Arterial Ulcers.
  • Small and Deep
  • Occurs medailly as well, not acude & is painful
  • Test if it's the Dtypes models - will also be an external test
• Corion:Dermis
• Hidratos and Lipidos can give energy

Lesions With Humidity On The Skin

• Three areas of Skin exist

1. Epidermis:

• Plus Borec with lots of superior layers from a canal and a lactone
• It is made of 20 layers with epithelial
• This layer is protective with the moontione
• PH neutro 7
• Jatoú 5.5 is ph ácido pore this layer

2. Dermir & Cociona

• Anejos epidémiovoros can also stop the the formation of libres
• There are lots of esteras ore piel

3. There's a Tejido of the cell's

• the culete = is there a espejo present -
• Use upp even when it's not humeobd
• To upp you must períou
• Use normal or the pominexia oro
• If Humedad with the eredrido or beso or espejo can increase cancer
• upp may cause not necrosis but some hum
• Time used up nec = 14 dias - with I'd
• hum may improve in 2 dias & improve the
• incontinencia and si no funcionará -> descarte or is upp

Border

• upp cbrad distingidos - humidity is difusa
• upp - red, amaíillo, negio color can impact

Testing Mole dos

• This can use an externo to find the peroneal
• To test you should do what you can with supramoledclar and isteluo.
• upp you must do your best with moleolo