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What are other names commonly used for pressure injuries?
Pressure injuries can only occur on bony prominences.
False
What causes tissue necrosis in pressure injuries?
Ischemia due to impaired blood flow.
The incidence of pressure injuries in hospitals can be as high as _____%.
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Match the following incidence rates with their corresponding settings:
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What happens to blood flow when pressure is relieved on an area affected by prolonged pressure?
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Microthrombi formation is a result of prolonged pressure on tissues.
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What is the result of prolonged pressure that leads to tissue damage?
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The formation of blisters indicates injury to the __________ layers of skin.
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Match the following tissue alterations with their descriptions:
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What is the primary cause of pressure injuries?
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Shearing forces can result from the elevation of the head of a hospital bed.
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What type of tissue damage results from prolonged application of pressure to the skin?
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Friction and moisture can cause the skin and superficial fascia to remain fixed to the __________.
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Match the following terms with their definitions:
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What is the effect of external pressure greater than capillary pressure on blood flow?
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How does shearing force contribute to tissue injury?
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What happens to the tissue when pressure is applied for more than two hours?
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Why is lifting a patient preferable to pulling when repositioning in bed?
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How does the area of application affect the damage caused by pressure?
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Which of the following factors significantly increases the risk of developing pressure injuries?
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Inadequate nutrition can lead to an increase in subcutaneous tissue and reduce the risk of pressure injuries.
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What condition can result from abnormal protein levels in the blood and increase the risk for pressure injuries?
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Moisture from incontinence can lead to skin __________, making it more vulnerable to injury.
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Match the risk factors with their descriptions:
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Which nutrient is NOT specifically mentioned as contributing to pressure injury formation?
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Individuals who are heavily sedated are less likely to develop pressure injuries due to their reduced mobility.
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What condition may increase the risk of skin integrity impairment in older adults?
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Name one reason why edema increases the risk for pressure injuries.
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Elevated body temperature aids in improving the metabolic rate of cells.
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What are two chronic conditions that can increase the risk of skin breakdown?
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Increased skin dryness in older adults can be attributed to a decrease in the amount of oil produced by __________ glands.
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Match the following conditions with their effects on skin integrity:
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What can excessive body heat result in when tissue is under pressure?
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Skin integrity is unaffected by the position of the body on hard surfaces.
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Name one factor that can lead to skin integrity impairment aside from age.
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Study Notes
Pressure Injuries
- Pressure injuries are caused by impaired blood flow to soft tissue due to external pressure.
- They lead to tissue death (necrosis) and ulceration.
- They are commonly known as bedsores, pressure ulcers, or decubitus ulcers.
- They often develop over bony prominences like heels, hips, and the sacrum.
- They can also occur on any body part subjected to pressure, shearing forces, or friction.
- The incidence of pressure injuries is high in hospitals, long-term care facilities, and homes.
- In hospitals, the incidence can reach 29%.
- In long-term care facilities, the incidence ranges from 2.6 to 24%.
- The incidence in home settings is unknown but likely significant due to increasing home-based care for older adults.
Pressure Injury Development
- Prolonged pressure on tissue between a bony prominence and an external surface compresses capillaries, disrupting blood flow.
- Relieving pressure allows for increased blood flow, resulting in brief reactive hyperemia without lasting damage.
- Continued pressure leads to platelet aggregation and microthrombi formation, further obstructing blood flow.
- Ischemia and hypoxia occur, leading to tissue necrosis due to cell death.
- Superficial skin injury manifests as blisters, while deeper damage produces a dark reddish-blue appearance.
- Necrotic tissue forms an open wound, potentially exposing bone.
- Inflammation develops with increased temperature, pain, and white blood cell count.
- Secondary bacterial infection is common, causing enzymatic breakdown of necrotic tissue and foul-smelling drainage.
Pressure Injury Etiology
- Pressure injuries develop from external pressure or friction and shearing forces that damage blood vessels.
- External pressure greater than capillary and arteriolar pressure interrupts blood flow.
- Prolonged pressure (>2 hours) on bony prominences leads to tissue ischemia and hypoxia, causing irreversible tissue damage.
- Pressure over a smaller area causes more damage than over a larger surface area.
- Shearing forces occur when one tissue layer slides over another, stretching and bending blood vessels, leading to injury and thrombosis.
- Shearing forces are common in hospitalized patients when the head of the bed is elevated or when they are pulled up in bed.
- Friction and moisture contribute to skin and superficial fascia remaining fixed to the bedsheet while deeper tissues slide during movement, increasing shearing forces.
Pressure Injury Etiology
- Pressure injuries develop due to external pressure on blood vessels or friction and shearing forces that damage vessels.
- External pressure exceeding capillary and arteriolar pressure interrupts blood flow, leading to tissue ischemia and hypoxia.
- Prolonged pressure (over 2 hours) on bony prominences causes irreversible tissue damage.
- Pressure applied to a smaller area causes more damage than pressure distributed over a large surface.
- Shearing forces occur when tissue layers slide over each other, stretching and bending blood vessels, causing injury and thrombosis.
- Elevating the head of a hospital bed can cause shearing forces as the torso slides down, leading to skin fixation to the bedsheet while deeper tissues slide in the direction of movement.
- Pulling patients up in bed also subjects them to shearing forces, emphasizing the importance of lifting patients instead of pulling.
- Friction and moisture exacerbate shearing forces by fixing the skin to the bedsheet, while deeper structures move.
Risk Factors for Pressure Injuries
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Immobility:
- Individuals with limited mobility, including those with paralysis, extreme weakness, pain, or those who have decreased activity are at higher risk for pressure injuries due to the inability to change positions and relieve pressure.
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Inadequate Nutrition:
- Weight loss, muscle atrophy, and loss of subcutaneous tissue increase the risk of pressure injury development.
- Specifically, deficiencies in protein, carbohydrates, fluids, zinc, and vitamin C contribute to pressure injury formation.
- Hypoproteinemia, due to inadequate intake or abnormal loss, predisposes patients to dependent edema, which further weakens the skin and impairs healing.
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Bowel and Urinary Incontinence:
- Moisture from incontinence softens the skin, making it more prone to erosion and injury.
- Enzymes in feces, gastric tube drainage, and urea in urine contribute to skin excoriation, increasing the risk of breakdown and infection.
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Decreased Mental Status:
- Individuals with a reduced level of awareness, those who are unconscious, heavily sedated, or have dementia are at higher risk due to their inability to recognize and respond to pain associated with pressure.
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Diminished Sensation:
- Conditions like paralysis, stroke, or other neurological diseases can cause loss of sensation, hindering the ability to respond to trauma and recognize pressure-related discomfort.
- Older adults are at increased risk for impaired skin integrity due to diminished pain perception resulting from reduced cutaneous end organs.
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Excessive Body Heat:
- Elevated body temperature increases the metabolic rate, leading to increased oxygen demand, particularly under pressure where oxygen deficiency already exists.
- Severe infections with elevated body temperatures can further impact the body's ability to manage pressure-induced tissue compression.
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Advanced Age:
- Changes in skin and supporting structures during aging, including loss of lean mass, thinning epidermis, decreased skin strength and elasticity, and diminished vascular flow, contribute to increased risk of pressure injuries.
- Increased skin dryness due to decreased oil production further elevates the risk for older adults.
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Chronic Medical Conditions:
- Conditions like diabetes and cardiovascular disease can compromise oxygen delivery to tissues, leading to delayed healing and an increased risk of pressure injuries.
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Other Factors:
- Poor lifting and transferring techniques, incorrect positioning, hard support surfaces, and incorrect application of pressure-relieving devices can also contribute to pressure injury development.
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Description
This quiz explores the causes, effects, and prevalence of pressure injuries, commonly known as bedsores. Learn about the factors that contribute to their development and the statistics regarding their incidence in various care environments. Understanding this topic is essential for healthcare professionals to improve patient care.
