DERM.pdf

Disease Pressure Ulcer (Decubitus ulcer, pressure sore) Picture Etiology Localized damage to skin and underlying soft tissue over bony prominence Intense or prolonged pressure Pathophysiology Epidemiology 70% over the age of 70 Hospitalized patients Patients in wheelchairs Risk Factors...

Disease Pressure Ulcer (Decubitus ulcer, pressure sore) Picture Etiology Localized damage to skin and underlying soft tissue over bony prominence Intense or prolonged pressure Pathophysiology Epidemiology 70% over the age of 70 Hospitalized patients Patients in wheelchairs Risk Factors Immobility Incontinence Poor nutrition and hydration Medical conditions affecting blood flow History (Symptoms) Discolored skin/patches Pain or pruritus in affected area Physical Exam (Signs) DDx Stages of presentation: Stage 1: no blanchable erythema of intact skin Stage 2: Partial-thickness skin loss incontinence-associated with expoed dermis (no visible fat) dermatitis Stage 3: Full-thickness skin loss Skin tear (subacute, visible fat) Hematoma Stage 4: Full-thickness skin and necrotising fasciits tissue loss (undermining is likely) Unstageable: Obscured full-thickness skin and tissue loss Diagnostic Eval Diagnosis determined by exam Medical Management Stage 1 & 2: non-opertive, wound care is conservative: -Pressure reduction: repositioning and use of support surfaces -Wound management-debridement, cleasning agents, dressings, antimicrobials -Negative-pressure wound therapy, electrotherapy Stage 3&4: operative -Flap reconstruction, some lesions may be treated conservatively b/c of coexsiting medical Patient education Key Principles: -Reduction of pressure (rotate every 2 Prognosis: hours) 70-90% of pressure -Adequate debridement of necrotic and injuries are superficial devitalied tissue and heal by second -Control of infection intention -Meticulous wound care