Pressure ulcer Presented by: Dr. H. NAJARI Assisted professor Department of infectious disease Qazvin university of medical science

Definition Pressure ulcer, also known as Pressure sores, Bedsores and Decubitus ulcers, are localized injuries to the skin and/or underling tissue that usually occur over a bony prominence The most common sites are the skin overlying the sacrum, coccyx, heels or the hips Elbows, knees, ankles, back of shoulders or cranium can be affected

Bedsores can be developed quickly and often difficult to treat

CONTRIBUTING FACTORS Sustained pressure. pressure applied to soft tissue resulting in completely or partially obstructed to blood flow to the soft tissue Shear is also a cause, as it can pull on blood vessels that feed the skin. Shear occur when two surfaces move in the opposite direction Friction. Is the resistance to motion.it may occur when the skin is dragged across a surface.

RISK FACTORS Comma & paralysis After surgery Poor health and weakness Bed rest and wheelchair use Difficult moving and inability to easily change position while seated or in bed

RISK FACTORS Age Lack of sensory perception Weight loss Poor nutrition Excess moisture or dryness Bowel incontinence Medical condition affecting blood flow Smoking Limited alertness Muscle spasms

STAGING Bedsores fall into one of 4 stage based on their severity management of patients are based on the staging

STAGE I The site is tender, painful, firm, soft, warm or cool Non-broken skin Stage may be difficult to detect The skin appears red, non-blanchable The site is tender, painful, firm, soft, warm or cool

STAGE II Epidermis and part dermis is damaged or lost The wound may be shallow & pinkish or red It look like a fluid-filled or a ruptured blister

STAGE III Full thickness tissue loss The loss of skin usually exposes some fat The dead tissue ulcer looks crater-like The bottom of wound have some yellowish The damage may extend beyond the primary wound blew layers of healthy skin

STAGE IV Full thickness tissue loss with exposed bone, tendon or muscle The bottom of the wound likely contains dead tissue that is yellowish or dark and crusty The damage often extends beyond the primary wound layer of healthy skin

UNSTAGEABLE Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough Yellow, brown, black or dead tissue is covered surface of ulcer It is not possible to see how deep the wound is

Deep tissue injury The skin is purple or maroon but the skin is not broken A blood-filled blister is present The area is painful, firm or mushy The area is warm or cool compared with the surrounding skin In people with darker skin, a shiny patch or a change in skin tone may develop

Bone and joint infections COMPLICATIONS Sepsis Cellulitis Bone and joint infections Cancer