Bone Anatomy and Pressure Ulcers By Manuel A. Gallegos RN, BSN

Objectives: 1. Introduction to function and anatomy of the skeleton 2. Define pressure ulcer 3. Identify stages and risk areas 4. Prevention of Decubitus Ulcers

Function of Bones Vital organs: brain, heart, lungs are protected by the skeletal system (bones) Blood cells are produced by bone marrow Bones serve for structure and locomotion (movement)

Bone Marrow

Skeleton / Bones

Question 1 Answer: 1. B and C Only 2. A and D. 3. All of the above Bones have which functions? A. Assist with movement of blood B. Bones produce blood cells C. Protects vital organs that include brain and heart Answer: 1. B and C Only 2. A and D. 3. All of the above 4. None of the Above

Define Pressure Ulcer A pressure-induced ulceration of the skin occurring in persons confined to bed for long periods of time

Other Names for Pressure Ulcer Bed Sore Decubitus Ulcer Pressure Sore Ulcer

Causes of Pressure Ulcers Client is in one position for too long (in bed, wheelchair, or chair) and may be under-nourished Constant pressure against the skin reduces blood supply to skin and underlying tissue

Happens in areas that are not well padded with muscle or fat such as sacrum, heels, hips, shoulder blades, elbows Pressure sores are more likely to occur if client is immobilized by illness, or injury – stroke / brain injury Spinal cord injuries – paraplegia / quadriplegia

All of the following cause Pressure Ulcers except? 1. Client is in one position for too long 2. Happens in areas that are well padded with muscle or fat 3. Constant pressure against the skin reduces blood supply to skin 4. Spinal cord injuries – paraplegia / quadriplegia ANSWER: 2. Happens in areas that are well padded with muscle or fat

Stages of Pressure Ulcers

Stage I, Skin intact

Stage II

Stage III

Stage IV

Deep Tissue

Unstageable – deep and dead

Pressure Ulcer on Sacrum

Heel ulcer with black dead tissue

Pressure ulcer risk areas

Multiple Ulcers in the Sacral Area

Prevention of Pressure Ulcers Change position frequently or every (two-six) hours if client has a pressure ulcer or cannot move by themselves Pad boney areas with padding or pillows Daily skin inspection for pressure sores Report any new red areas or new skin breakdown – keep pressure off the area

Question 2 An 83 year old woman in your care cannot walk and is confined to her bed. You make sure she does not develop skin breakdown by: A) Checking patient’s skin at least once a day. B) Changing position at least every ten hours. C) If an area of skin is red or discolored, keep pressure off the area D) A and C only E) None of the above Answer? D answer?

Summary 1. Bones provide protection of vital organs, allow movement, produce red blood cells 2. Pressure ulcers are areas of damaged skin and tissue that develop when sustained pressure cuts off circulation (blood) to skin areas especially the skin on sacrum and heels 3. Prevent ulcers by checking the patient everyday, changing position often, reporting damaged skin promptly

Websites http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/ http://www.thefreedictionary.com/bedsore