1. Treatment and prevention of pressure ulcers Lara Álvarez Estévez

2. Index: 1. Definition 2. Risk factor's 3. Classification 4. Prevention 4.1 Skin Care 4.2 Postural changes 4.3 Nutritional care 5.Treatment 5.1 Debridement of necrotic tissue. 5.2 Clean the wound. 5.3 Prevention and addressing bacterial infection. 5.4 Select an appropriate dressing. 5.5 Maintaining the surrounding skin intact.

3. 1.Definition: Pressure ulcers Wounds or skin and surrounding tissues lesions caused by a blockage in both blood and lymphatic irrigation. Continuous pressure Ischemia

4. 2. Risk factors: Excessive uniaxial pressure Pressure ulcers Friction and shear forces Impact injury Heat Moisture Posture Immobility Sensory loss Age Disease Body type Poor nutrition Infection Incontinence Extrinsic Factors Intrinsic Factors

5. 3. Classification: Grade I Grade III Grade IV Grade II

6. 3. Classification:

7. 4. Prevention: 4.1 Skin Care: We will make a general cleaning every 24 hours following the protocol. Skin hygiene Thorough drying without friction - Warm water - Neutral soap skin - Cleared up Folds

8. 4. Prevention: 4.1 Skin Care: Complete absorption of creams Alcohols, colonies. Massaging. We must examine the state of the skin daily

9. 4. Prevention: 4.2 Postural changes:  Bedridden people  Sit people Scheduled and custom changes. 2 hours 15 minutes Register

10. 4. Prevention: 4.2 Postural changes: We must take into account: - We must maintain body alignment, distribution of weight, balance and stability. - We must not drag the patient. - We have to avoid direct contact of bony prominences. - The bed must be clean, dry and wrinkle. - The elevation of the head mustn´t exceed 30 degrees. - Monitoring probes, masks...

11. 4. Prevention: 4.2 Postural changes:  Supine  Lateral decubitus  Prone position  Sit

12. 4. Prevention: 4.3 Nutritional care: Diet appropriate to the patient's needs: -Dietary control. -Weight control. -Amounts of water and proteins must be sufficient. -If needed, give supplements of protein, calories, multivitamins. -Avoid food that produces gas or diarrhea.

13. 5. Treatment:  Ulcers grade I care: 1. To relieve pressure in the affected area. 2. Using hyper-oxygenated fatty acids. 3. Uso de medidas locales en el alivio de la presión.

14. 5. Treatment:  Ulcers grade II, III, IV care: 1. Debridement of necrotic tissue. 2. Clean the wound. 3. Prevention and treatment of bacterial infection. 4. Select an appropriate dressing. 5.Maintain the surrounding skin intact.

15. 5. Treatment: 5.1 Debridement: Elimination of dead tissue to improve the health of the remaining one. Types: - Surgical - Chemical (enzymatic) - Mechanics - Autolytic

16. 5. Treatment:  Surgical debridement: Using scalpel or scissors. It requires knowledge and skill. It must be made in layers, starting from the central area. Fast method. Analgesic Pain

17. 5. Treatment:  Chemical debridement: Enzyme products. Chemical removal of necrotic tissue. It promotes the growth of granulation tissue.  Mechanical debridement: In disuse. Unselective and traumatic technique. Mechanical abrasion.

18. 5. Treatment: 5.2. Lesion cleaning Physiological saline solution Pressure sink: - Gravity - 35 ml syringe with a 19 mm needle and a pressure of 2kg/cm²

19. 5. Treatment: 5.3. Prevention and treatment of bacterial infection: Classic symptoms: - Inflammation (erythema, edema, tumor, heat) - Pain - Odor - Purulent exudate Intensify cleaning and debridement

20. 5. Treatment: 5.4. Select an appropriate dressing: Protect the wound. Eliminate and control exudates. Be adaptable. Respect the surrounding skin. Keep wet the ulcer and dry the surrounding skin.

21. 5. Treatment: 5.5 Maintaining the surrounding skin intact: The most common surrounding skin problems are: - Mashing - Pain - Desquamation - Blisters - Erythema - Edema - Pruritus

22. Bibliography: http://www.cgtsanidadlpa.org/f/opes/aux_enfermeria/T20-AE-SCS-2007.pdf http://www.epuap.org/guidelines/QRG_Treatment_in_Spanish.pdf http://escuela.med.puc.cl/publ/manualgeriatria/PDF/EscarasUlceras.pdf http://www.cruzroja.es/centros_sanitarios/Palma/img/pdf/UPIPC.pdf https://www.nlm.nih.gov/medlineplus/spanish/ency/patientinstructions/000147.htm http://www.guiasalud.es/GPC/GPC_520_Ulceras_por_presion_compl.pdf http://www.sergas.es/busca?k=ulceras http://www.auladae.com/pdf/cursos/capitulo/ulceras_especial.pdf http://medicinafamiliar.uc.cl/html/articulos/390.html http://gneaupp.info/wp-content/uploads/2014/12/prevencion-diagnostico-y-tratamiento-de-las-ulceras http://gneaupp.info/wp-content/uploads/2014/12/prevencion-diagnostico-y-tratamiento-de-las-ulceras por-presion.pdf