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    Pressure Ulcers Simplified

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    Pressure Ulcers Simplified

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    Pressure Ulcers Simplified

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    © All Rights Reserved
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    of 8

    10

    PRESSURE
    ULCERS
    SIMPLIFIED

    This leaflet is intended to give you


    information and answers to some question
    you may have around pressure ulcers
    PRESSURE ULCERS SIMPLIFIED

    Pressure ulcer development has become an indicator


    of the quality of nursing care. From July 2012 all NHS
    organisations are expected to collect data of harms, which
    includes pressure ulcer prevalence using the NHS
    Safety Thermometer (The NHS Information Centre, 2012).
    Protection of the individual patient from pressure damage is a fundamental aspect of
    nursing care (Wounds UK, 2013) and is the responsibility of every clinician. Pressure
    ulcers can affect patients in every healthcare setting and are seen in all age groups.

    WHAT IS A PRESSURE ULCER?


    The European Pressure Ulcer Advisory Panel (EPUAP, 2014) defined pressure ulcers as
    a localised injury to the skin and/or the underlying tissue, usually over a bony
    prominence, as a result of pressure or pressure in combination with shear.’
    The main causes of pressure ulceration are:
    • Shear • Underlying health issues
    • Friction • Extremes of age
    • Unrelieved pressure • Incontinence, both urinary and faecal
    • Reduced mobility (Ousey, 2011)
    • Poor nutrition
    These intrinsic or extrinsic factors will increase a patient’s risk of pressure ulcer
    development.

    INTRINSIC FACTORS WITHIN THE PATIENT

    Malnutrition Caused by chronic disease, major surgery, nil by mouth status and neglect

    Immobility Sedation, anaesthesia, paralysis, pain, major trauma and chronic diseases

    Age Loss of sensation

    Medical condition Congestive cardiac failure, chronic respiratory disease, diabetes, anaemia
    and neurological disease

    Dehydration Slows down the body’s metabolism, reduces skin rigidity, more
    vulnerable to new wounds

    www.activheal.com
    Tel: 08444 125 755
    EXTRINSIC EXTERNAL FACTORS

    Pressure Compression of tissue between bone and hard surface

    Shear Shear forces initiated when part of the body tries to move but the surface
    remains motionless against the support surface

    Friction Friction forces occur when the shearing force increases sufficiently to
    overcome the body’s resistance to being moved, the area of tissue in contact
    with the support surface will then begin to slide

    Moisture Can be caused by incontinence, sweating, high temperature and


    wound exudate
    The patients skin can adhere to the damp surface and exacerbate damage

    WHERE DO PRESSURE ULCERS OCCUR?


    Most pressure ulcers appear over major weight bearing parts of the body. The sacrum
    and heels are the most common sites of ulcer development (Wilson, 2010). This is
    because of the impact on the thin protection layer when forces of pressure, sheer and
    friction are applied during motion. Also, there is often a reduced blood supply to the
    extremity due to comorbidites that compromise the vascular system (eg diabetes),
    Wounds Essentials (2012).

    Back Shoulder Elbow Buttocks Heel


    of the
    head

    Shoulder Elbow Thigh knee Leg Toe

    Ear Shoulder Elbow Hip Thigh Leg Heel

    For further reading visit: www.activheal.com/education


    DEVICE RELATED PRESSURE ULCERS
    It is known that a significant proportion of pressure ulcers in critically ill or immobile
    patients are related to the use of medical devices (Black et al, 2010). These are not
    always avoidable and require techniques to help reduce or prevent skin damage
    beneath medical devices. Medical devices including naso-gastric tubes and ventilation
    masks are made of rigid material, which can cause rubbing or create pressure on the
    soft tissues (Jaul, 2010). Many device related pressure ulcers occur because of poor
    positioning or fixation of equipment, or simply failure to check the device is repositioned
    correctly.

    Preventing device related pressure ulcers:

    • Correct positioning and care of equipment with appropriate fixation and stabilisation
    of the device
    • Use thin hydrocolloids, film dressings or barrier products underneath the device to
    reduce moisture friction and shear
    • Use of pressure reducing dermal gel pads (Fletcher, 2012)

    PRESSURE RELIEF EQUIPMENT


    Pressure ulcers will not be able to heal if they continue to be subjected to the forces that
    caused them. The equipment works by redistributing the pressure over a greater area of
    the body, so that the individual point supports less pressure.

    REPOSITIONING
    Involves moving patients into different positions, in order to remove or redistribute
    pressure from a particular part of the body.
    SKIN CARE
    Skincare is crucial to prevent any further breakdown of the skin, in addition to improving
    its tolerance. The skin should be inspected and cleansed regularly. When cleansing, a
    PH neutral agent should be used. After washing, the skin, the skin should be patted dry
    and emollient used to rehydrate any dry skin. Moisturising the skin to reduce dryness
    may help to reduce the risk of breakdown and enhance skin health (Stephen-Haynes
    2011). Prevention of skin breakdown is paramount. Barrier creams can be effective and
    used to prevent breakdown of intact skin and protect vulnerable skin.

    NUTRITION
    Good nutrition is essential in the management of pressure ulcers. Adequate nutritional
    intake is essential to wound healing. Patients may need a greater proportion of protein in
    their diet, to help ensure a positive nitrogen balance and replace any lost protein through
    their ulcers. A patient’s nutritional status should be assessed.

    WOUND CARE
    Wound care must be optimised and follow the basic principles of wound care:

    • Debride necrotic or sloughy tissue and clean the wound to remove any debris
    • Provide a moist wound healing environment through the use of appropriate dressings
    • Maintain an optimal bacterial balance
    • Protect the wound from further injury

    PATIENT EDUCATION
    The role of education is to gain the best outcome for the patient. This is achieved
    through the effective teaching of the patient and family about the principles of pressure
    ulcer management.

    Advanced Medical Solutions


    Premier Park, Road One, Winsford Industrial Estate, Winsford, Cheshire CW7 3RT
    GRADE 4

    • Full thickness tissue loss with exposed bone, tendon


    or muscle
    • Slough or eschar may be present
    • Often includes undermining and tunnelling
    • Depth varies depending on thickness of
    subcutaneous tissue
    • Can cause osteomyelitis or osteitis

    UNSTAGEABLE

    • Full thickness tissue loss with exposed bone,


    tendon or muscle
    • Slough or eschar may be present
    • Often includes undermining and tunnelling.
    • Depth varies depending on thickness of
    subcutaneous tissue
    • Can cause osteomyelitis or osteitis

    DEEP TISSUE INJURY

    • Purple or maroon area of discolouration


    • Intact skin or blood filled blister
    • Tissue may be painful, firm, mushy, boggy, warmer or
    cooler as compared to adjacent tissue

    Copyright © Advanced Medical Solutions Limited 2018


    For further reading visit: www.activheal.com/education
    EPUAP (EUROPEAN PRESSURE ULCER
    ADVISORY PANEL) PRESSURE ULCER
    CLASSIFICATION 2014

    GRADE 1

    • Intact skin with non-blanching redness of the localised


    area usually over a bony prominence
    • The area may be painful, firm, soft, warmer or cooler
    as compared to adjacent tissue
    • May indicate patient at risk

    GRADE 2

    • Partial thickness loss of dermis presenting as a shallow


    open ulcer with a pink wound bed without slough
    • May also present as an intact or ruptured serum
    filled blister
    • Shiny or dry shallow ulcer without sloughing or bruising
    • Not to be confused with skin tears, tape burns,
    moisture lesions
    • Bruising indicates deep tissue injury

    GRADE 3

    • Subcutaneous fat may be visible, but bone, tendon or


    muscle are not exposed
    • Slough may be present but does not obscure the
    depth of tissue loss.
    • May include undermining or tunnelling
    • Depth varies depending on subcutaneous tissue
    CONCLUSION
    Pressure ulcers are a serious health problem. Prevention and early intervention are
    critical for effective management. Successful prevention is key but requires a
    comprehensive approach.

    Mobilisation if able to is an important component in the management of pressure ulcers,


    as being immobile can have significant consequences. Encourage and assist the
    patient to move or shift into a new position. Mobilisation will help to reduce the duration
    and magnitude over vulnerable areas of the body.

    Management and treatment of pressure ulcers

    The management and treatment of pressure ulcers involves ensuring that all the
    contributory causes have been addressed. The main aims of pressure ulcer
    management are:

    • Reduce shear and motion using a suitable support surface


    • Manage the skin’s microclimate
    • Create an optimal wound healing environment
    • Improve patient comfort

    References:
    European Pressure Ulcer Advisory Panel (2014) Prevention and treatment of pressure ulcers: quick reference guide.
    Washington DC, United States of America: National Pressure Ulcer Advisory Panel. Moore,Z. Thorpe,E. (2015)
    Dressing for pressure ulcer prevention made easy. London:Wounds UK. Available from www.wounds-uk.com. NHS
    Information Centre(2012) Available at:http://ic.nhs.uk/services/nhs-safety-ther-mometer. Ousey,K. (2011) Pressure
    Ulcers: How to identify different categories. Wound Essentials. Vol 6 pg8-12. Wilson,M. (2010) A brief guide to pressure
    ulcer assessment. Wound Essentials. Vol 5. P 12-20. Wound essentials (2012) Pressure ulcer management how to
    guide. Vol 7 Issue 1 June. Black, J., Cuddington, J., Walko, M., Didier, L.A., Lander, M.J. and Kelpe, M.R. (2010)
    Medical Device Related Pressure Ulcers in Hospitalized Patients. International Wound Journal. 7 (5) 358-65.
    Stephen-Haynes, J. (2011) Skin Damage: Management in the Older Person. Wound Essentials. 6. 40-43. Jaul, F. (2011)
    A Prospective Pilot Study of Atypical Pressure Ulcer Presentation in a Skilled Geriatric Nursing Unit Ostomy Wound
    Management.57 (2) 49-54. Fletcher, J. (2012) Device Related Pressure Ulcer. Made Easy Wounds UK. HYPERLINK
    “http://www.wounds-uk.com” www.wounds-uk.com.

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