Pressure ulcers

See ((chronic nonhealing wounds))
See ((wounds))
Pressure injuries.

Refers to localized injury to the skin and underlying tissues, which are usually over bony prominences.

Pressure injuries result from tissue trauma occurring at the sites of increased mechanical force-such as pressure, shear, or friction.
Immobility, the health of the affected tissue, tissue perfusion are directly associated with the development of a pressure injury.
Additional factors include nutrition, the presence of moisture, diabetes, and low albumin levels.
Most commonly, pressure injuries are found on bony prominences.
At bone prominences forces increase on adjacent tissues, particularly in the sacrum and heel.
Prevalence of pressure injuries in the US care facilities is estimated at 8.8% (2015).

A mostly preventable complication of medical care.

Pressure injuries can be classified into four stages of increasing gap in severity using: theNationalPressure UlcerAdvisoryPanel staging system.

Long-term care residents are at high risk because of immobility, impaired nutrition, impaired mental status, and incontinence.

Associated with adverse effects on health, quality of life and well-being.

Seen in up to 17% of hospitalized patients and at least 12% in nursing home patients.

The elderly account for approximately 70% of all pressure ulcers.

Dry skin over the sacrum is a significant risk factor.

Incontinence care with a foam cleanser and an emollient decreases pressure ulcer incidence.

Hospitalized older adults with pressure ulcers are 2 times more likely to die within 30 days after discharge.

In-hospital pressure ulcers associated with greater risk of death arrhythmia 1 year after hospital discharge.

More than 85% spinal cord injured patients will have an infected pressure ulcer at least once in their life, 70% have multiple infected pressure ulcers (Anson CA et al).

Common among nursing home resident.

Prevalence among high risk nursing home residents is higher among black residents than among white residents (Li Y et al).

Pressure redistribution foam mattresses significantly reduce pressure ulcer incidence.

Nutritional supplements are associated with a small prevention effect.

Prevention of pressure injuries rests on the identification of patients at risk.
Immobility, the health of the affected tissue, tissue perfusion are directly associated with the development of a pressure injury.
Interventions to prevent pressure injury include: frequent mobilization and repositioning, although limited evidence supports this practice.
Pressure offloading is a common prevention tool and specialized mattresses are standard in preventing formation of pressure injury.
Pressure offloading of an affected site is the cornerstone of treatment.
The avoidance of excessive moisture drainage in optimal nutrition are important as preventative measures.
Offloading may be accomplished with a cushion, specialized mattress, and heel protection boots.

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