Pressure Ulcers: Difference between revisions
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Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.<br> | Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.<br> | ||
== SITES == | == SITES == | ||
The areas most susceptiblle to pressure in recumbent position include: | The areas most susceptiblle to pressure in recumbent position include: | ||
*<u>SUPINE</u> : <u></u> | *<u>SUPINE</u> : <u></u> | ||
#Occiput | #Occiput | ||
Line 38: | Line 38: | ||
#Vertebrae | #Vertebrae | ||
#Elbows | #Elbows | ||
#Sacrum | #Sacrum | ||
#Coccyx | #Coccyx | ||
#Heels | #Heels | ||
*<u>PRONE</u> :<u></u><u></u> | *<u>PRONE</u> :<u></u><u></u> | ||
#Ears (head rotated) | #Ears (head rotated) | ||
#Shoulders (anterior aspect) | #Shoulders (anterior aspect) | ||
#Illiac crest | #Illiac crest | ||
#Male genital region | #Male genital region | ||
#Patella | #Patella | ||
#Dorsum of feet | #Dorsum of feet | ||
Line 54: | Line 54: | ||
#Scapulae | #Scapulae | ||
#Vertebrae | #Vertebrae | ||
#Elbows | #Elbows | ||
#Sacrum | #Sacrum | ||
#Coccyx | #Coccyx | ||
#Heels | #Heels | ||
#Ears | #Ears | ||
#Shoulders (lateral aspect) | #Shoulders (lateral aspect) | ||
#Greater trochanter | #Greater trochanter | ||
#Head of fibula | #Head of fibula | ||
#Knees (medial aspect from contact between knees) | #Knees (medial aspect from contact between knees) | ||
#Lateral malleolus | #Lateral malleolus | ||
#Medial malleolus (contact between malleoli) | #Medial malleolus (contact between malleoli) | ||
<br> | |||
== Outcome Measures == | == Outcome Measures == |
Revision as of 12:26, 4 December 2016
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DEFINITION[edit | edit source]
The National Pressure Ulcer Advisory Panel,U.S (NPUAP) defines a pressure ulcer as an area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis.
The terms decubitus ulcer (from Latin decumbere, “to lie down”), pressure sore, and pressure ulcer often are used interchangeably
PATHOPHYSIOLOGY[edit | edit source]
In 1873, Sir James Paget described the production of pressure ulcers remarkably well, and his description is still quite accurate today.
Many factors contribute to the development of pressure ulcers, but pressure leading to ischemia and necrosis is the final common pathway.
Pressure ulcers result from constant pressure sufficient to impair local blood flow to soft tissue for an extended period. This external pressure must be greater than the arterial capillary pressure (32 mm Hg) to impair inflow and greater than the venous capillary closing pressure (8-12 mm Hg) to impede the return of flow for an extended time.Tissues are capable withstanding enormous pressures for brief periods, but prolonged exposure to pressures just slightly above capillary filling pressure initiates a downward spiral toward tissue necrosis and ulceration. The superficial dermis can tolerate ischemia for 2 to 8 hours before breakdown occurs. Deeper muscle, connective, and fat tissues tolerate pressures for 2 hours or less. Thus, there may be significant damage to underlying tissues while the epidermis and dermis remain intact.
Other factors contributing to pressure ulcers include-
- Friction
Friction is the resistance to motion. It may occur when the skin is dragged across a surface, such as when you change position or a care provider moves you. The friction may be even greater if the skin is moist. Friction may make fragile skin more vulnerable to injury.
- Shear
Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.
SITES[edit | edit source]
The areas most susceptiblle to pressure in recumbent position include:
- SUPINE :
- Occiput
- Scapulae
- Vertebrae
- Elbows
- Sacrum
- Coccyx
- Heels
- PRONE :
- Ears (head rotated)
- Shoulders (anterior aspect)
- Illiac crest
- Male genital region
- Patella
- Dorsum of feet
- SIDE-LYING -
- Scapulae
- Vertebrae
- Elbows
- Sacrum
- Coccyx
- Heels
- Ears
- Shoulders (lateral aspect)
- Greater trochanter
- Head of fibula
- Knees (medial aspect from contact between knees)
- Lateral malleolus
- Medial malleolus (contact between malleoli)
Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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References[edit | edit source]
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