CARE OF AGING SKIN AND MUCOUS MEMBRANES

The skin undergoes several changes with aging. For this reason, the skin has more risk of injury in this stage.

A PRESSURE ULCER is an area of skin that breaks down when something keeps rubbing or pressing against the skin. The tissue that is subjected to excessive pressure doesn't receive enough blood and this situation causes a tissue ischemia and increases the risk of breakdown.

Ulcer development depends on the amount of pressure, the length of time pressure is exerted and the underlying status of the tissues.  For this reason, the bony prominences are where more ulcers appear.

Some complications of pressure ulcer are the infection. The bacteria multiply, the healing is disrupted and damaged tissues.The main symptoms are hot, inflammation, hot, blush and pain.

Pressure ulcers most commonly occur on these locations:

There are a lot of risk factors which cause a pressure ulcer, but the most important are:

• Immobility and inactivity are the most important risk factors which cause ulcer development because the patient lies or sits too long in the same position.
• Skin aging and skin diseases.
• Person have a disease that affects blood flow, including diabetes or vascular disease.
• Urinary or Bowel incontinence.
• Loss of thermal sensation and pain.
• Person who have another condition that affects his mental status such as Alzheimer's disease.
• Malnutrition.
• Wrinkles on clothes or sheets and objects touching the skin.

It's very important to use the NORTON SCALE to value the risk of develop pressure ulcer. This scale has a sensitivity of 73-92% and a specificity of 61-94%.

Physical Condition	Mental Condition	Activity	Mobility	Incontinent	TOTAL SCORE
Good	Alert	Ambulant	Full	Not	4
Fair	Apathetic	Walk/Help	Slightly	Ocasional	3
Poor	Confused	Chairbound	Very limited	Usually/urine	2
Very bad	Stupor	Bed	Immobile	Doubly	1

• Norton Rating between 5 to 9 VERY HIGH RISK
• Norton Rating between 10 to 12 HIGH RISK
• Norton Rating between 13 to 14 MEDIUM RISK
• Norton Rating  >14  LOW RISK

An other scale used to value the pressure ulcer risk is:

THE BRADEN SCALE FOR PREDICTING PRESSURE SORE RISK.

CLASSIFICATION

Pressure ulcers are unstageable when the skin at the base of the ulcer is covered by necrotic tissue. 

• STAGE I: Erythema that when pressed, doesn't turn white/ There isn't epidermis's involvement.
• STAGE II: The skin blisters or forms an open sore. The area around the sore may be red and irritated./ Partial-thickness skin loss including epidermis.
• STAGE III: Full-thickness skin loss and injury or necrosis of the subcutaneous tissue.
• STAGE IV: Full-thickness skin loss and injury or necrosis of the subcutaneous tissue, muscle and bone.

CLICK TO WATCH VIDEO: PRESSURE ULCERS

GENERAL TREATMENT

The treatment is choosen according to the pressure ulcer's stage and the main objetive is heal the injury.

1. STAGE I: Relieve pressure and hyperoxygenated fatty acids.
2. STAGES II,III and IV: Debride necrotic tissue, clean with physiological saline or antiseptics (debridement or infection), bacterial infection prevention, decrease pain, choose the adequate dressing according to the pressure ulcer's characteristics: exudate level, infection, ulcers's stage...

PREVENTION

1. Keep the skin clean and dry, above all, after urinating or having bowel movement.
2. Moving and changing position frecuently (at last every 2 hour)
3. Use items that help reduce pressure (decubitus mattress, pillows, foam padding...)
4. Control uranary incontinence and bowel incontinence.
5. Eat well-balance meals and drink plently of water.

CLICK TO WACH VIDEO: PRESSURE ULCERS PREVENTION (in spanish)

I consider that the most pressure ulcer development may be prevented with a good health care. 
It's true that nurses sometimes haven't got enought time for all patients, but they should pay more attention to this type of patientes, above all the patients who have high risk of pressur ulcer's development. 

WE MUSTN'T FORGET THAT 95% OF THE PRESSURE ULCERS ARE AVOIDABLE

Bibliografía

MEDLINEPLUS