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:
- 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.
- Wrinkles on clothes or sheets and objects touching the skin.
- 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
- 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.
- STAGE I: Relieve pressure and hyperoxygenated fatty acids.
- 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...
- Keep the skin clean and dry, above all, after urinating or having bowel movement.
- Moving and changing position frecuently (at last every 2 hour)
- Use items that help reduce pressure (decubitus mattress, pillows, foam padding...)
- Control uranary incontinence and bowel incontinence.
- Eat well-balance meals and drink plently of water.
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.