022.pressure Sore (Bedsores) - 1

PRESSURE SORE(bed sores)
CONTENTS
1. Definition
2. Pathophysiology
3. Epidemiology
4. Common sites for bedsores
5. Risk Factors for bedsores
6. Causes of bedsores
7. Clinical Features
8. Differential diagnosis
9. Diagnosis
10.Treatments
11.Prevention
DEFINITION
• Pressure sore is tissue necrosis and ulceration due to
prolonged pressure. OR
• A pressure ulcer is localized injury to the skin
and/or underlying tissue, usually over a bony
prominence, as a result of pressure, or pressure in
combination with shear and/or friction
EXAMPLES OF PRESSURE SORES
PATHOPHYSIOLOGY
Blood flow to the skin stops once external pressure becomes
more than 30 mm Hg (more than capillary occlusive pressure)
and this causes tissue hypoxia, necrosis and ulceration. It is more
prominent between bony prominence and an external surface.
It is due to
• Impaired nutrition.
• Defective blood supply.
• Neurological deficit.
EPIDEMIOLOGY
• Bedsores is most common in black than white
• Male than female
• Most in older patient more than 65 aged
COMMON SITES OF BEDSORES
 Sacrum (tail bone)- most common site
-Semi-fowlers’ position
-Slouching in bed or chair
-higher risk in tube fed or incontinent patients.
 Heels- 2nd most common
-Immobile or numb legs
-Leg traction
-Higher risk with PVD(peripheral vascular disease)& diabetes
neuropathy
COMMON SITES OF BEDSORES…………..
 Trochanter (hip bone)
-Side lying
-Highest risk contractured residents
-Ulcers on lateral foot rather than heel itself
 Ischium (sitting erect bone)
-highest risk paraplegics
 Over the shoulder.
 Occiput.
RISK FACTORS
 Normal stimulus to relieve the pressure is absent in anaesthetized
patients
 Nutritional deficiencies worsens the necrosis
 Inadequate padding over the bony prominences in malnourished
patients
 Urinary incontinence in paraplegia patient causes skin soiling –
maceration – infection – necrosis
 Immobility
 Bedridden patient
CAUSES OF BEDSORES
Shearing.
 This is where pushing or pulling the skin means more than one layer of skin slides against
each other and this can cause damage to these layers or they may become detached from
each other all together.
Friction.
 This is where two surfaces rub together, so this could be the skin and bed sheets, or a
chair cushion, etc., or poorly fitting clothing or manual handling aids. Hot, moist skin is likely
to experience even more damage from friction than more healthy skin.
Pressure.
 A perpendicular load of force exerted on a unit of area (this could be a patients body weight
bearing down on a hip or sacrum).
 It causes local capillary occlusion (reduction in blood supply) and compresses the
structures between the skin surface and bone. The damage can often be caused under the
skin, but not become obvious until the skin above it has broken down.
Neurological causes
 Diabetic neuropathy
 Peripheral neuritis
 Tabes dorsalis
 Spina bifida
 Leprosy
 Spinal injury
 Paraplegia
 Peripheral nerve injury
 Syringomyelia
Pressure Ulcer Staging Classification
 Stage 1 – Intact skin with non-blanchable

redness of a localized area, usually over a
bony prominence. The area may be painful,
firm, soft, warmer or cooler than adjacent
tissue.
 Stage 2 – Partial thickness skin loss, presenting as a shallow
open ulcer with a red-pink wound bed without slough. May
also present as an intact or open serum-filled blister. Includes
tears, tape burns, maceration or excoriation.
 Stage 3 – Full thickness skin loss. Fat may be visible but bone,
tendon or muscle tissue
are not. Slough may be present
 Stage 4 – Full-thickness
tissue loss with exposed
bone, tendon or muscle.
Slough or
eschar may be present.
CLINICAL FEATURES
Unusual changes in skin color or texture
Swelling
Pus-like draining
An area of skin that feels cooler or warmer to the touch
than other areas
Tender areas
Differentials
Moisture associated dermatitis
Arterial ulcers
Venous ulcers
Diabetic foot
Diagnosis
The diagnose is made clinically through complete history taking

physical examination and local examination
 Although some investigation can be done
Pus for culture and sensitivity
Full blood picture
Random blood glucose
• Study of discharge, blood sugar, biopsy from the edge,
X-ray of the part, X-ray spine.
Management
Regular dressing
Changing the patients position every 2 hours
Drying the bedridden patient to avoid moist
 Antibiotics
Physiotherapy to bedridden patient
Management cont.……………..
Encourage patients to maintain their nutrition:
– Meat, fish, or alternatives.
– Fruit and vegetables.
– Bread, potatoes and cereals.
– Cheese, milk and dairy products.
– Plenty of fluids stop the skin becoming dehydrated and
can reduce the risk of ulceration.
prevention
Regular exercise
Using pillows
Keep skin clean and dry
Changing position frequently

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PRESSURE SORE(bed sores)

 Stage 1 – Intact skin with non-blanchable

The diagnose is made clinically through complete history taking

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