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Pressure Ulcer Management - PowerPoint PPT Presentation


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Pressure Ulcer Management. By Susan Yap, PT. Anatomy of the Skin. Epidermis Dermis Subcutaneous Tissue Fascia Muscle Tendon and Bone. Functions of the Skin. Protection Regulates Body Temperature Sensation. Effects of Aging on Skin. Dehydration Reduced Subcutaneous Fat

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Presentation Transcript
anatomy of the skin
Anatomy of the Skin
  • Epidermis
  • Dermis
  • Subcutaneous Tissue
  • Fascia
  • Muscle Tendon and Bone
functions of the skin
Functions of the Skin
  • Protection
  • Regulates Body Temperature
  • Sensation
effects of aging on skin
Effects of Aging on Skin
  • Dehydration
  • Reduced Subcutaneous Fat
  • Decreased Vascularization
  • Decreased Elasticity
physiology of wound healing
Physiology of Wound Healing
  • Healing by primary intention- wound edges are brought together and sutured
  • Healing by secondary intention- wound edges are not brought together and must heal by granulation, contraction and epithelialization
phases of wound healing
Phases of Wound Healing
  • Inflammatory Phase
    • Acute Phase = Vasoconstriction and clot formation
    • Followed by demolition phase
    • Chronic inflammation results in wound is overwhelmed by necrotic tissue
    • Characteristics: Edema, Erythema, Pain, Necrotic tissue and Exudate
  • Proliferative Phase
    • Granulation Tissue fills wound bed
    • Angiogenesis
    • Epidermal cells migrate across granulation tissue
    • Contraction of wound edges
    • Characteristics: Deep red granulation tissue, Transudate, Epithelialization occurring
  • Maturation Phase
    • Increase in tensile strength through collagen synthesis
    • Resulting scar tissue 70-80% as strong as original skin
    • Characteristics: Decrease vascularization, Increase tensile strength, Decrease size of scar
pressure ulcer
Pressure Ulcer

Any lesion cause by unrelieved pressure resulting in damage of underlying tissue ; usually over a bony prominence.

risk assessment
Risk Assessment
  • Impaired circulation
  • Impaired Mobility
  • Predisposing Illness or medication that impair healing
  • Decrease mental status
  • Incontinence
  • Nutritional deficits
  • Patients with existing pressure ulcer
  • Non compliance
early intervention
Early Intervention
  • Team Effort
  • Address functional mobility and ROM
  • Continence training
  • Education
  • Positioning
  • Pressure relieving/reducing devices
mechanical loading and support surfaces
Mechanical Loading and Support Surfaces
  • Bed bound
  • Chair bound
  • Avoid positioning directly on the trochanters
  • Positioning devices to relieve all pressure from the heels and to prevent direct contact to bony prominences
  • Prevent sheer injury
  • Ring cushions should be avoided
  • Support surfaces
initial evaluation
Initial Evaluation
  • Holistic approach
  • Functional mobility and ROM
  • Nutritional status
  • Pain level
  • Psychosocial health
  • Common complications of pressure ulcer
wound assessment
Wound Assessment
  • Etiology
  • Location
  • Size
pressure ulcer1
Pressure Ulcer
  • Stage I - Red non-blanchable
  • Stage II - Partial thickness skin loss
  • Stage III – Full thickness skin loss involving underlying subcutaneous tissue
  • Stage IV – Full thickness skin loss with extensive destruction damage to muscle bone
viable tissue
Viable Tissue
  • Granulation
  • Epithelialization
drainage exudate
Drainage/Exudate
  • Amount
  • Transudate/serous
  • Purulent
slide21
Odor
  • Describe
  • Intensity
  • Result of autolytic debridement or dressing
developing goals
Developing Goals
  • Process Oriented
  • Measurable
  • Time Oriented
debridement
Debridement
  • Mechanical
  • Sharp
  • Enzymatic
  • Autolytic
dressings
Dressings
  • Cardinal rule keep ulcer tissue moist
  • Eliminate dead space by loosely packing
  • Control exudate
  • Cost effective
  • Time effective
  • Location of wound
things to remember
Things to remember
  • Communication with Physicians
  • Documentation
  • Risk Management
  • Education
  • Quality Improvement
thank you

Thank You

Email : susan_yap@hchd.tmc.edu