PRESSURE SORES

INTRODUCTION
A pressure sores is an area of skin that breaks down when you stay in one position for too long without shifting your weight The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies. A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

causes
These factors increase the risk for pressure ulcers: Being bedridden or in a wheelchair Fragile skin Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis) Malnourishment Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers Older age Urinary incontinence or bowel incontinence

CLASSIFICATION
Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst): Stage I: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop. Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated. Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin. Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints

STAGES
STAGE1
STAGE2

STAGE3

STAGE4

STAGES
SHOWING 4 STAGES

COMMON PLACES FOR PRESSURE SORES

DIFFERENT PARTS REPRESENTING SORES

ETIOLOGY
Bedsores are accepted to be caused by three different tissue forces: Pressure, or the compression of tissues. In most cases, this compression is caused by the force of bone against a surface, as when a patient remains in a single decubitus position for a lengthy period. After an extended amount of time with decreased tissue perfusion, ischemia occurs and can lead to tissue necrosis if left untreated in an immunocompromised patient. Shear force, or a force created when the skin of a patient stays in one place as the deep fascia and skeletal muscle slide down with gravity. This can also cause the pinching off of blood vessels which may lead to ischemia and tissue necrosis. Friction, or a force resisting the shearing of skin. This may cause excess shedding through layers of epidermis

PATHOPHYSIOLOGY
Pressure ulcers may be caused by inadequate blood supply and resulting reperfusion injury when blood re-enters tissue. A simple example of a mild pressure sore may be experienced by healthy individuals while sitting in the same position for extended periods of time: the dull ache experienced is indicative of impeded blood flow to affected areas. Within hours, this shortage of blood supply, called ischemia, may lead to tissue damage and cell death. The sore will initially start as a red, painful area, which eventually turns purple. Left untreated, the skin may break open and become infected. Moist skin is more sensitive to tissue ischemia and necrosis and is also more likely to get infected.

PREVENTION
MEDICAL
TURNING THE PATIENT EVERY TWO HOURS DAY AND NIGHT AND AVOIDING PRESSURE ON THE SORES. USE OF SPECIAL MATTRESS WATER BED RIPPLE MATTRASS NET BED A FLUIDIZED BED LOW AIR LOSS BED SORBO PACKS ROHOCUSHION ENCOURAGE PATIENT TO BE MOBILE AS SOON AS POSSIBLE AND ENCOURAGE SHORT WALK THE PATIENT IS INSTRUCTED TO INSPECT PRESSURE SITES FOR SIGN OF PRESSURE AND TOUGHT METHODS OF SELF PRESSURE RELIEF.

PREVENTION
MEDICAL
TREATMENT OF ASSOCIATED DIEASES WILL HELP TO PREVENT SKIN BREAKDOWN. MAINTENANCE OF BALANCE DIET. GOOD INSTRUCTION IN TURNING AND LIFTING THE PATIENT.
DERMALEX SPRAY.

PREVENTION
PHYSIOTHERAPY
EXERCISES FOR STRENGHTHENING MUSCLES. ACTIVE EXERCISES TO ENCOURAGE MOBILITY . ICE MASSAGE. RELAXED PASSIVE MOVEMENTS.

BEDSORES
PICTURES DEPICTING BEDSORES

TREATMENT
Debridement Autolytic debridement Biological debridement Chemical debridement, or enzymatic debridement Mechanical debridement Sharp debridement Surgical debridement Ultrasound-assisted wound therapy

TREATMENT
INFECTION CONTROL. NUTRITIONAL SUPPORT. PROPER CARE. EDUCATING THE PATIENT. PATIENT INTERVENTION

PHYSIOTHEREPY
MASSAGE ROUND THE EDGES OF SORE ULTRASOUND TO SURROUNDS UVR TO FLOOR AND EDGES IONOZONE ICE PEME LASER

DO NOT
Do NOT massage the area of the ulcer. Massage can damage tissue under the skin. Donut-shaped or ring-shaped cushions are NOT recommended. They interfere with blood flow to that area and cause complications

WHEN TO CONTACT A MEDICAL PROFESSIONAL

Contact your health care provider if an area of the skin blisters or forms an open sore. Contact the provider immediately if there are any signs of an infection. An infection can spread to the rest of the body and cause serious problems. Signs of an infected ulcer include: A foul odor from the ulcer Redness and tenderness around the ulcer Skin close to the ulcer is warm and swollen Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body.

COMPLICATIONS
Pressure sores can trigger other ailments, cause patients considerable suffering, and be expensive to treat.[10] Some complications include autonomic dysreflexia, bladder distension, osteomyelitis, pyarthroses, sepsis, amyloidosis, anemia, urethral fistula, gangrene and very rarely malignant transformation. Sores often recur because patients do not follow recommended treatment or develop seromas, hematomas, infections, or dehiscence. Paralytic patients are the most likely people to have pressure sores recur. In some cases, complications from pressure sores can be life-threatening. The most common causes of fatality stem from renal failure and amyloidosis.

THANKS