Areas of Expertise
Pressure Ulcers
A pressure ulcer is localized injury to the skin and the underlying tissue, usually over a bony prominence, as a result of pressure, in combination with shear and /or friction. Pressure ulcers are stages suing the following system
A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
Stages
Stages
(Suspected) Deep Tissue Injury (DTI)
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and /or shear. The are may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared with adjacent tissue.
Stage 1
Intact skin with a non-blanching redness of a localized area over a bony prominence. Darkly pigmented skin may not have a visible blanching; its color may differ from surrounding area.
Stage 2
Partial-Thickness loss of dermis presenting as a shallow open ulcer with a red pink bed, without slough. May also present as a intact or open/ruptured serum filled blister
Stage 3
Full Thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Slough may be present but does not obscure the dept of tissue loss. May include undermine and tunneling.
Stage 4
Full thickness tissue loss with exposed bone tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often times include undermining and tunneling.
Unstageable
Full thickness tissue loss in which the base of the ulcer is covered with slough (yellow, tan, gray green, or brown) and eschar (tan brown or black) in the wound bed.
This staging system should be used only to describe pressure ulcers. Wounds from other causes such as arterial, venious, diabetic foot, skin years, tape burns, perineal dermatitis, maceration, or denudement should not be staged using this system. Other staging systems exist for some of these conditions and should be used instead.
Treatment
Treatment
Although no gold standard for preventing or treating pressure ulcers has been established, data from clinical trials indicate specific efforts are worthwhile. Preventive strategies include recognizing risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest, and preserving the integrity of the skin. Treatment principles include assessing the severity of the wound; reducing pressure, friction, and shear forces; optimizing wound care; removing necrotic debris; managing bacterial contamination; and correcting nutritional deficits.
