Anatomy Presfinal

8/8/2019 Anatomy Presfinal

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DECUBITUS ULCER

Presenters:

Angod, Lady Aizahlyn I.

Apat, Joselle Janina F.

Araune, Trixie Mariel E.







The skin is comprised of three major components:

-Epidermis

-Dermis

-Subcutaneous tissue

Though interrelated, each layer of skin has different structures, cell

types and functions.



Definition ´Decubitusµ from the Latin decumbere, ´to lie downµ

Decubitus ulcers, also known as bedsores and pressure sores,

are caused by impaired blood supply and tissue malnutrition

owing to prolonged pressure over skin, soft tissue, muscle, or

bone.

Can occur anywhere on body



Over view It can develop on any part of the body where sustained

pressure and compressive forces are maintained for

a sufficient period of time.

Decubitus ulcers are listed as the direct cause of

death in 7²8% of paraplegics.

Some estimates suggest that 60,000 people die from

decubitus ulcers or their sequelae per year.



RISK FACTORS



Risk Factors and C au ses The factors causing pressure ulcers are divided into 2

Groups

INTRINSIC - Disease, medication, malnourishment, age,dehydration/fluid status, lack of mobility, incontinence, skincondition, weight.

EXTRINSIC ² External influences which cause skin distortion ²Pressure, Shearing Forces, Friction, Moisture.



PressureTissues that are dependent on capillaries are deprived of their

blood supply because of pressure. Eventually the ischaemic

tissues will die.

Shearing ForcesShearing forces will only exist if pressure, usually caused by the persons

own body weight, is also present. Shear forces occur when a part of thebody tries to move but the surface of the skin remains fixed.



FrictionFriction forces occur when the shearing force increases sufficiently toovercome the bodies resistance to movement. The movement has anabrasive action

MoistureS

kin should not be left wet as moist skin sticks to material (e.g.bathing, perspiration, incontinence (as urine and feces are acidic,amniotic fluid) as it can become macerated making it more susceptibleto shear and friction.



SIGNS AND

SYMPT O MS



A bedsore appears first as a reddened area of skin,

which then starts to break down to form an open, raw,oozing wound.

Bedsores occur at areas of abnormal pressure on the

body: In a wheelchair, this is usually the tailbone (coccyx) or

buttocks area, shoulder blades, spine, or backs of thearms or legs.

In a bed, they may occur on the back of the head, ears,shoulder blades, hips, lower back, tailbone, or thebacks or sides of the knees, elbows, ankles, or toes.



Bedsores occur in st ag es:

Stage 1 has unbroken, but pink or ashen (in darker skin)

discoloration with perhaps slight itch or tenderness.

Stage 2 has red, swollen skin with a blister or openareas.

Stage 3 has a crater-like ulcer extending deeper into the

skin. Stage 4 extends to deep fat, muscle, or bone and may

have a thick black scab (eschar).



Here are some si g ns to indicate that an infection ha s

developed:

Thick yellow or green pus A bad smell from the sore

Redness or warmth around the sore

Swelling around the sore Tenderness around the sore

Si g ns that the infection may have spread incl ude:

Fever or chills

Mental confusion or difficulty concentrating

Rapid heartbeat

Weakness



DISEASE

PROCESS



Individuals sitting/lying in the same

position for long periods of time

(ischemia)

Inadequate blood supply to tissues(ischemia)

Tissue damage and cell death

Bed Sore or decubitus ulcer



Pressure Ulcer Stag es



Stag e I Pressure Ulcer Skin is intact:

The ulcer appears as a defined area ofpersistent red, blue, or purple hues in lightly

pigmented skin.

In darker skin tones, it may appear withdiscoloration, warmth, edema, induration or

hardness.





Stag e II Pressure Ulcer

Superficial ulceration of the skin:

Partial thickness skin loss involving epidermis,

dermis, or both.

The ulcer is superficial and presents clinically as

an abrasion, blister, or shallow crater.





Stag e III Pressure Ulcer

A deep crater; full thickness loss of skin

tissue:

damage to or necrosis of subcutaneous tissue that mayextend down to, but not through, underlying fascia.

The ulcer presents clinically as a deep crater with orwithout undermining of adjacent tissue.





Stag e IV Pressure Ulcer

Full thickness skin loss:

extensive destruction, tissue necrosis, or damage to

muscle, bone, or supporting structures

(e.g. tendon, joint capsule).

Undermining and sinus tracts also may be present.





C O MPLICATI O NS



Osteomyelitis

Hypercalcemia Myonecrosis

Necrotizing fasciitis

Amyloidosis

Sepsis

Gangrene Death

Autonomic dysreflexia



DIAGN OSTIC

TESTS



How d oes the d oct or diagnose bed sores?

A doctor can make the diagnosis by examining the

patient's skin. Special diagnostic tests areusually unnecessary unless there are symptoms

of infection.



W

hen are lab investigati o

ns necessary?

If a patient with bedsores develops symptoms of

infection, then a doctor may order diagnostic tests to

determine whether the infection has invaded the soft

tissues, bones, bloodstream or some other site. These

tests may include a complete blood count, a culture

of the infected bedsore, blood cultures to rule outsepsis, and bone X-rays to look for evidence of

osteomyelitis.



PRE V ENTI O NS



Relieving pressure on vulnerable areas of skin

Reducing shear and friction

Inspecting the patient's skin at least once each

day

Minimizing irritation from chemicals

Encouraging the patient to eat well

Encouraging daily exercise Keeping the skin clean and dry

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Anatomy Presfinal