PREVENTION AND CARE OF PRESSURE SORE

DEFINITION Pressure ulcers are localized areas of necrotic soft

tissue that occur when pressure applied to the skin over time is greater than normal capillary closure pressure which is about 32 mm hg

RISK FACTORS

CLINICAL MANIFESTATION Contd..

STAGES

MANAGEMENT

STAGE-1

Pressure to be removed Nutritional electrolyte balances are maintained Friction and shear reduced Avoid moisture to the skin

STAGE -2

Wash with sterile saline solution

Avoid antiseptic solution

Semi permeable occlusive dressing

Minimizing the loss of fluid and proteins

STAGE 3 AND 4

Drain the necrotic tissues and cleaned /debrided

Topical treatment is prescribed New granulation tissue must be protected

Prevent further trauma pressure

SURGICAL MANAGEMENT Debridement Drainage Bone resection Skin grafting

NURSING MANAGEMENT

PREVENTION

Change position at least every 2 hours to relieve pressure.

Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.

Eat well-balanced meals that contain enough calories to keep you healthy.

CONTD….

Drink plenty of water (8 to 10 cups) every day. Exercise daily, including range-of-motion

exercises. Keep the skin clean and dry. After urinating or having a bowel movement,

clean the area and dry it well. A doctor can recommend creams to help protect the skin.

COMPLICATION autonomic dysreflexia bladder distension osteomyelitis pyarthroses sepsis amyloidosis, anemia, urethral fistula, gangrene and very rarely

malignant transformation

NURSING INTERVENTION

BIBLIOGRAPHY

Lewis “medical surgical nursing” sixth edition Mosby publication (2000) vol 2page no 1207-1208

Brunner and sudharth “medical surgical nursing”

12th edition Lippincott publication (2010)page no 185-190

Net references

www.google.pressure sore.com

www.wikipedia.pressure sore.com

www.google pressure sore prevention. com