KAMRAN YOUSAF FCPS(PAK),MRCS(GLASGOW,UK) Meeqat Hospital

1. BED SORE MANAGEMENT
A PREVIEW
KAMRAN YOUSAF
FCPS(PAK),MRCS(GLASGOW,UK)

2. DEFINITION
• TERMINOLOGY
• BED SORE,,,PRESSURE SORE,,,PRESURE ULCER
• DECUBITUS ULCER
• INURY TO SKIN AND UNDERLYING TISSUES
DUE TO PROLONGED UNRELIEVED PRESSURE

3. WHY ?

4. RISK FACTORS
• ADVANCED AGE > 70 YEARS
• MALNUTRITION AND DEHYDRATION
• PHYSICAL DISABILITY
• CHRONIC MED ILLNESS

5. WHAT REALLY HAPPENS ?

6. MECHANISM OF INJURY
• PROLONGED SUSTAINED PRESSURE
LEADS TO
EXCESS PRESSURE THAN NORMAL
CAPILLARY PRESSURE
THUS
NARROWS THE SMALL VESSELS OF SKIN
THEREFORE
REDUCED TISUE PERFUION & SKIN BREAKDOWN

7. FORCES
PRESSURE
FRICTION
SHEAR
MOISTURE

8. COMMON SITES OF BED SORES
• BACK OF THE HEAD
• SHOULDERS
• EAR LOBES
• SCAPULAR AREAS
• TAILBONE/SACRUM
• GREATER TROCHANTERS
• KNEE
• ANKLE AND HEELS

11. STAGES OF BED SORES

12. STAGE 1
• SUPERFICIAL,,,EPIDERMAL
• CHANGE OF COLOUR ONLY
• DOESN’T BLANCH
• DARK SKIN
• WARM,,,OEDEMATOUS
• NO SKIN BREAK

15. STAGE 2,PARTIAL THICKNESS SKIN LOSS
AND / BLISTER
• INVOLVES DERMIS
• SKIN BREAKDOWN

19. STAGE 3,,,FULL THICKNESS SKIN LOSS
FAT EXPOSED
• EPIDERMIS,DERMIS,SUBCUT TISSUE
• FULL SKIN BREAKDOWN
• MUSCLE,BONE,TENDON NEITHER EXPOSED
NOR DAMAGED

21. STAGE 4,,,FULL THICKNESS TISSUE
LOSS
• DEEP ULCER
• REACHES MUSCLE
• BONE AND
• TENDON

26. UN-CLASSIFIED
• OCCASIONALLY,,,
A DRY SCAB COVERS
MORE SERIOUS AND DEEP INFECTED BED SORE

27. ASESSMENT FOR BED SORE
• BRADEN SCORING SYSTEM
• NORTON SCORE

31. 2 HOURS --- 2 WEEKS

32. COMPLICATIONS
• CELLULITIS/ABSCESS
• SEPSIS
• BONE AND JOINT INFECTIONS
• CANCER

33. COMPLICATIONS
• MUSCLE ATROPHY
• JOINT CONTRACTURES
• PNEUMONIA
• DVT

34. TREATMENT
• ADMIT THE PATIENT
• DEVISE A COMPLETE TREATMENT PLAN
• MONITOR
• FREQUENTLY RE-ASSESS

35. TREATMENT
• SURGICAL
• MEDICAL
• NURSING CARE

36. SURGICAL
• DEBRIDEMENT AND I/D
• AUTOLYTIC
• MECHANICAL
• ENYMATIC
• SHARP
• BIOSURGICAL

37. SURGICAL,,,GRAFT AND FLAP

38. THE DRESSINGS
• HYDOPHYLLIC
• HYDROGEL
• ALGINATE
• FOAM
• ACCUZYME
• PANAFIL

39. MEDICAL
• CONTROL OF MED ILLNESS
• BALANCED DIET
• ANEMIA
• DEHYDRATION AND ELECTROLYTE IMBALANCE
• ANTIBIOTICS

40. NURSING CARE
• REGULAR POSTURE CHANGE,,, 2 HOURLY
• REGULAR DRESSING
• DAILY INSPECTION OF SKIN
• EARLY CHANGE OF PAMPERS/NAPKINS
• HYGIENE CARE
• DIET FOLLOW UP
• FAMILY EDUCATION/TRAINING

44. PREVENTION IS BETTER
THAN CURE

46. THE NURSING PERSPECTIVE

47. BEWARE,,,,
• PATIENT IS OLD AGE
• LIMITED PHYSICAL MOBILITY
• MEDICAL ILLNESSESS
• PROLONGED STAY

48. APPLY BRADEN SCALE

49. INSPECT
• SKIN ,,,,, ESPECIALLY AT THE PRESSURE AREA
• BOWEL/URINE
• BED SHEET/PILLOW COVERS/DRESS
• AIR MATTRESS

50. STAGE THE BED SORE

51. ENSURE
• REGULAR MEDICATION
• TIMELY DRESSINGS
• REGULAR POSTURE CHANGE
• HYGIENE
• DIET INTAKE