Pressure sores (bedsores)

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 783 times

248 Pressure sores (bedsores)

Instruction

Look at this leg.

Salient features

History

• Prolonged bed rest

• Diabetes mellitus

• Anaemia

• Malnutrition

• General debility.

Examination

• Pressure sore over the sacrum (Fig. 248.1).

image

Fig. 248.1 (A) Pressure ulcer at first visit. (B) Clean sacral pressure sore.

(With permission from Levi, Rees 2007.)

Proceed as follows:

• Look for pressure sores elsewhere, particularly the skin overlying the occiput, ears, elbows, hips and ankles.

• Comment on any obvious paralysis or incontinence (the latter contributes to ulcers in the sacral areas).

• Comment on skin traction or any orthopaedic splints (as 70% are orthopaedic patients).

• Tell the examiner that you would like to culture and biopsy the ulcer if it has not been healing properly or looks suspicious.

Diagnosis

This patient has a large non-healing ulcer (lesion) over the sacral region caused by pressure (aetiology) and requires special nursing care to allow the pressure sore to heal (functional status).

Questions

What are the causes of pressure sores?

• Loss of sensation and when circulation or nutrition to the skin and underlying tissue are compromised: diabetes mellitus, malnutrition, peripheral vascular disease, oedema, arthritis, anaemia, general debility.

• Other: sedation, urinary or faecal incontinence, sedation and anaesthesia.

Advanced-level questions

How are pressure sores graded?

Grade I: erythema, skin intact

Grade II: skin loss, epidermis or dermis (abrasion, blister, shallow crater)

Grade III: full thickness loss and damage to subcutaneous tissues

Grade IV: extensive destruction, tissue necrosis or damage to the underlying muscle or bone.

How are pressure sores best prevented?

• Good nursing care, nutrition and maintenance of skin hygiene

• Moribund, paralysed patients should be turned frequently (at least every hour) and pressure points should be inspected for areas of redness and tenderness

• Water-beds, alternating pressure mattresses and sheep skins are useful.

Professor Hans Ludwig Frankel, MB, OBE developed the Frankel classification for spinal injuries. Following his medical education at University College and University College Hospital in London, he was recruited by Sir Ludwig Guttmann to work at the National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, where he dedicated his career to the care of persons with spinal cord injury. Sir Guttmann was the first to show that pressure sores were preventable.

Related posts:

Default ThumbnailSixth cranial nerve palsy Osteoarthrosis Optic atrophy Default ThumbnailHepatomegaly Carotid artery aneurysm Felty’s syndrome