Pressure ulcers

Pressure ulcers appear mostly in patients who are immobilized for a long period such as geriatric patients and factors such as circulatory disorders, skin dehydration, incontinence, etc. are involved. These types of injuries are caused in the parts of the body that are subjected to a certain pressure for a long time.

There is another risk group in the appearance of pressure ulcers (PU) such as traumatology patients, neurological patients who, due to their condition, are not able to detect pain, which is the first warning sign when an ulcer appears, as well as disabled patients. motors are high-risk agents in the ischial region.

To date, it is known that 95% of the cases of the appearance of this type of injury could be avoided when correct prevention measures are carried out. It has been detected that from 3 weeks of immobilization pressure ulcers can occur.

When the skin presents irrigation interruptions for more than 2 or 3 hours, it is when pressure ulcers occur, this as a consequence of the pressure of the bones exerted on a hard support, crushing the blood vessels and reducing the supply of nutrients and oxygen to the skin. the area under pressure, this causing tissue necrosis.

The skin begins to thin to the point where it completely loses its thickness, affecting the dermis, epidermis and subcutaneous cellular tissue. When the ulcer grows to a considerable size, it completely destroys the underlying skin, muscle, and bone.

Wheelchairs, beds, casts and/or splints are the objects that most frequently damage bony prominences: Lumbar Region, Hips, Heels, Ankle Malleolus, Sacral Region and elbows.

Risk factor’s:

•Pressure, the pressure exerted by the support (wheelchair, bed, etc.) on the patient’s bone plane. This pressure produces occlusion of blood capillaries and interruptions in blood circulation.

•Shear forces, the epidermis rubs when the patient slides on the bed.

• Temperature and maceration, when the environmental temperature exceeds 25°, sweating promotes the appearance of pressure ulcers, just as when there is fecal or urinary incontinence.

• Pathophysiological causes, skin disorders, enema lack of skin elasticity and dryness. Thinness, malnutrition, obesity, hypoproteinemia and dehydration. Immune disorders, cancer and infections. Motor deficiencies, paralysis, anesthesia.

Classification

Assess and record the ulcer at least once a week to adequately verify its evolution:

Type 1 ulcers, cutaneous erythema on healthy skin that does not blanch on pressure. In patients with a dark complexion, edema, induration, discoloration and sometimes heat in the local area are observed.

Type 2 ulcers, Appearance of abrasion or burn, superficial ulcer with partial thickness loss of skin affecting the epidermis, dermis or sometimes both.

Type 3 ulcers, Necrosis of the subcutaneous tissue and full thickness skin loss, sometimes of considerable depth.

Type 4 ulcers, Tissue necrosis and injury to muscles, bones or tendons due to full thickness skin loss.

 


Treatment

Health professionals and relatives of patients frequently face this type of ailment, which must be treated with the following elements:

-Comprehensive assessment of the patient -Prevention measures -Planning and execution of care -Debridement -Cleaning of the lesion -Control of the exudate -Administration of systemic antibiotics

Ulcer treatment today offers a wide variety of products that requires health professionals to be informed of the main indications and characteristics that they offer.

Types of dressings used in the treatment of pressure ulcers

The selection of dressings should be made considering the location of the lesion, the stage, the severity of the ulcer, the amount of exudate, the presence of tunneling, the condition of the skin in perilesional areas, infections and general signs of the condition. of the patient, the level of care, availability of resources and the ease of application in self-care.

-Polyurethanes -Hydrocolloids -Polymeric foams -Hydrogels -Alginates -Silicone dressings -Activated charcoal dressings

The ideal dressing must be strictly biocompatible, protect the wound from possible external physical attacks, chemical and bacterial attacks, keep the ulcer area continuously moist and the surrounding skin dry, control exudates and necrotic tissue through its absorption, maintain the minimum amount of residue in the lesion, be adaptable to difficult locations and of course allow a comfortable application and removal.

Experience and professional clinical knowledge are essential to choose the best treatment for the healing of these ulcers. They include the use of techniques that prioritize cleaning the lesion, removing necrotic tissue, correct absorption of exudate, protection of the edges and perilesional skin. , promote the growth of granulation tissue, epithelialization and healing.

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