Pressure Ulcers in Older Adults
K. Rao Poduri in Geriatric Rehabilitation, 2017
A pressure ulcer is a localized injury to the skin and/or the underlying tissue usually over a bony prominence as a result of pressure or pressure in combination with shear.1 Pressure ulcers are also called decubitus ulcers, bedsores, or pressure sores. Pressure ulcers vary in severity from reddening of the skin to deep craters with muscle and bone involvement. Pressure ulcers develop fast and are difficult to treat; they usually develop over bony prominences such as heels, ankles, and the sacrum.1,2 Populations that are at the highest risk for developing pressure ulcers are individuals with medical conditions requiring prolonged confinement to beds or wheelchairs and who have a limited ability to change position. Pressure ulcers need a multidisciplinary approach in order to prevent and treat.
Life Care Planning for Spinal Cord Injury
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
Decubitus ulcers are potentially life threatening, but progression of these wounds to advanced stages is largely preventable. Great care must be taken to prevent injury to the integument from pressure by shifting sitting positions and frequent turning. If sensory feedback is poor or non-existent, many individuals use electronic devices such as watch alarms to provide timely cueing for lifting and repositioning. Special cushions for sitting and mattresses for extended recumbence have been developed to lessen the pressure upon bony prominences. Special seats that distribute the pressure are used in wheelchairs to prevent sacral decubiti. Vulnerable areas such as the heels must be padded. Sheep skin and other materials are often used for heel and foot protection, as well as orthotic devices to fully offload pressure on the heels, a common site for decubiti. If a decubitus develops, all pressure must be removed, or the decubitus can progress to loss of skin and tissues to the point of exposing bone. The sores must be kept clean or they can become infected. Extensive counseling and prevention education should be started early and continued in the years following the injury. Routine inspection by the patient, caregivers, and through periodic skilled nursing visits should usually identify the onset of these wounds in the earlier stages. Treatment of decubitus ulcers, once developed, requires extensive care and may lead to costly hospitalizations with or without the need for plastic surgery intervention.
Management of the Diabetic Foot
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Active disruption of the skin occurs with high stress, 700-1000 lb/in.2. This might occur by stepping on a nail or piece of broken glass. It is not the most common cause of ulcers. Low stress, 2-3 lb/in.2 may disrupt the skin in a bedridden patient by decubitus ulcer formation, and will be more common in the neuropathic patient. It will not, however, cause plantar foot ulcers in the walking neuropathic patient. Foot ulcers are caused by repetitive moderate stress, 40-60 lb/in.2. These are the forces transmitted to the skin by the normal motion of the bones. The resultant callus formation fails to be painful, the patient does not limp, and ulcer formation may result.
Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis
Published in Expert Review of Neurotherapeutics, 2021
Adriano Chiò, Antonio Canosa, Andrea Calvo, Cristina Moglia, Alessandro Cicolin, Gabriele Mora
The pathophysiology of pain in ALS is multifactorial [116,119]. Much of the chronic pain in ALS seems to result as a secondary effect of the motor impairment of ALS (i.e. nociceptive pain). Nociceptive causes of ALS pain develop as disease progresses, due to degenerative changes in connective tissue, bones and joints leading to musculoskeletal pain related to muscle atrophy and weakness and prolonged immobility. Joint contractures are common, as shoulder pain [120]. Spasticity and cramps are also common primary causes of pain in ALS. In a study, about one third of ALS patients had prominent spasticity, and 42.5% of them reported pain, evaluated with a numeric rating scale [121]. In about 25% of patients cramps are the major cause of pain, in particular in those with spinal phenotype [122]. Decubitus ulcers are caused by skin pressure, even if they are rather uncommon despite patients reduced mobility. In the more advenced phases of the disease patients may complain diffuse and unexplained pain.
Palliative dermatology – An area of care yet to be explored
Published in Progress in Palliative Care, 2018
N. A. Bishurul Hafi, N. A. Uvais
Palliative literature about skin is largely limited to wound care and management of pruritus.6–8 There are only three studies describing the prevalence of dermatoses among palliative care patients. This again is a testimony of the neglect dermatologists have towards palliative care and vice versa. In the first study of the kind by Barnebe et al. on 65 patients admitted in a palliative care unit, at least one-third of the patients (34%) had some dermatological conditions. Most common condition encountered was dermatisis (24.6%), which included seborrheic dermatitis (9.2%), stasis dermatitis (12.3%) and contact dermatitis (3.1%). It was followed by superficial cutaneous infections (20%) inclusive of bacterial, viral and fungal infections. Striae or telengectesia was present in 16.9% patients. Decubitus ulcer and xerosis were reported in 10.8%, 6.2% patients, respectively.9 Both the investigators of the study were not dermatologists by training, which might have resulted in a lower prevalence of dermatoses compared to the studies described below.
Abstracts book
Published in Acta Clinica Belgica, 2020
A 72-year-old woman, with Parkinson, arterial hypertension and diet-controlled diabetes, visited the emergency department (ED) with a 3-week history of physical deterioration, anorexia, immobility and a ‘decubitus wound’ on the right flank. She presented hemodynamically stable, lethargic, without fever and glycemia of 177 mg/dl. Her right flank showed a foul-smelling wound with manually removable necrotic soft tissue (Figure 1) and erosion of the two distal ribs. Blood results showed a normal leucocyte count (80% neutrophils), CRP of 55.7 mg/L, GFR of 61 ml/min/1.73 m2 and a lactic acidosis (3.8 mmol/l). The clinical findings suggest a category 4 decubitus with underlying infection, an NSTI or the latter as consequence of the former. CTscan demonstrated right kidney nephrolithiasis and pyelonephritis with an adjacent retroperitoneal abscess broadly breaking through the soft tissues, described as necrotizing fasciitis (Figure 2). An urgent right nephrectomy and wound debridement were performed combined with intravenous antibiotherapy (Figure 3). The patient recovered well. All cultures identified P. mirabilis and Bacteroides on day 4.
Related Knowledge Centers
- Angina
- Bed Rest
- Recovery Position
- Sleep
- Supine Position
- Unconsciousness
- Prone Position
- Prostration
- Fetal Position
- First Aid