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.
Caring for people with impaired mobility
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
Pressure ulcers can occur anywhere on the body. Pressure ulcers can be caused by the weight of the body or persistent contact with a medical device, or shearing and friction forces associated with poor manual handling. The most vulnerable areas of skin are around bony prominences, especially if they are in contact with hard surfaces such as an operating table or standard hospital mattress. People nursed in the supine position may develop pressure ulcers on the back of the heels and ankles; the area around the buttocks (ischial tuberosity), the elbows and shoulder blades, and the occiput (back of the head) (EPUAP 2015). Individuals nursed in the prone position are vulnerable to pressure ulcers on the toes, knees, hips, elbows and ribs (EPUAP 2015). Stephen-Haynes and Maries (2020) recommend the use of specialist equipment, silicone padding, careful positioning, and close attention to skin care for people nursed in the prone position. Wheelchair-bound individuals are at risk of developing pressure sores on their buttocks, spine, elbows, heels, back of the knees, palms and genitals (Stephens and Bartley 2018). Comprehensive assessments and care plans should be carried out for wheelchair users and their carers, which include equipment, positioning, cushions, and environment (Stephens and Bartley 2018). Medical devices and associated lines and tubes may cause pressure injuries wherever they are in contact with the skin (NPIAP 2020).
Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
Wenguang Xia, Xiaolin Huang in Rehabilitation from COVID-19, 2021
Pressure ulcers are divided into the following stages.Stage 1 stress injury: Erythema does not disappear when pressed. The epidermis of the local tissue is intact, with non-pale redness.Stage 2 pressure injury: Partial dermis defect. The wound bed is alive. The basal surface is pink or red and moist. Serum blisters may appear intact or ruptured, but the fat layer and deeper tissues are not exposed.Stage 3 pressure injury: Full-thickness skin defect. The ulcer surface may show the phenomenon of subcutaneous fat tissue and granulation tissue wound edge curling.Stage 4 pressure injury: Full-thickness skin and tissue damage. Fascia, muscle, tendon, and/or cartilage are exposed on the ulcer surface.
MRI based 3D finite element modelling to investigate deep tissue injury
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Willeke A. Traa, Mark C. van Turnhout, Kevin M. Moerman, Jules L. Nelissen, Aart J. Nederveen, Gustav J. Strijkers, Dan L. Bader, Cees W. J. Oomens
A pressure ulcer is defined as: “a localized injury to the skin and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure or pressure associated with shear” (NPUAP et al. 2014). Pressure ulcers may originate in the superficial skin layers and progress towards the deeper tissues, or in the deeper tissue near a bony prominence and progress to the skin surface. The latter case is termed a deep tissue injury where, in its early stage, the skin remains intact. Deep tissue injury is particularly a problem for insensate individuals, such as the spinal cord injured or unconscious individuals, since their lack of sensation does not alert them of a developing ulcer. These wounds progress rapidly and are usually categorised as stage 3 or 4 following skin breakdown (NPUAP et al. 2014) with an unpredictable prognosis.
Suppression of LRRC19 promotes cutaneous wound healing in pressure ulcers in mice
Published in Organogenesis, 2018
Jie Sun, Zhijing Wang, Xirui Wang
Pressure ulcers are defined as a localized damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction.1 These wounds are commonly associated with elderly, bedridden, and debilitated patients, spinal-cord injury and neuropathy, and patients undergoing major orthopedic reconstruction. Pressure ulcers are a significant problem in healthcare, not only affecting the quality of life, morbidity and mortality of patients but also in terms of healthcare costs.2 Pressure ulcers are becoming an increasingly common and serious problem for wheelchair users as well as hospitalized patients with acute care. Hospital-acquired pressure injuries occur in 3%–34% of hospitalized patients worldwide depending on the care institution and result in longer hospital stays, higher morbidity, increased human suffering and expenditure for patient care.3,4 And they are expected to increase in frequency as the population ages.
Blood perfusion changes during sacral nerve root stimulation versus surface gluteus electrical stimulation on in seated spinal cord injury
Published in Assistive Technology, 2019
Liang Qin Liu, Martin Ferguson-Pell
According to National/European Pressure Ulcer Advisory Panel guideline, pressure ulcer has been newly named as pressure injury, which is described as an area of localized injury to the skin as a result of prolonged pressure alone, or pressure in combination with shearing forces (National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel [NPUAP/EPUAP], 2009). It is typically categorized into four key stages depending on severity. The higher the grade is, the more severe the injury to the skin and underlying tissue will be. In stage one, the skin is not broken but is red or discolored; the redness or change in color does not fade within 30 minutes after pressure is removed. In stage two, the epidermis or topmost layer of the skin is broken, creating a shallow open sore, and drainage may, or may not, be present. At stage three, the break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue, and the wound is deeper than in stage two. In stage four, the breakdown extends into the muscle and can extend to the bone; at this stage, there is often a large amount of dead tissue and drainage.