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).
Nutritional Strategies for Wound Healing in Diabetic Patients
Jeffrey I. Mechanick, Elise M. Brett in Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
Pressure ulcers develop from localized areas of tissue breakdown in skin or underlying tissues caused by persistent pressure from sustained mechanical loads. This usually occurs over bony prominences but can occur elsewhere. The pressure obstructs capillary flow and can lead to tissue necrosis [24,25]. Pressure ulcers are particularly common in patients who are bedridden or restricted by wheelchair or prosthesis limitations [24]. The pathophysiology of pressure ulcer development is somewhat different from that of other ulcer types. With pressure ulcers, there is a complex interplay of external mechanical forces and internal physiology. The external forces that have been identified include pressure, immobility, friction, shearing forces, and moisture [26]. Some of the internal factors include concomitant disease, vascular impairment, immune dysfunction, poor tissue status, dehydration, and malnutrition.
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.
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.
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.
The relationship between torso inclination and the shearing force of the buttocks while seated in a wheelchair: Preliminary research in non-disabled individuals
Published in Assistive Technology, 2020
Satoshi Shirogane, Shigeru Toyama, Atsushi Takashima, Toshiaki Tanaka
For wheelchair users, the development of pressure ulcers on the supporting surface of the buttocks presents a serious risk that warrants concern (Allman, 1997). Past investigations have revealed that among those who are unable to ambulate without assistance, including the elderly and individuals with spinal cord injuries, pressure ulcers occur with alarming frequency (Brandeis, Morris, Nash, & Lipsitz, 1990; Brienza et al., 2010; Chen, DeVivo, & Jackson, 2005). Furthermore, once these ulcers develop they require significant treatment and may potentially lower an individual’s quality of life (Gorecki et al., 2009). Pressure ulcers develop when external pressures to some body parts cause blood flow in the soft tissues between the skin and bones in that area to either decrease or cease. If this continues over time, the tissue falls into a state of irreversible ischemic damage (Grey, Enoch, & Harding, 2006). Causative factors include pressure and numerous other compounding factors. Currently, the exact pathological mechanism is not completely understood. Therefore, in clinical settings it is common to carry out “seating” interventions, including wheelchair and cushion adjustments that make them more compatible (i.e. altering or adjusting devices to conform them to the bodily condition of the patient). This method disperses the pressure placed on the surface of the body, thus preventing it from accumulating at any single point. It is recommended to reduce the length of time that patients sit; however, that is the extent of the available countermeasures (NPUAP, 2014).