Pressure Ulcers: Causes, Diagnosis, Treatment

A pressure ulcer is a nutritional disorder of skin and subcutaneous tissue. It arises vessels through long-term action of pressure and compression blood. It may come to the death of the skin and infections.

Causes

Most often a pressure sore occurs in the case of being bedridden. Pressure sore risk consists mainly of parts of the body, between the skin and the underlying bone is no or only little muscle is located. To call heels, ankles, are mainly combs, Coccyx Pelvis, the back of the head, Pelvis. Ultimately, however, occur at all Points a pressure ulcer. A pressure ulcer can also, under ill-fitting dentures or to occur in close casts. In the case of pressure ulcer development, three factors play a crucial role:

  • Printing (Pad Printing)
  • Time (Pressure Retention Time)
  • Planning (Risk Factors)

Only when a certain pressure over a longer period of time (two hours): in the case of an existing Disposition of the patient, there is damage to the skin. A factor for not alone to bedsores.

Pressure

The blood circulation in the skin capillaries, the finest blood vessels that provide oxygen and nutrient supply to the individual organs is hindered, as soon as the pressure in the capillaries exceeds a certain level. The pressure on the skin can be exerted from the outside or from the inside:

  • Pressure from the outside: For example, folding sheets in the bed, unpadded storage rails, crumbs in bed, but also catheters and probes, if they are under the patient
  • Pressure from the inside Through the bone, muscle and fat pads directly under the skin.

Time

It is crucial, how long the pressure on certain areas of skin, districts charged. If the nutrition of the skin was interrupted in cells less than two hours, you can start to recover. In the case of prolonged lack of oxygen to individual cells die, it forms a necrosis (tissue death).

Disposition

The skin is damaged by, for example:

  • Fever: sweating it comes to dehydration of the body and increased oxygen consumption
  • Moisture: moist skin softens and is more susceptible to
  • Incontinence: In the case of incontinent patients, the skin is not only moisture, but also by the acidic pH?Value of the and may be due to bacterial contamination (intestinal bacteria)
  • Obesity: thickness patients usually sweat more, at the same time on the skin is weight larger
  • Shear forces: The \”inclined plane\” in the wrong Seats and tugs at the skin

The skin is poor circulation:

  • Anemia and heart weakness, a lack of blood supply favor
  • Diabetes mellitus: this is also the cell metabolism in addition to blood circulation disturbed

The pressure relief is hampered by lack of movement (immobility), Bedridden (such as unconsciousness), paralysis such as hemiplegia and therapeutic immobilization (plaster). Other risk factors are, for example: defence weakness of the body due to an inadequate diet (for Example, lack of protein, zinc or Vitamin C), poor General condition, cachexia (wasting) and chronic diseases that lead to fluid loss and atrophy of the skin.

Characteristics, Diagnosis, History

There are four levels of severity of pressure ulcers. In the case of a pressure ulcer in the first degree, one sees only a circumscribed redness of the skin. In the second degree the skin is already broken occurred. In the case of a pressure sore, third degree, is a deep skin defect, muscles, Tendons and ligaments are visible. In the worst Form there is a Defect with bone involvement.

Complications

As an aggravating factor, an infection of the wound can be added. If the tissue dies, it must be surgically removed.

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Treatment

A pressure ulcer must be treated, it is usually already too late. Very important is the prevention is not so it comes to a pressure ulcer. Especially in bedridden patients, the skin should be well maintained. RUB with circulation-promoting ointments and Massage the areas at risk can prevent a pressure ulcer from the outset. In addition, care should be taken on a soft storage, possibly on specialty mattresses.

Good care of the two hourly repositioning of patients. It is taken for a storage plan: the supine position, side position to the right, possibly the prone position, lateral position, left, back position, etc. At the first sign of a pressure sore (redness of the skin) is already a good skin care the appropriate therapy.

Open wounds must be cleaned carefully. Anti-inflammatory and healing ointments be applied on the wound surface. No improvement of the disease occurs after three to four days of appearances, you should change your medication. The skin and the surrounding tissue is dead already, so it must be surgically removed.

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