2. Pressure ulcer Presented by: Dr. H. NAJARI Assisted professor
Department of infectious disease
Qazvin university of medical science

3. Definition
Pressure ulcer, also known as Pressure sores, Bedsores and Decubitus ulcers, are localized injuries to the skin and/or underling tissue that usually occur over a bony prominence
The most common sites are the skin overlying the sacrum, coccyx, heels or the hips
Elbows, knees, ankles, back of shoulders or cranium can be affected

4. Bedsores can be developed quickly and often difficult to treat

5. CONTRIBUTING FACTORS
Sustained pressure. pressure applied to soft tissue resulting in completely or partially obstructed to blood flow to the soft tissue
Shear is also a cause, as it can pull on blood vessels that feed the skin. Shear occur when two surfaces move in the opposite direction
Friction. Is the resistance to motion.it may occur when the skin is dragged across a surface.

6. RISK FACTORS
Comma & paralysis
After surgery
Poor health and weakness
Bed rest and wheelchair use
Difficult moving and inability to easily change position while seated or in bed

7. RISK FACTORS Age Lack of sensory perception Weight loss Poor nutrition
Excess moisture or dryness
Bowel incontinence
Medical condition affecting blood flow
Smoking
Limited alertness
Muscle spasms

8. STAGING Bedsores fall into one of 4 stage based on their severity
management of patients are based on the staging

10. STAGE I The site is tender, painful, firm, soft, warm or cool
Non-broken skin
Stage may be difficult to detect
The skin appears red, non-blanchable
The site is tender, painful, firm, soft, warm or cool

11. STAGE II Epidermis and part dermis is damaged or lost
The wound may be shallow & pinkish or red
It look like a fluid-filled or a ruptured blister

12. STAGE III Full thickness tissue loss
The loss of skin usually exposes some fat
The dead tissue
ulcer looks crater-like
The bottom of wound have some yellowish
The damage may extend beyond the primary wound blew layers of healthy skin

13. STAGE IV
Full thickness tissue loss with exposed bone, tendon or muscle
The bottom of the wound likely contains dead tissue that is yellowish or dark and crusty
The damage often extends beyond the primary wound layer of healthy skin

14. UNSTAGEABLE
Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough
Yellow, brown, black or dead tissue is covered surface of ulcer
It is not possible to see how deep the wound is

15. Deep tissue injury
The skin is purple or maroon but the skin is not broken
A blood-filled blister is present
The area is painful, firm or mushy
The area is warm or cool compared with the surrounding skin
In people with darker skin, a shiny patch or a change in skin tone may develop

16. Bone and joint infections
COMPLICATIONS
Sepsis
Cellulitis
Bone and joint infections
Cancer