1. Pressure Ulcer Management By Susan Yap, PT

2. Anatomy of the Skin Epidermis Dermis Subcutaneous Tissue Fascia Muscle Tendon and Bone

3. Functions of the Skin Protection Regulates Body Temperature Sensation

4. Effects of Aging on Skin Dehydration Reduced Subcutaneous Fat Decreased Vascularization Decreased Elasticity

5. Physiology of Wound Healing Healing by primary intention- wound edges are brought together and sutured Healing by secondary intention- wound edges are not brought together and must heal by granulation, contraction and epithelialization

6. Phases of Wound Healing 1. Inflammatory Phase Acute Phase = Vasoconstriction and clot formation Followed by demolition phase Chronic inflammation results in wound is overwhelmed by necrotic tissue Characteristics: Edema, Erythema, Pain, Necrotic tissue and Exudate 2. Proliferative Phase Granulation Tissue fills wound bed Angiogenesis Epidermal cells migrate across granulation tissue Contraction of wound edges Characteristics: Deep red granulation tissue, Transudate, Epithelialization occurring 3. Maturation Phase Increase in tensile strength through collagen synthesis Resulting scar tissue 70-80% as strong as original skin Characteristics: Decrease vascularization, Increase tensile strength, Decrease size of scar

7. Pressure Ulcer Any lesion cause by unrelieved pressure resulting in damage of underlying tissue ; usually over a bony prominence.

8. Risk Assessment Impaired circulation Impaired Mobility Predisposing Illness or medication that impair healing Decrease mental status Incontinence Nutritional deficits Patients with existing pressure ulcer Non compliance

9. Early Intervention Team Effort Address functional mobility and ROM Continence training Education Positioning Pressure relieving/reducing devices

10. Mechanical Loading and Support Surfaces Bed bound Chair bound Avoid positioning directly on the trochanters Positioning devices to relieve all pressure from the heels and to prevent direct contact to bony prominences Prevent sheer injury Ring cushions should be avoided Support surfaces

11. Initial Evaluation Holistic approach Functional mobility and ROM Nutritional status Pain level Psychosocial health Common complications of pressure ulcer

12. Wound Assessment Etiology Location Size

13. Pressure Ulcer Stage I - Red non-blanchable Stage II - Partial thickness skin loss Stage III – Full thickness skin loss involving underlying subcutaneous tissue Stage IV – Full thickness skin loss with extensive destruction damage to muscle bone

14. Stage I

15. Stage II

16. Stage III

17. Stage IV

18. Viable Tissue Granulation Epithelialization

19. Necrotic/Nonviable Tissue Eschar Slough

20. Drainage/Exudate Amount Transudate/serous Purulent

21. Odor Describe Intensity Result of autolytic debridement or dressing

22. Developing Goals Process Oriented Measurable Time Oriented

23. Debridement Mechanical Sharp Enzymatic Autolytic

24. Dressings Cardinal rule keep ulcer tissue moist Eliminate dead space by loosely packing Control exudate Cost effective Time effective Location of wound

25. Things to remember Communication with Physicians Documentation Risk Management Education Quality Improvement

26. Thank You Email : susan_yap@hchd.tmc.edu