Pressure Ulcer Stages
This stage pressure ulcer is defined as a partial thickness loss of the dermis
Stage 2:
Shallow open ulcer with a red/pink wound bed, without slough
May also present as an intact or open/ruptured serum-filled or sero-sanguineous filled blister.
Treatment (and duration) for osteomyelitis
6 weeks of antibiotics
12 weeks if OM with diabetes
List 2-3 risk factors for the developing of pressure ulcers
reduced or absent sensation
impaired mobility
decreased blood flow
muscle atrophy
poor nutrition
chronic illness (DM)
AMS
True or false: hyperbaric oxygen therapy has been shown to help with pressure injury
True: HBOT is the delivery of O2 at 10-fold or higher O2 for therapeutic effect:
1) for complex ulcers with “hospital level” infection and/or gangrene
(2) acute arterial obstruction post revascularization
(3) refractory osteomyelitis
(4) flap failure (e.g., transtibial amputation dehiscence)
(5) crush injury
(6) radiation therapy–induced ulcers or mucosal injury
Pressure-associated skin damage often develops over these parts of the body (as opposed to moisture associated skin damage)
bone /bony prominence
This stage pressure ulcer is defined as intact skin with nonblanchable redness of a localized area
Stage 1
Area may be more painful, firm, or soft, or warmer or cooler than adjacent tissues
May be difficult to detect in persons with dark skin tones.
Definitive diagnosis of OM should be made by
bone biopsy (96% sensitive)
Neuropathy (cant feel wound)
Arteriosclerosis (inflammation, reduced oxygen supply, ROS)
3 vitamins/minerals to supplement that may aid in wound healing
vitamin C- form collagen cross links
Vitamin A- delayed wound healing if def
Zinc- healing of venous ulcers
These labs may be helpful in identifying risk factors for wounds or may raise suspicion that an individual may be high risk
WBC
ESR/CRP
HA1c <6.5 (5.7-6.5 pre-D)
Albumin <3.5, Prealbumin <15
This stage pressure ulcer is defined as full thickness tissue loss with exposed bone, tendon or muscle
Stage 4
Slough or eschar may be present
Often include tunneling.
What may you find on 3-phase bone scan that would suggest OM
focal hyper perfusion, hyperemia, increased bone uptake (slide)
What makes a wound 'unstageable'?
full thickness tissue loss in which the actual depth of the ulcer is completed obscured by slough (yellow, tan, gray, green, brown) or eschar (slide)
How long does it take stage 1 and stage 2 pressure injury to heal?
treatment for stage 2/3 pressure injury?
Stage 2 or shallow Stage 3 with scant to minimal drainage foams or films, zinc oxide paste or barrier creams are often sufficient.
This stage pressure ulcer is defined as full thickness tissue loss. Fat may be visible but bone, tendon or muscle are NOT exposed
stage 3
xray findings that may suggest OM
reactive bone formation and periosteal elevation (slide)
Mechanism of how pressure injury leads to ulcer
compresses tissue--> restricted blood flow--> ischemic/necrosis--> ruptures cells and vessles--> tissue deformation
How long does it take stage 3 and stage 4 pressure injury to heal
How often to turn a patient to help prevent pressure injury
every 2 hours
This type of injury is defined as purple or maroon area of intact skin or blood filled blister
suspected deep tissue injury
due to damage of underlying soft tissue from pressure and/or shear.
Evolution may be rapid, exposing additional layers of tissue even with treatment.
If MRI is contraindicated, study with highest sensitivity and specificy for revealing OM is
bone scan
true or false: as a pressure injury heals, it should be referred to its stage that it INITIALLY presented
true
Negative pressure wound therapy is a good option for these stage/stages of pressure ulcers
Treatment of choice for stage 3-4 pressure injuries in spinal cord injury
reconstructive surgery