Statistics
Two parts:
- Most common area for pressure ulcers in adults?
- Most common area for pressure ulcers in children?
Adults: sacrum
Children: occiput
Besides the sacrum and occiput, name 3 other common sites of pressure injuries
Sacrum, occiput, shoulder, elbow, heel, ear, trochanter, knee, ankle, scapula, ischium, ball of foot
*slide 2*
A patient with a spinal cord injury develops a shallow open wound over the sacrum with partial-thickness loss of the epidermis and dermis. No adipose tissue is visible. What is the stage of this pressure injury?
Stage 2 pressure ulcer
*slide 3*
What wound care principle guides dressing selection for superficial (Stage 1 and Stage 2) pressure injuries based on wound moisture?
If it's dry, wet it; if it's wet, dry it.
Dry wound → add moisture (e.g., hydrogel).
Draining wound → absorb moisture (e.g., foam or alginate dressing).
Which type of wheelchair is most effective at reducing pressure ulcer risk in patients who cannot independently perform pressure relief?
Tilt-in-space
*slide 10*
What percentage of SCI patients will develop a pressure ulcer at some point in their life
Free bonus (100 points): what percentage of SCI patients develop a pressure ulcer in the acute setting?
80% lifetime
25% in acute setting
In addition to prolonged pressure, which mechanical force significantly contributes to deep tissue injury by distorting and occluding blood vessels?
Shear
A patient develops a pressure injury over the ischial tuberosity. Examination reveals full-thickness skin loss with visible subcutaneous fat. Muscle, tendon, and bone are not exposed. What is the stage of this pressure injury?
Stage 3 pressure ulcer
*slide 4*
Following adequate debridement of a chronic pressure injury, what therapy is commonly used to manage wound exudate while promoting granulation tissue until the wound is ready for closure?
Negative pressure wound therapy (Wound VAC)
*slide 8*
A patient who uses a wheelchair develops a localized area of erythema over the ischial tuberosity. The skin remains intact, but the redness does not disappear when pressure is applied. What stage pressure injury is present?
Stage 1
*slide 11*
What is the most common location of pressure injury in an SCI patient after two years?
Ischial tuberosities (sacrum is #1 for the first 2 years)
Prolonged pressure over a bony prominence results in tissue ischemia and eventual necrosis through compression of which structure?
Capillaries (microvasculature)
A patient is found to have a sacral pressure injury completely covered by thick yellow slough. The base of the wound cannot be visualized. How should this pressure injury be classified?
Unstageable pressure ulcer
*slide 5*
Name the 3 most common nutritional supplements that have some evidence to help with wound healing
Vitamin C (1 g/day)
Zinc sulfate (220 mg/day)
Copper (2 mg/day)
Two parts: In prevention of pressure ulcers...
- How often should a patient be repositioned?
- How often should the patient weight shift (if able)?
Reposition: q2hr by staff/family
Weight shift: q15-30 min
Approximately what percentage of hospitalized patients develop a hospital-acquired pressure injury?
8.4% (from NPIAP)
Why are pressure injuries often more severe in the underlying muscle than suggested by the appearance of the overlying skin?
Muscle has higher metabolic demands and is therefore more susceptible to ischemia than skin
Following prolonged immobilization, a patient develops an intact pressure-related lesion with deep purple discoloration and a blood-filled blister over the greater trochanter. What is the most appropriate diagnosis?
Deep tissue pressure injury
*slide 6*
What is the recommended daily protein intake for a patient with a Stage 3 pressure injury to promote wound healing? Measured in g/kg/day
Stage 1-2: 1.2-1.5 g/kg/day
Stage 3-4: 1.5-2 g/kg/day
A 52-year-old man with T6 paraplegia has had a chronic ischial pressure injury for 25 years. Despite appropriate wound care, the ulcer has recently enlarged and developed raised, rolled edges with easy bleeding. What diagnosis should be suspected?
Marjolin ulcer (squamous cell carcinoma arising in a chronic pressure injury)
*slide 12*
Pressure injuries are estimated to cost the U.S. healthcare system approximately how much annually?
$26–27 billion per year
Pressure ulcers begin to occur when pressure to an area exceeds what amount? (expressed as mmHg)
70 mmHg
Several months ago, a patient developed a pressure injury with full-thickness tissue loss and exposed tendon. The wound is now completely epithelialized. What is the correct stage to document?
Healed Stage 4 pressure injury
*slide 7*
A patient with a chronic Stage 4 sacral pressure injury has failed prolonged wound care and is being evaluated for definitive surgical management. What reconstructive procedure is most commonly performed?
Myocutaneous flap reconstruction (e.g., gluteus maximus flap)
*slide 9*
What is the most commonly used tool to assess the risk of developing pressure injuries?
The Braden Scale
*slide 13*