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Pressure Ulcers
- Pressure ulcers arise due to a combination of situations
and factors.
- On a cellular level, ischemia occurs to tissue when too
much pressure is applied to one area for a prolonged
period of time. This pressure is usually from a bony
prominence on one side and a hard surface on the other
side. The soft tissue between these two surfaces is
subjected to abnormal pressure. The ischemia produced
leads to tissue necrosis.
- The tissue closest to the bone is typically the first
tissue to undergo necrosis. Therefore, visible skin
discoloration or redness may actually be an indicator of
underlying adipose or muscular necrosis.
- It has been demonstrated that the capillary pressure on
the arterial side is around 30-32 mmhg and around 12 mmhg
on the venous side. Sustained pressures at values higher
than these may result in circulatory compromise and
tissue necrosis.
- Frictional and shearing forces also play roles in tissue
necrosis and must be reduced or eliminated.
- General health, skin texture and turgor, patient's
mobility (during sleep or on an OR table), nutritional
status and body weight (too thin and too heavy are both
problematic) must all be evaluated and corrected in order
to reduce the risk of a pressure sore.
- Learn how to properly stage pressure
ulcers or go to the AHCPR Guideline for
an explanation of staging, treatment and prevention.
References: The Care of Wounds, A Guide for Nurses by Carol
Dealey Bsc (Hons), RGN, RCNT. Blackwell Scientific Publications
1994
Pictures courtesy of Dr. Tamara D. Fishman and Dr. Allan D.
Freedline
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