Pressure Sores

Front 1

What is the largest organ in the body? How dominant is it?

Back 1

The skin, the largest organ in the body makes up 15% of our body weight.

Front 2

What are the functions of the skin?

Back 2

The skin is a barrier from the outside, including chemical, physical and infectious agents, ultra violet rays. It provides mechanical, physical defense from damage to tissues. It provides immunity, it consists of dendrite cells, lymphocytes, white blood cells. It contains nerve sensory receptors to pain, touch and temperature. It aids the thermostatic cvontrol of the body to hot and cold via glands, adjusts body humidity and liquid retention, prevents dehydration, stores energy via fat, forms and stores Vitamin D.

Front 3

What damage is caused by damage to the skin?

Back 3

Loss of fluids, proteins and salts, dangerous materials, infectious organisms, bacteria, fungi and foreign objects may enter the body. Damage to the skin's roles damages is complete function.

Front 4

What are the main layers of the skin?

Back 4

The external layer is the epidermis. The middle layer is the dermis. the deepest layer is the hypodermis or subcutaneous layer.

Front 5

Describe the epidermis.

Back 5

The epidermis contains 4 or 5 layers. It does not include blood vessels or lymphatic cells. It contains melanocyes which give the skin its color. Epidermis renews itself every four weeks.

Front 6

Describe the dermis.

Back 6

The dermis contains hair shafts, sweat and fat glands, lymphatic vessels, sensory receptors, a network of blood vessels, muscle cells, collagen and elastin fibers fibroblasts, microphages and immune cells.

Front 7

Describe the hypodermis or subcutaneous tissue.

Back 7

The hypodermis or subcutaneous tissue is made mostly of fatty tissue. It retains body heat and is a source of energy. It includes in lesser amount than the dermis, a network of blood vessels and heals slowly. The connective tissue is mixed with fatty tissue, helps control body heat and isolation, contains blood supply for the skin and fatty tissue underneath.

Front 8

How does the body heal itself?

Back 8

Upon rupture, the body has a system of self healing which is activated immediately and is made up of several stages.

Front 9

Describe the stages of self healing of the skin.

Back 9

Homeostasis, inflammation, granulation, epithelization, remodeling.

Front 10

What is homeostasis, inflammation, granulation?

Back 10

1. Homeostasis- The blood stops, blood clot which becomes a scab eventually. The blood stops by a reflex reaction called vasospasm. New red blood cells arrive and clot the blood. The red blood cells secrete PDGF to heal. Fibrinogen turns into fibrin. Growth factor is activated.
2. Inflammation-About three hours after and for about 3 days after dissue damage white blood cells and especially neutrophils and macrophages, whose job it is to clean up the debris of the wound from bacteria and debris. There is redness, heat, swelling, pain and loss of function. The blood vessels dilate and there is an increase in white blood cells, especially lymphocytes of types T and B for immune protection.
3. Granulation- new tissue is formed about 3 days after the wound lasting about 3 weeks. After being cleaned up from debris and bacteria, fibroblasts and myofibroblasts get to work producting collagen for angiogenesis, new blood vessels and red blood cells rich with platelets with enzymes and growth factors.

Front 11

What is epthelization and remodeling?

Back 11

4 Epitheal cells regenerate from the outside to the center. The cells mutiply and push those formed earlier upwards creating a corneum stratum layer which protects the healing area.
5 Remodelling- Three weeks until about 2 years after the rupture, new scar tissue is formed. The new skin will be up to 80% of its original strength.

Front 12

What are various names for pressure sores?

Back 12

pressure ulcers, decubitus ulcers, bed sores, dermal ulcers.

Front 13

Define a pressure sore.

Back 13

Pressure sore is a condition of local damage to the skin and the underlying tissue which is caused by longterm lack of blood supply resultant from localized pressure, fracture, friction or a combination of factors. Necrotic tissue tends to develop when soft tissue is pressed between grammic extrusion, bone and hard surface for a continuous period of time.

Front 14

What body areas are most susceptible to bed sores?

Back 14

Joints, ankles, sacrum when lying down, ischial tuberosity from prolonged sitting, hips, shoulders, elbows are all areas that may be prone to pressure sores.

Front 15

Describe a typical process of bed sore development.

Back 15

Pressure leads to lymph and blood blockage, bacteria, hematoma, necrosis to muscle and tissue, dermis and epidermis necrosis.
Pressure to ischemia to vasculary leakage to edema to hematoma to necrotic muscle and tissue to necrosis of dermis and epidermis.

Front 16

What additional factors increase likelihood of bed sores?

Back 16

Mechanical pressure, friction, moisture.

Front 17

What does prolonged pressure do?

Back 17

Prolonged pressure arrests blood and lymph flow to the area, decreases oxygen and nutrient flow to the area, disturbs removal of waste or toxic products.

Front 18

What is the capillary pressure in the tissues?

Back 18

20-32-40 mercury mm . The very least amount of pressure which does not decrease capillary blood flow is 32. Above this may disturb blood flow.
On the back pressure can go as high as 70 and disturb blood flow. While seated, pressure can go as high as 3-500 which is exerted on the bones of the bottom, obstruct capillary blood flow to the tissues.

Front 19

What is the capillary pressure in the soft tissues?

Back 19

Soft tissue capillary blood flow in veins is between 20 and 40. When the exernal pressure increases above 32 over time, a process of events leads to bed sores.

Front 20

What is the process leading to bed sores?

Back 20

Prolonged pressure above3 capillary arterial pressure causes blood flow restriction, ischemia and hypoxia. Low blood supply causes cellular death and damage to skin tissue. Necrotic tissue may result from lack of blood supply to a certain area.

Front 21

What is shearing?

Back 21

This is the force when the patient slips, with head above 30 degrees, against the sheet, on the sacrum, capillary distortion, blood vesseel stoppage, hypoxia and local ischemia.

Front 22

What happens as the blood vessels lengthen in bed sores?

Back 22

As the blood vessels stretch, the blood vessel walls become thinner. Vessel occlusion may be due to distortion.

Front 23

How is it recommended to prevent friction?

Back 23

Friction can be avoided by using lubrication, bandaging and padding, correct positioning of the patient, techniques for moving other than dragging along the sheet, using supports.

Front 24

What do we need to know regarding wetness and bed sores?

Back 24

Wetness is caused by sweat, urine, secretions from wounds and fecial fluids. Wet skin is more suspectible to rupture and then vulnerable to cracking, infectious bacteria, fungi. Use a breathing fabric which will areate and remove moisture. Use lower underpants and towelling or pads to absorb liquid. Keep bedding and clothing dry.

Front 25

What about skin temperature?

Back 25

Moisture combined with raised skin temperature, weakens the skin and increases the susceptibility to fiction and skin damage.

Front 26

What internal factors increase risk of developing bed pressure sores?

Back 26

Lack of movement, neurological damage including lowered sensory input, states of consciousness causing sleep and confusion, lack of control of bodily functions, poor nutrition such as albume zinc and iron counts, malnourishment,systemic disease which cause edema, dehydration, poor kidney, liver and heart function, collagen sickness, digestive diseases, sicknesses of the peripheral blood supply from decreased venous or arterial blood supply especially to the lower body metabolic disease such as diabetes, thyroid, decreases immune systema nd increase in infectious agents, skin changes in old age.

Front 27

What additional factors may incease risk of bed pressure sores?

Back 27

Medical treatments with steroid drugs, sedatives, sleeping pills, anticoagulants may provide additional risk.
Also, alcohol consumption, smoking, low blood pressure and dehydration, post operative nd accident, orthopedic casts, restricted movement due to connection to equipment.

Front 28

What factors determine the degree of tissue damage from pressure sores?

Back 28

The degree and amount of time of pressure, the type of tissue under pressure-muscle being the most sensitive- blood pressure and blood supply to the tissue, degree of friction, moisture, infection and edema.

Front 29

What is the standard grading of severity of bed sores?

Back 29

The severity is defined by the anatomical structure.
From light to severe, there are four levels and names are given according to the amount of anatomical tissue loss.

Front 30

Describe the four stages of severity of developing bed sores.

Back 30

1. redness 2 light wound formation 3 the wound becomes an ulcer in a deeper tissue 4 the ulcer becomes infected and destroys internal tissue, muscle, bone or ligaments.

Front 31

Describe level one

Back 31

At level one, only the epidermis is harmed. Redness does not go away upon removal of the localized pressure. The appearance is difference on light and dark skin.

Front 32

Describe level two.

Back 32

At level two, rubbing, tearing, blistering may appear. Both the epidermis and dermis are associated with the sore. Local heat and redness.

Front 33

Describe level three.

Back 33

At level three, all three layers of skin are associated. The wound may include scab, necrotic tissue or form a crater shape.

Front 34

Describe level four.

Back 34

At level four, necrosis is apparent on the skin and through tissue unti the ligament, muscle, joint or bone. There is deep and wide destruction.

Front 35

What is the added fifth level?

Back 35

The added fifth level is unstable. the base of the wound is covered with slough in yellow, green or brown and with Escher. Only after removal of these two layers can the depth, size and level of severity be assessed properly.

Front 36

What is "suspected deep tissue injury"?

Back 36

The skin is whole but there are several suspicious signs such as; changes in skin color, skin temperature, sensation (pain, stiff, soft, foamlike)

Front 37

What is a Kennedy Terminal Ulcer?

Back 37

This is a pressure sore appearing on a terminal patient predicting impending death. It suddenly appears on the sacrum and develops also immediately through all the levels from rubbing to blisters to a deeper wound. the edges are not stable. The color may change quickly from normal to red, pale yellow, and black.

Front 38

Where do bed sores normally appear?

Back 38

heels, ankles, sacrum, trochanters, back, elbows, spine, knees.
In addition, ears, forehead, nose, fingers and toes.
95% of bed sores appear on the lower half of the body, below the hips.
65% of these pressure sores appear in the hip area.

Front 39

Where are the most common pressure sores from sitting?

Back 39

The most common pressure sores from sitting are located unde the ischial tuberosities.

Front 40

Where are the most common pressure sores from lying down?

Back 40

The toes, heels, sacrum, spine elbows, shoulder blades, back of the head appear from lying down.

Front 41

Where are the most common pressure sores from lying on the side?

Back 41

The ankle, knee, hip, shoulder, ear appear from lying on the side.

Front 42

Where are the most common pressure sores from lying on the stomach?

Back 42

The elbow, rib cage, thigh, patella knee cap, toes appear from lying on the stomach.

Front 43

What excretion comes from bed sores? What are its qualities?

Back 43

Exudate hinders and disturbs the healing process, causing loss of protein, damage to surrounding tissue and providing food for bacteria.

Front 44

How many levels are there regarding bed sore discharge?

Back 44

1. no discharge.
2. small discharge.
3. intermedidate discharge.
4. large discharge
5. with or without odor.