Pressure Ulcers

Pressure Ulcers

Pressure Ulcers: Chronic Wounds That Can Be Prevented If We Understand Them Deeply Enough

Pressure ulcers are chronic wounds caused by prolonged pressure on the skin, preventing blood from flowing to the area normally, leading to cells lacking oxygen and eventually dying. Although it may sound simple, pressure ulcers can spread deep into the muscles or bones, and can cause serious complications such as bloodstream infections or squamous cell carcinoma if left untreated.

Deeper Causes: Not Just Pressure
Pressure ulcers are not caused by pressure alone, but by a combination of three main factors:
1. Pressure. When an area of ​​skin is pressed against a hard surface, such as a hip bone pressed against a mattress, the pressure in the capillaries increases until blood cannot flow through, causing the tissue in that area to lack oxygen (ischemia). If the pressure lasts for more than two hours, tissue death begins.
2. Shear. When the skin stays in place, the underlying tissue moves, such as when a patient is helped up incorrectly, the skin is pulled until the small blood vessels are stretched or bent. Impairs blood circulation
3. Moisture Urine, feces, sweat or fluid from the wound can make the skin fray and cause wounds more easily, especially in patients who cannot control their bowel movements.

Risk factors that increase the severity of wounds
•Limited mobility: Paralyzed patients or those who are bedridden for long periods of time
•Malnutrition: Lack of protein, vitamin C and Zinc, which are necessary for tissue repair
•Neurological complications: such as neuropathy, diabetes or spinal cord injuries, causing patients to not feel pain or discomfort
•Lack of proper care: such as not changing positions regularly or not noticing the wound from the beginning

Pressure Ulcer Staging
The staging system by the National Pressure Injury Advisory Panel (NPIAP) is used to assess the severity of the wound:
Stage 1: Redness persists even when pressure is stopped, feels warm, swollen or harder than the surrounding area
No skin opening
Stage 2: Superficial wound or blisters, indicating that some skin loss has begun
Stage 3: Deep wound reaching the subcutaneous fat layer, yellow tissue may be visible No muscle or bone invasion
Stage 4: Deep wounds that involve muscle, tendon, or bone may contain eschar or pus
Unstageable: Necrotic tissue covering the depth of the wound is not assessable. Debridement is required before staging can be performed

Complications to watch out for
•Wound infection: such as cellulitis, abscess
•Osteomyelitis: Infection in the bone, especially in deep wounds
•Sepsis: Life-threatening bloodstream infection
•Squamous cell carcinoma from long-term chronic wounds

Diagnosis and medical care
•Physical examination: Daily examination to assess the wound and change dressings
•Lab: CBC, ESR, CRP, albumin, prealbumin to monitor nutritional status and infection
•Culture: If the wound is pus-filled or infected
•Imaging: X-ray, MRI, or bone scan if suspected bone infection

Treatment guidelines
1. Pressure relief: Change positions every 2 hours, use air cushions or pressure redistribution beds
2. Wound care: Treat wounds using the principle of moist wound healing, use dressings that are appropriate for the stage of the wound, such as hydrocolloid, foam, alginate, and perform debridement if there is necrosis
3. Nutrition: Protein 1.25–1.5 g/kg/day, vitamins C, Zinc, and L-arginine help heal wounds
4. Antibiotics: Only in cases of infection, should not be used as routine
5. Surgery: such as flap surgery in cases of deep wounds or complications

Prevention: The heart of bedridden patient care
•Assess the risk from the beginning: Use tools such as the Braden Scale
•Plan regular position changes
•Provide appropriate nutrition, especially in elderly or emaciated patients
•Train caregivers and staff to recognize wounds early on

Summary

Conclusion Pressure sores are caused by pressure on the skin, causing poor blood circulation and tissue death. They are common in bedridden patients or those with limited mobility. There are 4 stages of wounds, ranging from redness to deep to the bone. Treatment involves pressure relief, wound care, and proper nutrition. Prevention involves frequent position changes and keeping the skin clean.