A Case Presentation of Decubitus Ulcer.pptx

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1. A Case Presentation of Decubitus Ulcer LTC Level 8

2. Overview Bedsores – also called as pressure ulcer and decubitus ulcer Are injuries to skin and underlying tissue resulting from prolonged pressure on the skin Bedsores most often develop on skin that covers bony are of the body, such as the heels, ankles, hips and tailbones. People most at risk of bedsores have medical conditions that limit their ability to change positions or cause them to spend most of the time in a bed or chair. Bedsores can develop over hours or days Most sores heals with treatment, but some never heal completely.

3. Unusual change in skin color or texture Swelling Pus-like draining An area of the skin that feels cooler or warmer to touch than other areas Unusual change in skin color or texture Symptoms Tender areas

4. Bedsores fall into one of several stages based on their depth, severity and other characteristics, The degree of skin and tissue damage ranges from red, unbroken skin to a deep injury involving muscle and bone

5. Common sites of pressure ulcers For people who use wheelchairs, bedsores often occur on skin over the following sites: Tailbone or buttocks Shoulder blades and spine Backs of arms and legs when they rest against the chair For people who needs to stay in bed, bedsores may happen on: The back or sides of the head The shoulder blades The hip and lower back or tailbone The heels, ankles and skin behind the knees

6. Pressure Ulcer Points

7. Causes Bedsores are caused by pressure against the skin that limits blood flow to the skin Limited movement can make the skin vulnerable to damage and lead to development of bedsores. Three primary contribution for bedsores are: Pressure Friction Shear

8. This might be due to poor health, spinal cord injury and other causes Risk Factors Immobility Skin becomes more vulnerable with extended exposure to urine and stool Incontinence Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain and discomfort can result in not being aware of warning signs and the need to change position Lack of sensory perception People need enough fluids, calories, protein, vitamins and minerals in their daily diets to maintain healthy skin and to prevent breakdown of tissue. Poor Nutrition and Hydration Health problems that affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores. Medical conditions affecting blood flow

9. Rarely, a skin ulcer can lead to sepsis. Cellulitis is an infection of the skin and connected tissues. It can cause warmth, redness and swelling of the affected area. People with nerve damage often do not feel pain in the area affected by cellulitis. Complications Cellulitis An infection from a pressure sore can burrow into joints and bones. Joint infection (septic arthritis) can damage cartilage and tissue. Bone infections (osteomyelitis) can reduce the function of joints and limbs. Bone and joints Infection Long term, non healing wounds ( marjolin’s ulcer) can develop into a type of squamos cell carcinoma. Cancer Sepsis

10. PATIENT'S INFORMATION Patient's Name: Ali Mohammed Alnaser File Number: 3346614 Age: 66 years old Gender: Male Date of Birth: 10-Jan-1959 Medical History : Psychosis, Diabetics Mellitus, Electrolyte Imbalance GCS: 15/15 Transfer from Almoosa Specialist Hospital to Long term Care on June 1, 2024 in 7 th Floor LTC rehab Transfer to 12 th Floor LTC rehab on November 12, 2024

11. PROCEDURES DONE 10/12/2024: CT Brain without contrast 16/12/2024: Chest X-ray Blood culture and sensitivity Sputum Culture and sensitivity Urine culture and sensitivity

12. NUTRITION DIET puree DM, low salt, low fat, high potassium, high protein, iron rich diet 3 scoops bene protein BID mixed with foods Ensure plus BID RECOMMENDED POSITION: All position

13. SKIN ISSUES Sacral Stage 4 with over granulated tissue Left and Right trochanter unstageable (reported on skin updates December 27, 2024) Lower buttocks skin peeling

14. Both Trochanter Unstageable Sacral Stage 4 Fishbone Diagram 3 PROCESS COMMUNICATION 2 ENVIRONMENT PEOPLE 1 Mepilex dressing not available all the time Fitted sheet are too large POLICY TECHNOLOGY Infrequent diaper care Lotions sometimes not available Workload or delegation Lack of Assessment/reassessment on skin integrity Acknowledgement of proper moving and handling of patients Linen creases and wrinkles Positioning schedule not followed Insufficient manpower Awareness in proper injury, dressing and prophylactic dressing application Diaper sometimes are tight Mental health status of the staff Sudden procedure for other patients Poor skin turgor of the patient (Fragile skin due to old age Lack of clear handover Inadequate documentation Insufficient communication among staff

15. LESSON LEARNED: Do skin assessment and reassessment habitually Early/ Immediate referral for further skin assessment to the wound care team. Abide by the SSKIN BUNDLE all the time Frequent repositioning of the patient Frequent diaper change Do not vigorously rub/ scrub the skin during bathing and diaper care Apply recommended wound care dressing or proper prophylactic dressings at all times.