Bed sore

This is the PPT for bed sore, its stages, assessment with braden score and its management.

1. BED SORE
AND ITS
MANAGEMENT
By
Ms. Pooja Singh
Fatima Hospital, Mau

2. INTRODUCTION
Epidemiology
•1-3millionAmericanareaffected
•1in4personsintheUSAwhodiedin1987hada
dermalulcer
•Pressureulcersdevelopprimarilyinelderlypatients

3. •Setting
-Hospital 60 percent
-Nursinghomes18percent
-Home 18 percent
•1/3 of patients undergoing surgery for hip fracture
develop a pressure ulcer
•The longer the patients stays in a nursing home, the
greater the likelihood of developing a pressure ulcer

4. DEFINITION
Apressureulcerorpressuresoreordecubitusulceror
bedsoreislocalizedinjurytotheskinandother
underlyingtissue,usuallyoverabonyprominenceas
resultofprolongedunrelievedpressure.

5. CAUSES/ RISK FACTORS
➢Friction
➢Shear
➢Impaired physical mobility
➢Altered level of consciousness
➢Faecal and urinary incontinence
➢Malnutrition

6. CONT..
➢Dehydration
➢Excess body heat
➢Advanced age
➢Chronic medical condition-diabetes, cardiovascular
disease

7. PATHOPHYSIOLOGY
Various risk factors act on areas of soft tissue overlying bony
prominence
When this pressure exceeds normal capillary pressure
Occlusion and tearing of small blood vessels
Reduced tissue perfusion
Ischemic necrosis
Pressure sore

8. COMMON SITES OF BED SORE

9. STAGES/ CLASSIFICATION
•Staging system for pressure ulcers are based on the depth
of tissue destroyed.
•Based on the depth there are four stages of bed sore
•Stage I -Non-blanchable redness of the intact skin
•Stage II -Partial thickness skin loss and blister
•Stage III -Full thickness skin loss [ fat visible]
•Stage IV -Full thickness tissue loss

10. STAGE I –NONBLANCHABLE REDNESS
OF THE INTACT SKIN
•Intact skin presents with non-blanchable erythema of a
localized area usually over o bony prominence.
•Discoloration of the skin, warmth, oedema, or pain may
also be present
•Stage 1 indicates at risk persons
•Involves only the epidermal layer of the skin

12. STAGE II -PARTIAL THICKNESS SKIN
LOSS AND BLISTER
•A partial thickness loss of epidermis presents as a
shallow open ulcer with a red-pink wound bed without
slough
•Stage ii is damage to the epidermis and the dermis. In
this stage , the ulcer may be referred to as a blister or
abrasion.

14. STAGE III -FULL THICKNESS SKIN
LOSS [ FAT VISIBLE]
•A stage iii is full thickness tissue loss. Subcutaneous fat
may be visible, but bone, tendon, or muscle is not
exposed
•Epidermis, dermis and subcutaneous tissue involved
•Subcutaneous layer has a relatively poor blood supply.
So its difficult to heal

16. STAGE IV -FULL THICKNESS TISSUE
LOSS
•Astageivulceristhedeepest,extendingintothe
muscle,tendonorevenbone.
•Fullthicknesstissuelosswithexposedbone,tendonor
muscle.

18. PREVENTION
•Positionchanging
•Skininspection
•Nutrition
•Lifestylechanges
•Usepressurerelievingdevices

19. BRADEN SCALE FOR PREDICTING
PRESSURE ULCER RISK
•Sixcriteria
•Sensoryperception
•Moisture
•Activity
•Mobility
•Nutrition
•Frictionandshear

20. BRADEN SCALE FOR PREDICTING
PRESSURE ULCER RISK
•Eachcategoryisratedonascaleof1to4,excludingthe
frictionandshearcategorywhichisratedona1-3scale
•Ascoreof23meansthereisnoriskfordevelopinga
pressureulcerwhilethelowestpossiblescoreof6points
representstheseverestriskfordevelopingbedsore.

21. MANAGEMENT
•Changingposition
•Usingsupportsurfaces
•Cleaning
•Controllingincontinence
•Removalofdamagedtissue
•Dressings

22. CONT..
•Oralantibiotics
•Healthydiet
•Educatingthecaregiver
•Infectioncontrol
•Woundintervention

23. SURGICAL MANAGEMENT
•Tissueflap
•Plasticsurgery
•Hyperbaricoxygen
•Topicaluseofhumangrowthfactors