Term
| A localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combo with shear and/or friction |
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Definition
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Term
| What characteristics make people at greatest risk for pressure ulcers? |
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Definition
-Lack of protective sensation (SCI, diabetes, stroke, burn/scar tissue)
-Immobility (spinal stenosis, burn pt)
-Poor Nutrition
-Incontinent or uncontrolled sweating (moisture)
-Muscle Atrophy (paraplegia LMN more prone to ms atrophy) |
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Term
| Name the top 4 high risk groups of pressure ulcers |
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Definition
1. SCI
2. Elderly
3. Orthopedic Immobility (esp those with hip fractures)
4. Those in ICU (due to immobility) |
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Term
| What is the turning schedule for dependent and independent |
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Definition
Independent = every 15 min
Dependent = every 30 min |
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Term
| What is the cost of pressure ulcers? |
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Definition
| The cost to heal a single Stage IV pressure ulcer has been reported to be an average of $70,000 |
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Term
| Name the 4 levels of skin breakdown |
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Definition
1. Hyperemia - within 30 min or less (redness that lasts less than 1 hr)
2. Ischemia - 2-6 hrs of continuous pressure (deeper erythemia that may take 36 hours or more after pressure has been removed to heal)
3. Necrosis - 6 or more hours (blue or gray color and may become indurated)
4. Ulceration - may occur within 2 weeks after necrosis |
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Term
| Physical therapy role in pressure ulcer management |
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Definition
-Evaluation of risk factors (via Braden scale, prevention, education on pressure relief)
-Prevention Education
-Identifying cause (so it won't happen again)
-Assessment of posture/positioning
-Equipment Evaluation (total contact seating surface should be equal)
-Pressure ulcer care (hopefully will not get to this point)
-Education for prevention of additional complications |
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Term
| Name 7 pressure ulcer risk factors |
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Definition
1. Immobility
2. Sensation
3. Shear
4. Friction
5. Smoking
6. Temperature/Moisture
7. Intrinsic Factors (ms atrophy, medications, nutrition and co-morbid medical conditions) |
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Term
| Name 2 risk assessment tools for pressure ulcers |
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Definition
1. The Norton Scale/Gosnell's Scale
2. The Braden Scale** |
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Term
| Acute care positioning program |
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Definition
-At least every 2 hours
-Do not lay on developing sore
-More than 2 hours when pt is less red (progress to longer duration as pt builds tolerance)
-Max time = 4-6 hours = in accordance with cath schedule
-Slight redness is fine as long as it lasts less than 30 min |
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Term
| Pressure ulcer prevention |
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Definition
1. Positioning Program
2. Pressure Reducing Cushions/ Mattresses
3. Pressure Mapping - interface pressure measurement
4. Improved Mobility
5. Transfer training to reduce friction
6. Moisture control/hygiene
7. Nutrition
8. Wound care |
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Term
| What cushion is best for pt with increase risk of pressure sore? |
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Definition
| Roho, but it req more maintenance than Jay |
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Term
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Definition
1. To assist the therapist in evaluating the most appropriate cushion or bed mattress for individual at risk for pressure ulcers
-Does not take the place of clinical judgement
2. To educate the client on the importance of position changes in w/c and bed
3. To assist in justifying cushion or mattress recommendations to 3rd party payers |
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Term
| How many stages are there for pressure sores? |
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Definition
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Term
| Name the pressure ulcer stages! |
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Definition
1. Stage 1: Non-blanchable erythema, intact skin
2. Stage 2: A blister or shallow crater, not into the subcutaneous
3. Stage 3: A wound thru the dermis and into subcutaneous, but not into ms or bone
4. Stage 4: A deep wound involving ms, bone, etc
5. Unstageable: Eschar or slough on bed
6. Deep Tissue Injury |
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Term
| A term being used more widely recently to describe the deep purplish discoloration seen on pts when a severe insult has occurred, but hte tissue is not opened (epidermis intact) |
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Definition
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Term
PUSH
Pressure Ulcer Scale for Healing |
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Definition
-Measure length x width
-Exudate
-Tissue Type
-Visual graph to see healing over time |
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Term
| Typically indicated for ulcers of grade 3 or 4 that have shown poor healing witha ccepted wound management techniques |
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Definition
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Term
| Name 4 goals of surgical flaps |
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Definition
1. Excise the ulcer and surrounding eschar
2. Remove underlying necrotic or infected bone
3. Fill the dead space with fascia or ms flaps
- Introduce improves vascularity with flaps and by distributing pressure over bony prominences
- Flap should be designed as large as possible, placing the suture line away from the away from the area of direct pressure
- Flap design that does not violate adjacent territory to preserve options for further reconstruction
4. Removal of underlying bony prominences may be indicated |
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Term
| Surgical Interventions for Pressure Ulcers |
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Definition
-Inferior gluteal artery perforator (IGAP) flap
-Free flaps
-In addition the sight of the pressure ulcer may dictate the area used for flap and must consider the potential for additional flaps |
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Term
| 5 aspects of Post Surgical management |
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Definition
1. Protocol depends on the DR, site of wound, and surgical procedure
2. Position in a manner that keeps pressure off a fresh surgical site (most often prone)
3. Use an air-fluidized bed when pressure on the surgical flap is unavoidable
4. Progressively mobilize the individual to a sitting position over at least 4 to 8 weeks
5. Pt education to prevent additional ulcers |
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Term
| What is the PT role for pressure ulcers have 4-6 weeks of satisfactory healing |
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Definition
1. Begin passive ROM exercises in preparation for sitting (should be able to see the flap while ranging)
2. Once 90 degrees of hip flexion is obtained, initiate sitting program over a 2 to 2 1/2 week period until the individual can sit up for up to 5 hours
3. Observe the pt's skin before and after each sitting time |
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