WHAT IS PRESSURE SORE? WHAT ARE THE TREATMENT METHODS?
WHAT IS PRESSURE SORE
LOCALISED DAMAGE TO THE SKIN OR SUBCUTANEOUS SOFT TISSUE DUE TO PROLONGED EXPOSURE TO PRESSURE ON BONE PROMINENCES, MORE SO IN BEDRIDDEN PATIENTS. PRESSURE SORES HAVE DIFFERENT STAGES DEPENDING ON THE SEVERITY.
THE RISK OF DEVELOPING PRESSURE SORES ON WHEELCHAIR USERS AND BEDRIDDEN PATIENTS IS HIGHER: - HIPS, COCCYX, SPINE, SCAPULA - BACK OF LEGS, ARMS, EARS, HEELS, ETC.
WHAT CAUSES PRESSURE SORES?
PROLONGED PRESSURE, LACK OF PAIN SENSATION, IMMOBILISATION OF THE PATIENT AND LOSS OF CONSCIOUSNESS. THE MOST IMPORTANT FACTOR IS THE PRESENCE OF PRESSURE. FACTORS CAUSING PRESSURE SORES: MOISTURE AND WETNESS OF THE SKIN, CRUMPLED SHEETS, FRICTION AND TEARING FORCES THAT MAY OCCUR DURING TRANSPORT OF THE PATIENT CONTRIBUTE TO THE FORMATION OF PRESSURE SORES. IN ADDITION, FACTORS SUCH AS MALNUTRITION, LACK OF SUBCUTANEOUS FAT TISSUE IN THE PATIENT ALSO FACILITATE THE FORMATION OF PRESSURE SORES.
WHAT ARE THE DIAGNOSTIC METHODS?
DIAGNOSIS AND GRADING OF PRESSURE SORES ARE MADE BY CLINICAL EXAMINATION.
STAGES OF PRESSURE SORES
IN ORDER TO PREVENT THE DEVELOPMENT OF SERIOUS PRESSURE SORES, IT IS NECESSARY TO IDENTIFY PRESSURE INJURIES IN THE EARLY PERIOD, TO STAGE THEM CORRECTLY AND TO MAKE A DIFFERENTIAL DIAGNOSIS WITH OTHER LESIONS.
STAGE I. PRESSURE INJURY
REDNESS THAT DOES NOT FADE WITH PRESSURE ON INTACT SKIN (ERYTHEMA)
ALTHOUGH THE INTEGRITY OF THE SKIN IS INTACT, THERE IS REDNESS IN A LOCALISED AREA THAT DOES NOT FADE WHEN FINGER PRESSURE IS APPLIED. IT MAY BE DIFFICULT TO EVALUATE IN DARK-SKINNED INDIVIDUALS. REDNESS THAT DOES NOT FADE WITH PRESSURE, SKIN SENSITIVITY-HARDNESS AND HEAT INCREASE MAY APPEAR BEFORE CHANGES IN THE APPEARANCE OF THE SKIN. DISCOLOURATION DOES NOT INCLUDE DISCOLOURATION IN THE FORM OF PURPLE OR MAROON DISCOLOURATION, WHICH MAY INDICATE DEEP TISSUE DAMAGE.
STAGE II. PRESSURE INJURY
PARTIAL THICKNESS OF SKIN LOSS EXTENDING TO THE DERMIS
THE WOUND BED IS VIVID, PINKISH-RED, MOIST AND THE SKIN MAY SHOW INTACT OR BURST BULLAE FILLED WITH WATER. THESE INJURIES ARE USUALLY CAUSED BY IMPROPER VENTILATION OF THE TISSUES AND SHEAR-INDUCED TEARING OF THE SKIN OVER THE PELVIS AND HEEL.THIS STAGE SHOULD NOT BE USED TO DESCRIBE DERMATITIS ASSOCIATED WITH FAECAL AND URINARY INCONTINENCE, DERMATITIS IN THE CREASE AREAS, SKIN DAMAGE DUE TO INTERNAL DAMPNESS.
STAGE III. PRESSURE INJURY
FULL THICKNESS SKIN LOSS
A WOUND IN WHICH SUBCUTANEOUS FAT TISSUE IS VISIBLE, FULL THICKNESS SKIN LOSS IS OFTEN PRESENT. DEPENDING ON THE TISSUE DAMAGE BENEATH THE SKIN SURFACE, A CRATER-LIKE APPEARANCE MAY OCCUR. THE DEPTH OF TISSUE DAMAGE MAY VARY DEPENDING ON THE SITE OF THE WOUND;
STAGE IV. PRESSURE INJURY
STAGE FOUR:
POSSIBLY SEVERE INFECTION OF THE SKIN. MUSCLES, BONES AND EVEN TENDONS MAY BE INVOLVED. AN INFECTED WOUND TAKES MUCH LONGER TO HEAL AND THE INFECTION MAY SPREAD TO OTHER PARTS OF THE BODY. WOUND
UNSTAGEABLE PRESSURE INJURY
FULL-THICKNESS TISSUE AND SKIN LOSS OF UNKNOWN DEPTH
FULL-THICKNESS TISSUE AND SKIN LOSS WHERE THE EXTENT OF TISSUE DAMAGE TO THE WOUND IS NOT CONFIRMED BECAUSE IT IS COVERED BY YELLOW FIBROUS TISSUE AND/OR ESCHAR. REMOVAL OF YELLOW FIBROUS TISSUE OR ESCHAR TISSUE RESULTS IN A STAGE III OR STAGE IV PRESSURE INJURY. STABLE (I.E. DRY, ADHERENT, INTACT AND NON-MELTING) ESCHAR TISSUE ON THE HEEL(S) OR AN ISCHAEMIC LIMB SHOULD NOT BE REMOVED
WHAT ARE THE COMPLICATIONS OF PRESSURE SORES?
- LIFE-THREATENING. CAN CAUSE DEATH.
- INFECTION CAN SPREAD TO THE BLOOD, HEART AND BONE.
- IT CAN CAUSE AMPUTATIONS (LOSS OF LIMBS).
- IT MAY REQUIRE PROLONGED HOSPITALISATION THAT MAY KEEP YOU AWAY FROM WORK, SCHOOL AND SOCIAL ACTIVITIES FOR MONTHS.
- IT CAN LEAD TO A CONDITION CALLED AUTONOMIC DYSREFLEXIA, IN WHICH YOUR NERVOUS SYSTEM INVOLUNTARILY OVERREACTS TO EXTERNAL OR PHYSICAL STIMULI.
- BECAUSE YOU ARE LESS ACTIVE DURING PRESSURE SORE TREATMENT, THIS CREATES A HIGHER RISK OF RESPIRATORY PROBLEMS OR URINARY TRACT INFECTIONS.
- PRESSURE SORE TREATMENT CAN BE VERY COSTLY IN TERMS OF MEDICAL EXPENSES IF IT IS NOT CARRIED OUT ON TIME AND BY AUTHORISED PERSONS.
HOW TO PREVENT PRESSURE SORES?
1. MEASURES TO PREVENT PRESSURE SORES ARE EASIER AND MORE ECONOMICAL THAN TREATING PRESSURE SORES AFTER THEY HAVE OCCURRED.
2. THE MOST EFFECTIVE METHOD TO PREVENT PRESSURE SORES IS FREQUENT CHANGE OF POSITION AND, IF THE PATIENT HAS THE ABILITY TO MOVE, TO RESTORE MOVEMENT AS QUICKLY AS POSSIBLE. THE POSITION OF THESE PATIENTS SHOULD BE CHANGED AT INTERVALS OF AT LEAST 1-2 HOURS.
3. THOSE SITTING IN A WHEELCHAIR SHOULD ENSURE BLOOD SUPPLY TO THESE AREAS BY RAISING THEMSELVES WITH THEIR HANDS EVERY 1-2 HOURS.
4. LEATHER AND MATTRESS CARE IS VERY IMPORTANT. THE SKIN SHOULD BE WIPED WITH SOAPY WATER EVERY DAY AND DRIED IN SUCH A WAY THAT NO MOISTURE REMAINS. MASSAGE SHOULD BE APPLIED IN ORDER TO INCREASE THE BLOOD CIRCULATION AND DURABILITY OF THE SKIN. BED LINEN SHOULD BE CLEAN AND DRY. THERE SHOULD BE NO FOLDS ON THE BED AND BED LINEN UNDER THE PATIENT.
5. CLEANING AFTER URINATION AND DEFECATION IS VERY IMPORTANT IN BED-BOUND PATIENTS.
6. ANAEMIA, PROTEIN DEFICIENCY, VITAMIN DEFICIENCIES, IMPROPERLY MADE DRESSINGS AND SPLINTS, FACTORS THAT MAY CAUSE PRESSURE SORES TO OPEN, FACTORS THAT REDUCE BODY RESISTANCE SHOULD BE ELIMINATED.
7. MUSCLE AND JOINT STIFFNESS SEEN IN PARALYSED PATIENTS SHOULD BE COMBATED. ALTHOUGH MANY BEDS, WHEELCHAIRS AND MATTRESSES HAVE BEEN DEVELOPED TO PREVENT THE FORMATION OF WOUNDS, A DEVICE TO PREVENT ALL PRESSURE SORES HAS NOT YET BEEN PRODUCED.
PRESSURE SORE TREATMENT
PRESSURE SORE TREATMENT INCLUDES CHANGING YOUR POSITION REGULARLY, USING SPECIAL DRESSINGS TO REDUCE OR RELIEVE PRESSURE, A GOOD DIET AND THERAPEUTIC APPROACHES THAT HELP TO IMPROVE PRESSURE SORES. SOMETIMES SURGICAL INTERVENTIONS AND OPERATIONS MAY BE NECESSARY. PRESSURE ULCER TREATMENT SHOULD BE CARRIED OUT WITH TEAMWORK AND A MULTIDISCIPLINARY APPROACH.
TREATMENT OF PRESSURE SORES ACCORDING TO STAGES
- STAGE 1: IT IS RECOMMENDED TO REPLACE THE PERSON'S BED OR, IF USING A WHEELCHAIR, THE WHEELCHAIR CUSHION WITH A MATTRESS OR CUSHION WITH PRESSURE-REDUCING AND PRESSURE-DIFFUSING PROPERTIES. IN THE SAME WAY, AN AIR MATTRESS THAT CONTINUOUSLY CIRCULATES AIR CAN BE PLACED ON THE PATIENT'S BED. PAYING ATTENTION TO THE PATIENT'S LYING POSITION AND CHANGING THE POSITION EVERY 2 HOURS DURING THE DAY, ENSURING BODY HYGIENE, REDUCING HUMIDITY AND IMPROVING THE PATIENT'S DIET ARE OTHER ISSUES TO BE CONSIDERED.
- STAGE 2: CAREFUL ASSESSMENT OF THE WOUND IS VERY IMPORTANT. BECAUSE IN MANY BEDSORES, THE WOUND MAY APPEAR TO BE ON THE SURFACE, BUT IT MAY HAVE SPREAD TO DEEPER TISSUES, I.E. IT MAY HAVE ENTERED THE THIRD STAGE. IN THIS STAGE, THE PRESSURE CAUSING THE WOUND MUST BE REMOVED AS IN THE FIRST STAGE. IN ADDITION, THE WOUND SHOULD BE PROTECTED FROM INFECTION AND REGULAR DRESSINGS SHOULD BE APPLIED.
- 3RD STAGE: IN THIS STAGE, THE INFECTION IN THE WOUND BED IS FIRSTLY TERMINATED. IT IS NECESSARY TO USE ANTIBIOTICS, CLEAN THE DEAD TISSUE AROUND THE WOUND AND APPLY REGULAR DRESSINGS WITH THE RIGHT MATERIALS. SINCE THE WOUND WILL TAKE A LONG TIME TO CLOSE AND HEAL ON ITS OWN, SURGICAL INTERVENTION MAY GENERALLY BE REQUIRED. AT THIS STAGE, IT IS CRITICAL THAT THE PATIENT FOLLOWS A DIET RICH IN PROTEIN AND ENERGY.
- STAGE 4: THE TREATMENT OF THE WOUND IS THE SAME AS IN THE THIRD STAGE. HOWEVER, SINCE BONE TISSUE IS ALSO AFFECTED, MORE EXTENSIVE PROCEDURES MAY BE REQUIRED FOR SURGICAL REMOVAL OF DAMAGED AND INFECTED TISSUES AND CLEANING OF THE WOUND.
