Prevention and management of pressure ulcers

A pressure ulcer is the visible evidence of pathological changes in blood supply to the dermal and underlying tissues, usually due to compression of the tissue over a bony prominence. Pressure ulcers are one of several types of chronic ulcers of the skin, including venous stasis, diabetic ulcers, and arterial insufficiency ulcers. The differential diagnosis of pressure ulcers is imperative, since the management of each wound type differs substantially.

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Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200319093p ◽

2021 ◽

pp. 93-93

Author(s):

Dragana Petrovic-Popovic ◽

Milan Stojicic ◽

Maja Nikolic-Zivanovic

Keyword(s):

Surgical Treatment ◽

Pressure Ulcer ◽

Traffic Accidents ◽

Pressure Ulcers ◽

Stage Iv ◽

Clinical Center ◽

Bony Prominence ◽

The University ◽

Epidemiological Characteristics ◽

Reconstructive Methods

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

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Socioeconomic effects of pressure ulcer

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.1.11 ◽

2021 ◽

Vol 64 (1) ◽

pp. 11-15

Author(s):

Jun-Ho Lee

Keyword(s):

Pressure Ulcer ◽

Outpatient Care ◽

Complex Disease ◽

Pressure Ulcers ◽

Cost Effective ◽

Treatment And Prevention ◽

Medical Institutions ◽

Bony Prominence ◽

Hospitalization Period ◽

Socioeconomic Burden

A pressure ulcer is defined as localized ischemic skin or soft tissue damage resulting from disruption of the blood supply by pressure over the bony prominence. However, it is not just a wound that causes pain to individuals, but also a complex disease that causes socioeconomic losses. In 2019, total 30,983 patients with pressure ulcers were treated at medical institutions in Korea, and 76 billion Korean won (KRW) was spent on this treatment. Inpatient care cost amounted to 65.5 billion KRW, whereas outpatient care cost amounted to 9.8 billion KRW. The average hospitalization cost per patient was 6,696,605 KRW, and the average hospitalization period was 57.4 days, averaging 116,707 KRW per patient per day. The average outpatient care cost per patient was 421,134 KRW, and the average period in the clinic was 8.9 days, calculated at 47,428 KRW per day. The development of pressure ulcers inevitably causes socioeconomic losses and puts strain on limited medical resources; therefore, the best socioeconomic solution is prevention. Prevention has been shown to be much more efficient in cost-effective studies on treatment and prevention. Therefore, investment of more resources to prevent the development of pressure ulcers is the best solution to reduce the related socioeconomic burden.

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Skin problems

Oxford Handbook of Rehabilitation Medicine ◽

10.1093/med/9780198785477.003.0014 ◽

2019 ◽

pp. 195-202

Author(s):

Manoj Sivan ◽

Margaret Phillips ◽

Ian Baguley ◽

Melissa Nott

Keyword(s):

Pressure Ulcer ◽

Pressure Ulcers ◽

Management Strategies ◽

Leg Ulcers ◽

Systemic Diseases ◽

Venous Ulcers ◽

Common Skin ◽

Chronic Ulcers ◽

The Common ◽

Localized Damage

This chapter includes some of the common skin-related problems encountered in rehabilitation settings, including pressure ulcers, chronic venous ulcers, ischaemic ulcers, and osteomyelitis. A pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure, shear, and friction, either individually or in combination. The definition, features, and grades of pressure ulcers are discussed, followed by prevention and management strategies. The prevalence of leg ulcers ranges from 1 to 3 per 1000 population and can rise to 8.5% in those aged more than 65 years. The commonest causes of chronic ulcers are venous ulcers (60–70%), mixed ulcers (15–20%), arterial (10%), and systemic diseases and unusual causes (5%). The causes and management of leg ulcers are also discussed.

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Role of Patient Specifics on Mechanical Risk and Load Relief During Support of Bony Prominences

ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation ◽

10.1115/fmd2013-16034 ◽

2013 ◽

Author(s):

Ahmet Erdemir

Keyword(s):

Pressure Ulcer ◽

Pressure Ulcers ◽

Region Of Interest ◽

Clinical Effectiveness ◽

Incidence Rates ◽

Patient Specific ◽

Support Surface ◽

Load Relief ◽

Bony Prominence ◽

Pressure Ulcer Development

Prolonged mechanical loading of tissue in between a bony prominence and a support surface can lead to pressure ulcers. Despite recent initiatives to curb down incidence rates, the health care burden of pressure ulcer prevention remains significant [1]. Etiology of pressure ulcers are commonly attributed to interface pressures. As a result, interventions, e.g., support surfaces, routinely aim to reduce contact pressures. However, the clinical effectiveness of such an objective can be questionable [2]. Recent studies have shown that internal mechanics of the tissue can be associated with pressure ulcer development [3], potentially indicating the inefficacy of interventions targeted solely at contact pressure relief. Tissue characteristics at a bony prominence, e.g., tissue thickness and material properties, also influence load distribution within and on the surface of the tissue. Given the variability in patient populations and for a bony region of interest [4], it is possible that patient specific risk and load relief (with the use of support surface) may differ widely.

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Exercise Plan in Preventing of Pressure Ulcers among Post Operative Patients

International Journal for Research in Applied Science and Engineering Technology ◽

10.22214/ijraset.2021.38341 ◽

2021 ◽

Vol 9 (10) ◽

pp. 582-586

Author(s):

Dr. Eman Elsayed Hussein

Keyword(s):

Pressure Ulcer ◽

Pressure Ulcers ◽

Percent Level ◽

Knowledge Score ◽

Structured Interview ◽

Venous Stasis ◽

Interview Schedule ◽

Breathing Exercises ◽

Orthopaedic Patients ◽

Post Test

Abstract: Background: Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose significant burden on patients, their relatives and caregivers. Pressure ulcers have been described as one of the most costly and physically debilitating complications since the 20th century. The pain and discomfort due to pressure ulcer prolongs illness, rehabilitation, time of discharge and even contribute to disability and death. Lengthy periods of immobilization are emotionally stressful for patients. Immobility related problems include pressure ulcers, pneumonia, constipation, loss of appetite, urinary stasis, urinary track infections and venous stasis or deep vein thrombosis. When the complications due to immobilization are prevented it helps an individual to be physically, emotionally and psychologically sound. These complications can be prevented through simple basic patient care like skincare, active-passive exercises, changing position and deep breathing exercises. Nurses have a key role in prevention of these complications by educating the patients. Hence the study was conducted “To evaluate the effectiveness of structured teaching programme regarding prevention of complications of immobilized patients . methods: The study involved 50 immobilized orthopaedic patients using the structured interview schedule. STP was implemented and post-test was conducted after 8 days using the same structured interview schedule to find out the effectiveness. Results: 86% of respondents were taking mixed diet and 60% had compound fracture. The main cause for the fracture was road traffic accident (46 %). Regarding effectiveness of Structure exercise plan , the overall mean percentage knowledge score in the pre-test was 34.71% and 80.91% in the post-test. The statistical paired ‘t’ test indicates that enhancement in the mean percentage knowledge score was found to be significant at P≤0.05 percent level for all the aspects . Conclusion: This study revealed that nursing staffs’ knowledge and practice about pressure ulcer preventive measures could be improved. Participants in the study reported that they could use the educational program effectively and easily in the prevention of pressure ulcers among their immobilized patients, which decreases the occurrence of pressure ulcers and as well as improved patient outcome. Keywords: pressure ulcer, post operative patients, structure exercise plan

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From the Cochrane Library: Foam surfaces for preventing pressure ulcers (Preprint)

10.2196/preprints.34112 ◽

2021 ◽

Author(s):

Yvonne Nong ◽

Torunn Sivesind ◽

Robert P. Dellavalle

Keyword(s):

Systematic Review ◽

Pressure Ulcer ◽

Pressure Ulcers ◽

Cochrane Library ◽

Cochrane Systematic Review ◽

Pressure Ulcer Prevention ◽

The Cochrane Library ◽

Ulcer Prevention

UNSTRUCTURED This article summarizes an important Cochrane systematic review on the evidence of foam surfaces for pressure ulcer prevention.

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TESTICULAR TORSION OF UNDESCENDED TESTIS IN A CHILD

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.03.2389 ◽

2011 ◽

Vol 18 (03) ◽

pp. 535-537

Author(s):

MAQSOOD AHMAD ◽

MUMTAZ AHMAD ◽

MUHAMMAD SAQIB

Keyword(s):

Differential Diagnosis ◽

Early Diagnosis ◽

Physical Examination ◽

Blood Supply ◽

Spermatic Cord ◽

Testicular Torsion ◽

Undescended Testis ◽

Accurate Diagnosis ◽

Acute Scrotum ◽

Prompt Treatment

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.

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Age-related aspects of differential diagnosis of acute cough in children and adults

Russian Pulmonology ◽

10.18093/0869-0189-2017-28-4-461-468 ◽

2018 ◽

Vol 28 (4) ◽

pp. 461-468

Author(s):

I. V. Leshchenko ◽

S. A. Tsar’kova ◽

A. D. Zherebtsov

Keyword(s):

Differential Diagnosis ◽

Anatomical Location ◽

Pathological Changes ◽

Review Of Literature ◽

Acute Cough ◽

Age Related ◽

Common Causes ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

Cough is one of the most common causes of seeking the primary medical care, especially during the autumn and the spring. This article is a review of literature aimed at differential diagnosis of possible causes of acute cough in children and adults. Given a vast majority of diseases associated with cough, differential diagnosis have to consider several issues. The key issue is cough duration and possible anatomical location of the pathological changes. An algorithm of differential diagnosis of acute cough in children and adults and description of most common diseases associated with acute cough are given in the review. Further diagnostic work-up should be driven by the duration of cough as soon as the acute cough could be first manifestation of a chronic disease.

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