![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](https://image.slidesharecdn.com/bedsore-210731093703/85/Bed-sore-9-320.jpg)
![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](https://image.slidesharecdn.com/bedsore-210731093703/85/Bed-sore-14-320.jpg)
Bed sore
- 1. BED SORE AND ITS MANAGEMENT By Ms. Pooja Singh Fatima Hospital, Mau
- 2. INTRODUCTION Epidemiology • 1-3 million American are affected • 1 in 4 persons in the USA who died in 1987 had a dermal ulcer • Pressure ulcers develop primarily in elderly patients
- 3. • Setting - Hospital 60 percent - Nursing homes 18 percent - 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 A pressure ulcer or pressure sore or decubitus ulcer or bed sore is localized injury to the skin and other underlying tissue, usually over a bony prominence as result of prolonged unrelieved pressure.
- 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 • A stage iv ulcer is the deepest, extending into the muscle, tendon or even bone. • Full thickness tissue loss with exposed bone, tendon or muscle.
- 18. PREVENTION • Position changing • Skin inspection • Nutrition • Lifestyle changes • Use pressure relieving devices
- 19. BRADEN SCALE FOR PREDICTING PRESSURE ULCER RISK • Six criteria • Sensory perception • Moisture • Activity • Mobility • Nutrition • Friction and shear
- 20. BRADEN SCALE FOR PREDICTING PRESSURE ULCER RISK • Each category is rated on a scale of 1 to 4, excluding the friction and shear category which is rated on a 1-3 scale • A score of 23 means there is no risk for developing a pressure ulcer while the lowest possible score of 6 points represents the severest risk for developing bed sore.
- 21. MANAGEMENT • Changing position • Using support surfaces • Cleaning • Controlling incontinence • Removal of damaged tissue • Dressings
- 22. CONT.. • Oral antibiotics • Healthy diet • Educating the caregiver • Infection control • Wound intervention
- 23. SURGICAL MANAGEMENT • Tissue flap • Plastic surgery • Hyperbaric oxygen • Topical use of human growth factors