Treatment of pressure ulcers

Article by Emergency Resuscitation Doctor – Emergency Resuscitation Department – Share99 Phu Quoc International Health Hub

Pressure ulcers are easy to appear without knowing how to properly care for the patient. In fact, treating pressure ulcers is not an easy task because most of the causes of the disease are caused by the influence of certain bodies in the body.

1. What are pressure ulcers?

Pressure ulcers are determined by changes in the skin and tissue under the skin caused by pressure on the bone bulges. Without attention these forces will cause ulcers. Accordingly, the best treatment for pressure ulcers is prevention, but in the most optimal conditions there are also uns preventable cases.

Pressure ulcers in the elderly have the highest rate, due to long hospital stays, patients with spinal damage, or cardiovascular diseases at high risk of pressure ulcers. Factors contributing to the formation of pressure ulcers include nutritional deficiencies, volume depletion, increased or decreased weight, anemia, inaperience defegestion, renal failure, diabetes mellitus, malignanty, sedatives, major surgery, conversion disorders, smoking and bedridden or sitting in a wheelchair. Finally, the skin of the elderly reduces thickness and elasticity, so the risk of damage to pressure should be increased.

Mechanism of damage: due to pressure, sliding forces, friction and humidity. More than 90% of pressure ulcers appear on the bone bulges of the lower part of the body. The time and pressure required causes tissue destruction depending on the risk factors available. The second edictic factor is the sliding forces, caused by the slippage of adjacent surfaces, which causes pressure on the capillary lines of the sub-skin layer, for example, lifting the upper body of the patient, the sliding pressure affects the end of the patient's amputation. Friction is the force generated when two surfaces shift through each other such as the patient sliding in bed, the friction force causing epidermis damage. Finally, moisture increases the risk of pressure ulcers, which have a pronounced correlation when existing between urinary ina <3> autonomy and ulcers. Due to the increased risk of skin infections, pressure ulcers in the sebum area must be in order to place long-term urination when the person loses control.

Iron deficiency anemia

Anemia makes ulcers more severe

2. Clinical evaluation of pressure ulcers

The best assessment of pressure ulcers is the classification of ulcers according to how severe it is according to the degree of depth of the lesion.

  • Pressure ulcers level I: Acute inflammatory response in all layers of the skin, manifested as an area of non-whitening encephalitis is well defined on the intact skin background.
  • Pressure ulcer II: Manifested by breaking the epidermis and legs, having wormwood around, or clouds of stiffness, or both. It is a consequence of the widespread inflammatory response that leads to the reaction of fibroblasts.
  • Pressure ulcer III: The inflammatory response is characterized by completely uneven skin ulcers that extend into the skin's lower tissue but have not yet passed through the lower mite layer. Here the lesion has a background of discharge, odor, necrosis.
  • Pressure ulcers level IV: Penetrate into the deep mesminal layer, destroying the last barrier to spread. Clinically, it resembles pressure ulcer III however bones, joints, or muscles may be affected.

Complications of pressure ulcers are associated with significant incidence and mortality. Most complications appear with ulcers of degrees III and IV and these complications include cellulitis, osteoarthritis, joint infections, acute purulent osteoarthritis and tetanus. Tetanus further complicates pressure ulcers so anti-tetanus immunity should be prevented with anti-serum and vaccination – tetanus vaccination.

3. How to prevent pressure ulcers?

Because the incidence and mortality rate is very large, and can cause an economic burden caused by having to treat this problem, prevention is the main purpose. Identifying a person at risk is the first step in choosing precautions.

At-risk patients should be evaluated regularly and placed in an environment that promotes the growth of soft tissue. This development can be achieved thanks to the use of proper anced techniques and supporting surfaces. The patient's skin must be examined to detect red areas that are an early indicators of pressure changes. When changing the pose, the patient must be lifted without being dragged up from the bed or stroller to avoid creating friction that damages the epidermis. Avoid lifting the patient's upper body to higher than 30 degrees to limit sliding forces.

Special types of cushions, beds, and mechanical tools are available and have the effect of preventing pressure ulcers due to changes in pressure on the bone convexity. Tools such as gel cushions, foam cushions, chair cushions, and sheepskin cushions have the effect of preventing ulcers in special anatomy locations. without any single instrument that is effective in the prevention of all pressure ulcers.

Static floating cushions, altered by pressure gas cushions, liquid gas beds will help prevent and treat pressure ulcers. These beds tend to reduce pressure thanks to the use of gases or floating substances to maintain an even distribution of patient weight. However, such means cannot replace basic nursing care.

Care to prevent pressure ulcers is also associated with improving medical conditions that can cause patients to develop pressure changes. Nutritional deficiencies, loss of autonomy and initridence must be limited. Nutritional status is assessed when receiving patients to hospital or in nursing homes: When there are developed ulcers, the nutritional condition that has often been damaged has been badly damaged and difficult to adjust.

Incision care

Care to prevent pressure ulcers

4. Handling pressure ulcers

The first step in the treatment of pressure ulcers is to assess the level of ulcers and the general condition of the person, including nutritional status. Regardless of the degree of ulcers, adherence to the above outlined prevention principles is still important.

4.1. Clean the wound and remove necrotic tissue

The main purpose of treating pressure ulcers is to create an environment that promotes healthy seed tissue. The wound is washed without discomfort with gauze impregnated with physiological saline, watering the wound and rinsing with swirling water. Cell-toxic antiseptices such as hydrogen peroxide and povidon-iodine should be avoided.

Necrotic tissue prevents wound healing and creates favorable conditions for infection. The ideal method for removing necrotic tissue in pressure ulcers is to clean the necrotic tissue. The method of removing necrotic tissue with enzymes using factors such as fibrinolysin, collagenase and dextranomer should only be used during periods between surgical necrotic tissue removals to help digest thin layers of necrosis that are less accessible when cutting. Since these factors cannot penetrate through item scales or cannot remove large numbers of tissues, their use is limited. There is no evidence to show that local antibiotics have a good effect in cleaning wounds and drying ice. Moreover, local antibiotics can make tissues sensitive, promote the appearance of drug-resistant microorganisms, and cause body toxicity.

4.2. bandage

As soon as the wound is clean, if there is visible granular tissue, the use of bandages that promote wound healing is recommended. The usual rule is to maintain moisture to the ulcers and dry the surrounding skin. Additional factors for the choice of ice use include the purpose of controlling the secret service, and time requirements with the caregiver. The selected dressing consists of gauze laced with a solution of salt and dressing.

The reason for using the bandages is that they can usually stay at the ulcer for several days, on the contrary the dressing will have to be replaced several times a day. This convenience is especially useful for the control of ulcers in outpatients. These bandages should not be used in the event of a clinical infection.

Wound bandages help avoid sepsis

Bandage ulcers to avoid infection

4.3. Handling complications

The two most common complications are infections and wounds that do not heal. With clean wounds that do not heal, the patient's total condition must be re-evaluated and tried for 2 weeks with a broad-spectrum antibiotic in place. In patients who need surgery, surgery may be required to treat wounds that do not heal. Take appropriate body antibiotics when you have complications such as sepsis, soft tissue infections, or osteomyelitis.

Share99 International Health Hub is not only famous for its high expertise but also full of modern medical equipment. Especially, the examination and treatment procedures at Share99 are carried out by a team of highly trained and professional doctors that will bring high effectiveness of treatment.

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SEE MORE:

  • Should bedridden patients use cushions?
  • Levels of burns
  • Post-burn rehabilitation

About: John Smith

b1ffdb54307529964874ff53a5c5de33?s=90&r=gI am the author of Share99.net. I had been working in Vinmec International General Hospital for over 10 years. I dedicate my passion on every post in this site.

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