prevention and care of pressure sore
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PREVENTION AND CARE OF PRESSURE SORE
DEFINITION Pressure ulcers are localized areas of necrotic soft
tissue that occur when pressure applied to the skin over time is greater than normal capillary closure pressure which is about 32 mm hg
RISK FACTORS
CLINICAL MANIFESTATION Contd..
STAGES
MANAGEMENT
STAGE-1
Pressure to be removed Nutritional electrolyte balances are maintained Friction and shear reduced Avoid moisture to the skin
STAGE -2
Wash with sterile saline solution
Avoid antiseptic solution
Semi permeable occlusive dressing
Minimizing the loss of fluid and proteins
STAGE 3 AND 4
Drain the necrotic tissues and cleaned /debrided
Topical treatment is prescribed New granulation tissue must be protected
Prevent further trauma pressure
SURGICAL MANAGEMENT Debridement Drainage Bone resection Skin grafting
NURSING MANAGEMENT
PREVENTION
Change position at least every 2 hours to relieve pressure.
Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.
Eat well-balanced meals that contain enough calories to keep you healthy.
CONTD….
Drink plenty of water (8 to 10 cups) every day. Exercise daily, including range-of-motion
exercises. Keep the skin clean and dry. After urinating or having a bowel movement,
clean the area and dry it well. A doctor can recommend creams to help protect the skin.
COMPLICATION autonomic dysreflexia bladder distension osteomyelitis pyarthroses sepsis amyloidosis, anemia, urethral fistula, gangrene and very rarely
malignant transformation
NURSING INTERVENTION
BIBLIOGRAPHY
Lewis “medical surgical nursing” sixth edition Mosby publication (2000) vol 2page no 1207-1208
Brunner and sudharth “medical surgical nursing”
12th edition Lippincott publication (2010)page no 185-190
Net references
www.google.pressure sore.com
www.wikipedia.pressure sore.com
www.google pressure sore prevention. com
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