Pressure Ulcer Prevention and Management Strategies

Understanding Pressure Ulcers (UPP)

A Pressure Ulcer (UPP) is a lesion primarily caused by uncontrolled and prolonged pressure between a bone and a hard surface. This compression affects the underlying arteries, preventing proper irrigation and resulting in tissue ischemia and necrosis.

Pathophysiology of Ulcer Development

1. Pressure on planar surfaces
2. Decreased blood supply to the area
3. Oxygenation and nutritional deficits in tissues
4. Ischemia
5. Ulceration or injury
6. Necrosis

Risk Factors for Pressure Ulcers

• Pressure and Friction
• Humidity
• Immobility
• Shear forces (pinching)
• Decreased peripheral circulation
• Infections
• Cachexia and malnutrition
• Obesity
• Altered levels of consciousness
• Sphincter control issues
• Skin condition and malnutrition

High-Risk Body Areas

• Sacrum: 24%
• Buttocks: 23%
• Trochanter: 15%
• Heel: 9%

Treatment Protocols

Stage I Ulcers

• Relieve pressure on the affected area
• Hydration
• Preventive measures

Stage III, IV, and V Ulcers

• Wound cleaning
• Debridement of necrotic tissue
• Management and prevention of bacterial infections
• Selection of products to maintain moisture and body temperature
• Wound logging and monitoring

Signs of Local Infection

Local antibiotics may be required if the following signs are present:

• Thick, yellow, or green pus
• Malodorous wound
• Redness or heat around the wound
• Swelling (edema) around the wound
• Sensitivity to touch
• Stevens (worsening indicators)

Signs of Systemic Infection

Systemic antibiotics may be required for:

• Fever or chills
• Mental confusion or difficulty concentrating
• Rapid heartbeat (tachycardia)
• General weakness

Classification of Ulcer Stages

Stage I

Non-blanchable erythema on intact skin.

Stage II

Partial-thickness skin loss affecting the epidermis, dermis, or both. Appears as a superficial ulcer, abrasion, blister, or shallow crater.

Stage III

Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend downward, but not through the underlying fascia.

Stage IV

Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. Like Stage III, it may present with cavities or tunneling (winding road maps).

Essential Prevention Strategies

• Regular assessment
• Proper nutrition and feeding
• Adequate hydration
• Keep skin clean, dry, and moisturized
• Remove objects that may cause leg ulcers
• Use moisturizing cream
• Do not massage bony prominences
• Do not drag the patient in bed or chairs
• Implement postural changes
• Protect sensitive areas from ulceration