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pressure ulcer

an ulcer due to local interference with circulation; persons most at risk are those who are emaciated (nutritionally deficient in protein), obese, immobilized by traction or anything else, diabetic, or suffering from a circulatory disorder. Because urine and feces contribute to skin breakdown, incontinent patients are at high risk. Absence of sensation, advanced age, and immunodeficiency are also risk factors. Called also decubitus ulcer and, popularly, bedsore or pressure sore.

Three major factors in the development of pressure ulcers are (1) prolonged pressure on a part due to the weight of the body or a limb; (2) a shearing force that exerts downward and forward pressure on tissues beneath the skin (this can occur when the patient slides downward while sitting in a bed or chair, or when bedclothes are forcibly pulled from under the patient); and (3) nutritional status: good nutrition is essential for preventing pressure ulcers and healing already existing ones; a dietary deficiency should be suspected with a loss of 5 per cent or more of body weight or a serum albumin level below 3.5 mg/dl.

A pressure ulcer usually occurs over a bony prominence at the sacrum, hip (trochanter), heel, shoulder, or elbow. The lesion begins as a reddened area, which can quickly involve deeper structures and become an ulcer.
Prevention. Repositioning the patient must be done as often as necessary to prevent impairment of circulation to any one part. For some patients this may mean turning and repositioning every hour. Gentle massage of the area stimulates circulation to the areas most likely to be affected, but reddened areas should never be massaged, because massage encourages tissue breakdown. Thorough cleansing, especially to remove perspiration, urine, and feces, helps prevent chemical breakdown of the skin and aids in the removal of bacteria. Numerous different pressure-relieving devices are available.
Stages. For purposes of assessment, treatment, and evaluation of effectiveness of nursing and medical intervention, the pathologic changes occurring in the development of a pressure ulcer are divided into four stages.

In Stage 1 the area of skin is deep pink, red, or mottled. Digital pressure on the area will cause temporary blanching for up to 15 minutes after pressure is released. The skin will feel very warm and firm or tightly stretched across the area. At this stage no destruction of tissue has occurred and the condition is reversible. It is essential that the area be relieved of prolonged pressure, and that shearing forces be avoided. The reddened area may need protection by covering it with either a transparent film or a skin barrier.

Stage 2 is characterized by blistering, cracking, or abrasion of the skin. The surrounding skin is reddened and probably will feel hot or warmer than normal. Since there is now an opening in the skin for the entrance of bacteria, treatment must include cleaning the wound and providing some type of dressing or cover in addition to relieving pressure on the area.

Stage 3 is characterized by a craterlike sore with involvement of the underlying structures. Bacterial infection is almost always present at this stage and accounts for continued erosion of the ulcer and the production of drainage. Irrigation of the wound usually is done each time the dressing is changed. Wound débridement may be necessary to promote healing.

At Stage 4 there is deep ulceration and necrosis involving underlying muscle and possibly bone tissue. At this point the ulcer usually is extensively infected. It can be dry, black in color, and covered with a tough accumulation of necrotic tissue, or it can be wet and oozing dead cells and purulent exudate. Deep and extensive ulceration and tissue loss may require surgical repair with myocutaneous flaps to close the defect.

Topical applications vary widely. The diligence with which the prescribed regimen is carried out greatly influences its effectiveness. Guidelines summarizing current recommended practice for the treatment of pressure ulcers (publication number 95-0653) are available from the Agency for Health Care Policy and Research, P.O. Box 8547, Silver Spring, MD 20907-8547 (telephone 800-358-9295).
Pressure areas in common resting positions: A, Fowler's; B, supine; C, prone; and D, side-lying.

de·cu·bi·tus ul·cer

a chronic ulcer that appears in pressure areas of skin overlying a bony prominence in debilitated patients confined to bed or otherwise immobilized, due to a circulatory defect.


A pressure-induced ulceration of the skin occurring in persons confined to bed for long periods of time. Also called decubitus ulcer.


Pressure ulcer, see there, aka decubital ulcer.

de·cu·bi·tus ul·cer

(dē-kyū'bi-tŭs ŭl'sĕr)
Focal ischemic necrosis of skin and underlying tissues at sites of constant tissue pressure, recurring friction, and inadequate perfusion in patients confined to bed or immobilized by illness; malnutrition worsens the prognosis.
See: decubitus
Synonym(s): bedsore, bed sore, pressure sore, pressure ulcer.

Patient discussion about bedsore

Q. I ask a client's Dr. to script flexaril for a lower back spasm and he made it for a drug called zanaflex? I am unfamiliar with zanaflex, what is the difference between it and flexaril 25mg? Benefits? Risks? I got him to order the air mattress and extended bed because client is 6'3" and is already bedridden on my 1st day..try to beat the skin breakdown, already stage I decubitis ulcers. I tried to talk the client into slideboard and lift away arm wheelchair...noway..he wants to walk bent with a rolling walker. He already had a lift chair delivered, so he just goes from bed to lift chair. He refuses to let me bathe him. He can't see, and he has me check his draw up on insulin to make sure it's right. He sends the P.T. man right back out the door after he signs the sheet. Difficult pt.!

A. Flexeril and Zanaflex are different drugs but are both muscle relaxants. There are hardly any differences between the two, clinically wise. If the doctor thought one is better than the other for your client I would suggest you take his advice and use the one he gave you.

More discussions about bedsore
References in periodicals archive ?
During a post-mortem examination, pathologists found the teenager had died as a result of bronchopneumonia, caused by malnutrition, immobility and infected pressure sores.
Despite the criticism she went on to return a narrative conclusion, saying: "Sheila had a number of significant health issues which predisposed her to development of such sores and despite preventative measures being put in place supported by other healthcare professionals it was not possible to stem the development of pressure sores which led to her death."
An award of PS40,000 was made to a 55-year-old man who developed grade four pressure sores on his sacrum, heels and the back of his head.
Pitts' posture put all of her pressure on her left side, which formed a pressure sore from the inside out.
[sup][4] first described a gluteal perforator flap for repairing sacral pressure sores. Then, Verpaele et al .
Conclusion: Once pressure sores develop timely intervention and an appropriate flap with good post operative care yield satisfactory results.
PLAINTIFF'S CLAIM As a result of the delay in treating the pressure sores, the patient's condition was worse that it otherwise would have been.
Nowadays, many plastic surgeons consider the pedicled SGAP flap to be the flap of choice for sacral pressure sores. An anatomical study of the gluteal region by Ahmadzadeh et al.
Pressure sores involve skin and subcutaneous regions, and can reach muscles and bones if the condition becomes chronic.
The WAG funding has also bought what looks like a cheap plastic mat but, is in fact an pounds 8,000 pressure mapping system which can detect the development of pressure sores, a major health issue for wheelchair users.
Decubitus ulcers or pressure sores, as they are more often referred to, are a frequent complication of recumbency following spinal cord injury (SCI).
Maggots are currently used for treating conditions such as leg ulcers, pressure sores and other infected surgical wounds.