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ULCER DEFINITION:
We can define pressure ulcers as localized areas of necrosis that tend to occur when soft tissue is compressed between two planes, one bony prominences of the patient and the other an external surface. Affecting 9% of all hospitalized patients and 23% of those admitted to nursing homes. The early detection and treatment speeds recovery and reduces complications.
PATHOGENESIS:
They are produced by a prolonged and constant external pressure over a bony prominence and a flat disk, which causes ischemia of the vascular membrane, which causes vasodilation in the area (look red), extravasation of fluid and cellular infiltration. If co pressure decreases, there is an intense local ischemia in the surrounding tissues, venous thrombosis and degenerative changes, leading to necrosis and ulceration.
This process can continue and reach deeper levels, the destruction of muscles, fascia, bones, blood vessels and nerves.
The forces responsible for their occurrence are:
1 .- Pressure: A force acting perpendicular to the skin as a result of gravity, causing a crushing tissue between two planes, one belonging to the patient and an external to him (couch, bed, probes, etc.).. Pressure capillary ranges between 6 – 32 mm. Hg. Pressure exceeding 32 mm. Hg., occlude capillary blood flow in soft tissues causing hypoxia, and if not relieved, necrosis of the same.
2 .- Friction: It is a tangential force that acts parallel to the skin, producing friction, or drag motion
3 .- Vascular Impingement External Force: Combine the effects of pressure and friction (eg Fowler’s position that produces sliding of the body, can cause friction and pressure on the sacrum same area).
OTHER RISK FACTORS:
These are factors that contribute to the production of ulcers and can be grouped into five major groups:
1 .- Pathophysiological:
As a result of different health problems.
- Skin lesions: edema, dry skin, lack of elasticity.
- Disorder in the Oxygen Transport: Peripheral vascular disorders, venous stasis, cardiopulmonary disorders …
- Nutritional Deficiencies (default or excess): Thinness, malnutrition, Odessa, hypoproteinemia, dehydration ….
- Immune Disorders: Cancer, infection …….
- Altered State of Consciousness: Stupor, confusion, coma ……
- Shortcomings Motorcycles: paresis, paralysis …….
- Sensory Impairments: Loss of pain sensation ….
- Impairment of Disposal (urinary / bowel): Urinary incontinence and bowel.
2 .- Derived Treatment:
As a consequence of certain therapies or diagnostic procedures.
- Imposed immobility, result from specific therapeutic alternatives: devices / equipment such as casts, tractions, respirators ……….
- Treatments or drugs that have action inmunopresora: Radiotherapy, corticosteroids, cytostatics ……
- Polls for diagnostic and therapeutic: bladder catheterization, nasogastric ……
3 .- Situation:
Result of changes in personal, environmental, habits, etc..
- Immobility: associated with pain, fatigue, stress …..
- Wrinkle in linens, nightgown, pajamas, rubbing objects, etc. ..
4 .- Development:
Related to the maturation process.
- Children Infants: baby diaper rash …
- Elderly: Loss of skin elasticity, dry skin, restricted mobility …..
5 .- The Environment:
- Loss of self-image of the individual in the disease.
- The lack of health education to patients.
- The lack of unified criteria in the planning of the priests by the care team.
- The lack or misuse of prevention material, both the basic and supplementary.
- The motivation for the lack of professional training and / or specific information.
- The professional’s workload.
LOCATION:
Usually in areas of support that match bony prominences or maximum relief. The areas most at risk would be the sacral region, heel, ischial tuberosities and hips.