Decubitus Ulcers

(Pressure sores; bed sores; decubitus ulcers; decubitus)

Decubitus ulcers (DGS) are necrosed, ulcerated areas where the tissue is compressed between bony prominences and hard surfaces. They are caused by pressure in combination with friction, shearing forces or moisture. Risk factors include. a. an age of> 65, circulatory problems, immobilization and incontinence. The severity ranges from a non wegdrückbaren skin erythema up to the complete loss of skin with extensive Weichgewebenekrose. The diagnosis is made clinically. For ulcers in early stages, the prognosis is excellent, neglected ulcers and those in advanced stages involve the risk of serious infections and heal poorly. The treatment consists of pressure relief, preventing friction and shearing effects and careful skin care. Sometimes skin grafts or myocutaneous flaps are needed to facilitate healing.

Between 1993 and 2006 the number of hospitalized patients with pressure ulcers rose to> 75%, a rate that is so high above 5 times as that of the total hospital admissions. The rate rose most in the patients who developed during a Krankenhausaufenthaltens decubitus ulcers. Today, an estimated 1.3 to 3 million patients in the US decubitus ulcers, resulting in a substantial financial burden on patients and the health care facilities have.

Decubitus ulcers (DGS) are necrosed, ulcerated areas where the tissue is compressed between bony prominences and hard surfaces. They are caused by pressure in combination with friction, shearing forces or moisture. Risk factors include. a. an age of> 65, circulatory problems, immobilization and incontinence. The severity ranges from a non wegdrückbaren skin erythema up to the complete loss of skin with extensive Weichgewebenekrose. The diagnosis is made clinically. For ulcers in early stages, the prognosis is excellent, neglected ulcers and those in advanced stages involve the risk of serious infections and heal poorly. The treatment consists of pressure relief, preventing friction and shearing effects and careful skin care. Sometimes skin grafts or myocutaneous flaps are needed to facilitate healing. Between 1993 and 2006 the number of hospitalized patients with pressure ulcers rose to> 75%, a rate that is so high above 5 times as that of the total hospital admissions. The rate rose most in the patients who developed during a Krankenhausaufenthaltens decubitus ulcers. Today, an estimated 1.3 to 3 million patients in the US decubitus ulcers, resulting in a substantial financial burden on patients and the health care facilities have. Clinical Calculator: Waterlow scale to stratify the risk of pressure sores Etiology Risk factors for decubitus ulcers include the following: age> 65 (possibly subcutaneous due to reduced fat layer and the reduziertne capillary blood flow) Reduced mobility (eg due to prolonged hospitalization, bed rest. reduced spinal cord injury, sedation, weakness, spontaneous movement and / or cognitive impairment) exposure to skin irritants (eg. as a result incontinence) Limited resources for wound healing (eg. as a result of malnutrition, diabetes, peripheral arterial occlusive disease and / or venous insufficiency) Several scales (s. Braden scale for predicting the risk for Druckgeschwüre.und s. The Norton Scale for predicting pressure ulcer risk *) have been developed to predict the risk. Although the use of these scales is considered standard care, could not be proven that their use compared to qualified clinical judgment alone leads to fewer pressure ulcers. Therefore, the use of a risk assessment scale is recommended together with experienced clinical judgment. Braden scale for predicting risk for pressure ulcers. The patient is evaluated in six categories: sensory perception, moisture, activity, mobility, nutrition and friction and shearing forces. The decubitus risk increases if the score falls: 15-16 = low risk; 12-14 = moderate risk; <12 = severe risk. Adapted from Braden B, Bergstrom N: pressure ulcers in adults: prediction and prevention. Clinical Practice Guideline, No. 3, pp. 14-17, May 1992. US Department of Health and Human Services. The Norton Scale for predicting pressure ulcer risk * Criterion Result health 4 = Good 3 = Adequate 2 = Bad 1 = Very bad Mental Health 4 = Attentive 3 = Apathetic 2 = Confused 1 = stupor Activity 4 = Ambulatory 3 = Goes with 2 = to wheelchair bound = 1 bound to bed mobility 4 = 3 = Fully Something impaired 2 = Very limited 1 = immobile incontinence 4 = 3 = 2 = normally occasionally / Urine 1 = Double * calculated as a sum of the scores in all five areas. A score <14 indicates a high risk of developing a pressure ulcer. Adapted from Norton, D: Calculation of risk: Reflections on the Norton scale. Decubitus 2:24, 1989. Pathophysiology The most important factors that contribute to pressure ulcers Pressure: When soft tissue between bony prominences and contact surfaces are pressed together, come microvascular occlusions with tissue ischemia and hypoxia; if the pressure is not relieved, a decubitus ulcer within 3-4 h may develop. This occurs most often on the sacrum, ischial tuberosity, trochanter, ankles and heels, but decubitus ulcers can develop anywhere. Friction: friction (rubbing against clothing or bedding) can contribute to the emergence of Dekubitalulzerationen by causing local erosion and cracks in the epidermis and superficial dermis. Shear: shear forces (. For example, when a patient lies on an inclined plane) burden and damage to the supporting tissue, as they are stressful for the muscles and the subcutaneous tissue, which are drawn by gravity down to the more superficial tissue layers, remain in contact with outer surfaces counteract. Shear forces contribute to decubitus ulcers, but are not direct causes. Moisture: Moisture (. Eg welding, incontinence) leads to tissue damage and maceration, which can lead to the appearance or worsening of a Dekubitalgeschwüres. Since muscles are more prone to ischemia compression as skin, muscle ischemia and necrosis may underlie a decubitus ulcer due to prolonged compression. Symptoms and complaints Regardless of the stage are decubitus ulcers painful or itchy, but are not necessarily noticed by patients with impaired perception and sense perception. Staging systems There are several staging systems. The most widely used system that was developed by the National Pressure Ulcer Advisory Panel (NPUAP) classifies ulcers on the strength of damage to the soft tissues. Stage I decubitus ulcers manifest as non-squeezable erythema, usually over a bony prominence. The color may be less visible in dark pigmented skin. The injury may also warmer, cooler, hard, soft, or softer than adjacent or contralateral tissue. Actually, it is at this stage a misnomer since no ulcer in the strict sense (to the dermis-reaching skin defect) present. However, inevitably forming an ulcer, if the disease is not broken here and vice versa. Decubitus stage I (back) Illustration of Gordian Medical, Inc. dba American Medical Technologies; Used with permission. var model = {thumbnailUrl: '/-/media/manual/professional/images/stage_i_pressure_ulcer_buttocks_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/stage_i_pressure_ulcer_buttocks_high_de.jpg?la = de & thn = 0 ', title:' decubitus level I (buttocks) ', description:' u003Ca id = "v38395939 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = "" para "" u003e u003cp u003eDieses photo of decubitus stage I shows a redness

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