Ulcers (PTA)
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| Stage I Pressure Ulcer | skin intact; changes in color, temperature, stiffness, or sensation
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| Stage II Pressure Ulcer | partial-thickness skin loss (epidermis and/or dermis); superficial abrasion, blister, or shallow crater
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| Stage III Pressure Ulcer | full-thickness skin loss; necrosis of subcutaneous tissue & underlying fascia; deep crater w/ or w/o undermining of adjacent tissue
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| Stage IV Pressure Ulcer | full-thickness skin loss; tissue necrosis, damage to muscle, bone, or support structures
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| (Bony Prominences Associated with pressure injuries) in Supine | Occiput---Scapula: spine, inf. angle---(Bony Prominences Associated with pressure injuries) Vertebral spinous processes---Humerus: medial epicondyle---Posterior iliac crest---Sacrum---Coccyx
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| (Bony Prominences Associated with pressure injuries) in Prone | Forehead---Acromion process (ant. portion)---Ant. head of humerus---Sternum---ASIS---Patella---Dorsum of foot
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| (Bony Prominences Associated with pressure injuries) in Sidelying | Ears---Acromion process (lateral portion)---Lateral head of humerus---Gr. Trochanter---Fibular head---Lateral & Medial malleoli
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| (Bony Prominences Associated with pressure injuries) in Sitting (Chair) | Spine of Scapula---Vertebral spinous processes---Ischial tuberosity
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| Pressure ulcers form because... | pressure to soft tissue that exceeds normal capillary pressure of the local circulation
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| 8 Factors contributing to pressure ulcers: | shear, friction, heat, moisture, medication, muscle atrophy, malnutrition, debilitating medical conditions
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| Neuropathic ulcers | 2° complication associated with combination of ischemia & neuropathy. Seen with Diabetes.
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| Where are neuropathic ulcers usually located? | plantar surface of foot, beneath met. heads
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| Describe a neuropathic ulcer wound. | prominent callus rim with good granulation tissue & little or no drainage.
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| Other key facts about neuropathic ulcers | usually painless (altered sensation); pedal pulse diminished or absent; distal limb shiny & cool to the touch; periwound skin is dry or cracked
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| Arterial insufficiency ulcers | occur 2° to ischemia from inadequate circulation of oxygenated blood; often due to complicating factors such as atherosclerosis
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| Location of Arterial Ulcers | lower 1/3 of leg: toes, web spaces, lateral malleolus
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| Appearance of Arterial Ulcers | Smooth edges, well defined, deep, NO granulation tissue
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| Pain Associated with Arterial Ulcers | Severe
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| Pedal Pulse with Arterial Ulcers | Diminished or absent
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| Edema with Arterial Ulcers | Normal (localized)
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| Skin temperature with Arterial Ulcers | Decreased
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| Tissue Changes with Arterial Ulcers | Thin & shiny; hair loss; yellow nails
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| Leg elevation with Arterial Ulcers | INCREASES pain!!
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| Venous insufficiency ulcers | occur 2° to inadequate functioning of the venous system resulting in inadequate circulation & eventual tissue damage & ulceration
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| Location of Venous Ulcers | proximal to medial malleolus
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| Appearance of Venous Ulcers | Irregular shape; shallow
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| Pain associated with Venous Ulcers | mild to moderate
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| Pedal Pulse with Venous Ulcers | Normal
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| Edema with Venous Ulcer | INCREASED
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| Skin Temperature with Venous Ulcer | Normal
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| Tissue Changes with Venous Ulcer | Flaking, dry skin, brownish discoloration
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| Leg Elevation with Venous Ulcer | decreases pain
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| Intervention for Arterial Insufficiency Ulcers | Cleansing, Rest, Reducing risk factors, & Limb Protection
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| General Recommendations for Arterial Insufficiency Ulcers | 1)Wash/dry feet thoroughly 2)Avoid unnecessary leg elevation 3)Inspect legs/ feet daily 4). Wear appropriately sized shoes w/seamless socks 5). Use bandages as necessary & avoid any unnecessary pressure 6). Avoid using heating pads or soaking feet in hot
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| Intervention for Venous Insufficiency Ulcers | Cleansing, Compression to control edema
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| General Recommendations for Venous Insufficiency Ulcers | 1). Elevate legs above heart when resting or sleeping 2). Attempt active exercise including frequent ROM 3). Inspect legs & feet daily 4). Wear appropriately sized shoes with clean, seamless socks 5). Use bandages as necessary & avoid scratching or other
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| How often should bed-bound patients be turned to prevent pressure ulcers? | every 2 hours
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