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Key Features

Essentials of Diagnosis

  • Examine at-risk patients on admission to hospital and daily thereafter

  • Pressure injuries should be described by one of six stages:

    • Stage 1: Non-blanchable erythema of intact skin

    • Stage 2: Partial-thickness skin loss with exposed dermis

    • Stage 3: Full-thickness skin loss

    • Stage 4: Full-thickness skin and tissue loss

    • Unstageable: Obscured full-thickness skin and tissue loss

    • Deep tissue: Persistent non-blanchable deep red, maroon or purple discoloration

General Considerations

  • Incidence rates range from 12% to 16% of hospitalized patients and vary according to patient characteristics

  • The primary risk factor for pressure injuries is immobility

  • Other contributing risk factors include

    • Reduced sensory perception

    • Moisture (urinary and fecal incontinence)

    • Poor nutritional status

    • Friction and shear forces

Clinical Findings

Symptoms and Signs

  • The skin overlying the sacrum and hips is most commonly involved, but bedsores may also be seen over the occiput, ears, elbows, heels, and ankles

Differential Diagnosis

  • Herpes simplex virus

    • In immunocompromised patients, particularly if there is a scalloped border, representing the erosions of herpetic vesicles

  • Skin cancer

    • In the perianal area, a nonhealing injury may be cancer

  • Pyoderma gangrenosum

    • Rapidly expanding injury associated with inflammatory bowel disease

  • Ecthyma gangrenosum

    • Ulcerating lesion, commonly due to Pseudomonas, observed in neutropenic patients

Diagnosis

Laboratory Tests

  • Based on clinical appearance

  • Suspect an alternative diagnosis if injuries not healing properly

Treatment

Medications

  • See Table 4–5

  • The type of dressing that is recommended depends on the location and depth of the injury, whether necrotic tissue or dead space is present, and amount of exudate

Table 4–5.Treatment of pressure injury.

Surgery

  • Established lesions require surgery for débridement, cleansing, and dressing

Therapeutic Procedures

  • Treatment is aimed toward removing necrotic debris ...

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