Pressure Sores:

• AKA decubitus ulcers, bedsores are preventable
• Caused by constant deficiency of blood supply to tissues
• Typically over bony prominences (sacrum, ischial tub. heel, great. troch.)
• Pressure causes ischemia, which causes necrosis
• Necrotic tissue can lead to infections, this can prevent normal scar tissue from forming
• Infection is usually localized and self limiting
• Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissue and cause a foul smelling discharge
• Painful, fever, increased white blood cell count
• If ulceration is large, pain and toxicity lead to loss of appetite, renal insufficiency, debilitation
• The progression is as follows; Hyperemia, Blisters, Blue red color, Breaks in skin, Tissue ulceration, Infection sets in and then the tissue dies

 

Risk Factors:

• Immobility
• Contractures
• Decreased nutrition
• Anemia
• Obesity
• Sepsis

• Edema

• Diabetes

 

Diagnosis:

• Homan's sign is only present in 30% of true cases
• False positive can occur with mm injuries, Achilles tendonitis, ruptured bakers cyst
• 50% of positive tests are not venous thrombosis
• Diagnosis is made on Hx, Doppler ultrasound, venous plexus scanning

 

Treatment:

• Oral antibiotics are effective
• Debridement and clean hygiene
• Topical antibiotics are not effective

 

Therapist concerns:

• Position accordingly. Encourage adequate hydration and nutrition
• Reposition every 2 hrs
• No hot or ice hydro

• Inspect skin each Tx and record
• Use moisturizing lotion or cornstarch

• Bolster, pillow to take pressure off

• Maintain current ADLs, activity level, ROM, Mobility

• Lower head of bed for venous return

 

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