![]() ![]() 10, 11 The benefit of dynamic versus static surfaces is unclear. Pressure-reducing surfaces lower ulcer incidence by 60 percent compared with standard hospital mattresses, although there is no clear difference among pressure-reducing devices. Dynamic devices are generally noisy and more expensive than static devices. Dynamic devices, such as alternating pressure devices and low–air-loss and air-fluidized surfaces, use a power source to redistribute localized pressure. 9 Static devices include foam, water, gel, and air mattresses or mattress overlays. Pressure-reducing devices can reduce pressure or relieve pressure (i.e., lower tissue pressure to less than the capillary closing pressure of 32 mm Hg) and are classified as static (stationary) or dynamic. Pressure from any hard surface (e.g., bed, wheelchair, stretcher)įriction from patient's inability to move well in bed Immunodeficiency or use of corticosteroid therapy Vasculitis or other collagen vascular disorders ![]() Progressive neurologic disorders (Parkinson disease, Alzheimer disease, multiple sclerosis) Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection. Topical antibiotics should be considered if there is no improvement in healing after 14 days. Bacterial load can be managed with cleansing. Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. Mechanical, enzymatic, and autolytic debridement methods are nonurgent treatments. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs. Debridement is indicated when necrotic tissue is present. Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. When an ulcer occurs, documentation of each ulcer (i.e., size, location, eschar and granulation tissue, exudate, odor, sinus tracts, undermining, and infection) and appropriate staging (I through IV) are essential to the wound assessment. Prevention includes identifying at-risk persons and implementing specific prevention measures, such as following a patient repositioning schedule keeping the head of the bed at the lowest safe elevation to prevent shear using pressure-reducing surfaces and assessing nutrition and providing supplementation, if needed. Predisposing factors are classified as intrinsic (e.g., limited mobility, poor nutrition, comorbidities, aging skin) or extrinsic (e.g., pressure, friction, shear, moisture). ![]() A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. ![]()
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