CHAPTER SIX

### CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

1. Identify the factors leading to pressure ulcer development.

2. List strategies for prevention of pressure ulcers.

3. Complete a risk assessment scale to determine pressure ulcer risk.

4. Effectively implement strategies for pressure load management.

5. List and define the categories of bed types.

6. Understand proper wheelchair positioning.

7. Define the NPUAP pressure ulcer stages.

8. Discuss the elements of proper pressure ulcer treatment.

### INTRODUCTION

There are many different wound etiologies that occur on patients and require medical intervention to achieve full healing. In the hospital and long-term care settings, the most common type of wound is the pressure ulcer, and the most common populations in which pressure ulcers occur are the patients with spinal cord injury and the elderly. In the spinal cord injury population, 25–40% of individuals will develop a pressure ulcer in their lifetime, and 70% of pressure ulcers occur in patients over the age of 70.1,2

A pressure ulcer is defined as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with friction/shear.3 Unlike other types of wounds, pressure ulcers are often viewed as a visible sign of neglect, although there are situations in which development of skin breakdown is unavoidable. Pressure ulcers are a significant cause of morbidity and mortality and occur in all care settings, from the home to the intensive care unit. The annual cost of treating pressure ulcers in 2004 was noted to be £1.4–2.1 billion in the United Kingdom, which was equivalent to approximately 4% of the total National Health System budget, and $2.2–3.6 billion in the United States for the same time period.4,5 The cost of a single pressure ulcer has been estimated to increase the cost of a hospital stay by$2,000–\$11,000.6

The population is rapidly aging, with the fastest growing segment of the population being individuals over the age of 80,7 thus it is expected that the number of pressure ulcers, and therefore the cost to the healthcare system, is going to increase dramatically in the next 20 years unless significant improvement can be made in prevention. Despite the many advances that have been made in the field of medicine, these advances have not significantly impacted the prevalence or incidence of pressure ulcers.

### PATHOPHYSIOLOGY

Pressure ulcers occur primarily due to immobility; however, there are other factors such as moisture, friction, and shear that also impact the formation of skin breakdown. Moisture, as a risk factor for skin breakdown, can be defined as excess fluid against the skin. (FIGURE 6-1) This can occur secondary to incontinence, wound drainage, or a patient who is perspiring. Excess moisture causes maceration of the skin, which makes it more vulnerable to ...

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