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A 39-year-old female was transferred from another hospital 4 days after an automobile accident resulting in an incomplete spinal cord injury (SCI) at C5-6 and a burst fracture at T5. She was transferred to the current hospital for neurosurgery to decompress and stabilize her spine. Upon the current admission, she was found to have a suspected deep tissue injury (SDTI) in the sacral area. After 2 days, it progressed to an unstageable pressure ulcer (PU). On the third day (1 week after her initial accident), the patient had spine surgery. On postoperative day 1 (POD 1), the physical therapist is asked to evaluate and treat the sacral pressure ulcer. The patient is married, lives with her husband and two children in a two-story home, and works part-time as a paralegal.

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Based on the patient's diagnosis, what do you anticipate may be the contributing factors to the pressure ulcer?

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What is the role of rehabilitation in optimizing healing potential?

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What are the most appropriate interventions?

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Identify referrals to other medical team members.

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  • BURST FRACTURE: Comminuted fracture of the vertebral body that results in bone fragments that may scatter and damage surrounding tissue
  • INCOMPLETE SPINAL CORD INJURY: Injury that does not completely sever the spinal cord, resulting in partial sensory and/or motor function below the neurological level of injury, including some function of the lowest sacral segment
  • SUSPECTED DEEP TISSUE INJURY (SDTI): Localized area of discolored purple or maroon intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear; may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue1
  • UNSTAGEABLE PRESSURE ULCER: Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed1

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  1. Perform a subjective and objective evaluation of a patient with a pressure ulcer.

  2. Diagnose a pressure ulcer by depth of tissue involvement and accurately stage according to the National Pressure Ulcer Advisory Panel (NPUAP) Staging Classification.

  3. Identify special equipment needed to facilitate wound healing.

  4. Develop a strategy to eliminate contributing factors based on patient and wound evaluation.

  5. Implement appropriate strategies to prevent other lesions from developing.

  6. Select appropriate pressure redistribution surfaces for a patient with a pressure ulcer.

  7. Develop a treatment plan to optimize wound healing including debridement method, dressing selection, and biophysical technologies.

  8. Describe the focus of patient and family education for the individual with pressure ulcers.

  9. Recommend appropriate care after discharge from the acute care setting.

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PT considerations during management of the individual with a pressure ulcer:

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  • General physical therapy plan of care/goals: Prevent further tissue loss at wound site; optimize wound healing with debridement, moist wound healing, ...

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