Objective*

Introduction*
Etiology*
location*
Stages*
Nursing implement*

At the end of this seminar

:
you will be able to

Identify the pressure ulcer*

(.
bed sores )
*Determined the pressure ulcer
sites .
.
The stages of ulcer

The nurse implements measure

Pressure sores , also known

as decubitus ulcer , occur
when capillary blood flow to
the area is REDUCED .This
may happen when the skin
over a bony prominence is
compressed between the
weight of the body and AN
external surface for a
prolonged period

Stage1
pressure sores are
characterized by
redness of the skin .
The reddened skin of a
beginning pressure
sore fails to resume its
normal color , or
blanch, when pressure
is relieved

Stage2
pressure sore is red and
is accompanied by
blistering or a shallow
break in the skin ,
sometimes descried as a
skin tear .impairment of
the skin leads to
microbial colonization
and infection of the
..wound

Stage3
Pressure sores classified as stage
3 are those in which the
superficial skin impairment
progresses to shallow crater that
extends to the subcutaneous
tissue.stage3 pressure sores may
be accompanied serous drainage
from leaking plasma or purulent
drainage .(white or yellow tinged
fluid) caused by a wound
infection. although a stage3
pressure sore is as significant
wound >the area is relatively
PAINLESS

Stage4

pressure sore are

the most traumatic
and life
threatening. The
tissue is deeply
ulcerated. exposing
muscle and bone
.the dead tissue
produces rank odor

Local infection ,which is the rule

rather than the exception ,easily
spread throughout the body .causing
a potentially fatal condition referred
to as sepsis
Once he or she has identified at risk
clients .the nurse implements
measures that reduce conditions
under which pressure sores are
likely to form . Some example are se
:follow

turning and repositioning the client frequently*

keeping client skin clean and dry*
massaging bony prominences if the client skin blanches with pressure *
relief
using a moisturizing skin cleanser rather than soap *
applying pressure-relieving devices to the bed and chairs *
padding body area that are subject to pressure and friction *
avoiding shearing physical force that separates layers of tissue in *
opposite direction , such as when a seated client slides downward
perform passive ROM CARE*

A dressing promotes healing by keeping a wound moist, creating a .

barrier against infection and keeping the surrounding skin dry. A variety of
dressings are available, including films, gauzes, gels, foams and various
treated coverings. A combination of dressings may be used. Your doctor
selects an appropriate dressing based on a number of factors, such as
the size and severity of the wound, the amount of discharge, and the
ease of application and removal

Removing damaged tissue

To heal properly, wounds need to be free of damaged, dead or

infected tissue. Removing these tissues (debridement) is
accomplished with a number of methods, depending on the
severity of the wound, your overall condition and the treatment
. goals