PRESSURE ULCERS. MULTIDISCIPLINARY APPROACH TO CHRONIC WOUNDS.

Pressure Ulcer (UP) can be defined as "skin damage and subjacent tissue caused by prolonged pressure on a hard plane, not necessarily intense, and independent of the position"

The UP can be extremely painful, especially during handling; treat these ulcers is much more difficult than preventing it, nursing is who correspond to take the initiative as the maximum responsible in the integrated approach to the UP, both in prevention and in the treatment.

Risk Factors influencing pressure ulcers:

- Pressure and Time

- Friction

- External force of vascular clamping

Typical locations of PU:

To prevent the most important:

- Identification of risk groups: must be a constant, recommended using scales that assess risk factors. To classify and evaluate these UPP we use: the Braden Scale and the Norton scale.

- Once identified risk groups: we must:

- Reduce pressure: by postural changes, use of materials such as mattresses, pads, ring to relieve pressure, local guards, rubber parts ...

- Skin care: with a careful inspection of the skin starting with a good daily washing and drying.

- Provide adequate nutrition: important a healthy and balanced diet, rich in protein and vitamins.

Rating:

- Grade 1: bluish skin, local heat, edema, erythema, friction blisters can appear.

- Grade 2: destruction of dermis and epidermis may affect subcutaneous layers.

- Grade 3: Destruction of the subcutaneous layer, formation of crater-shaped cavities.

- Grade 4: deep injury extending to bone, muscle or supporting elements.

Treatment:

Never underestimate the degree of ulcer despite the small it may seem, there is no single effective treatment, the choice will depend on the extent and valuation of each case.

In the initial stages: hyperoxygenated fatty acids.

Later stages: debridement (surgical, enzymatic) and granulation. (Dry or moist healing cure)

Main dressings: hydrogels, alginates, silver dressings, coal dressings, polyurethanes.

Treating pressure ulcers is much harder than preventing, prevention is the highest priority.

Video tutorial repositioning for pressure ulcer prevention:

Bibliography:

- Protocol pressure ulcer care University Hospital Ramon y Cajal

- Juan Angel Ortiz Hernandez Prevención y cuidados en úlceras por presión: ¿Dónde estamos? Gerokomos [magazine on the Internet]. 2009 Sep [cited 2013 Apr 01], 20 (3): 132-140. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2009000300007&lng=es. http://dx.doi.org/10.4321/S1134-928X2009000300007.

- Government of Aragon