Pressure Ulcers

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Other complications
Sinus tracts may develop that communi-cate with the deep viscera including the bowel or bladder. Heterotrophic calcification also occasionally occurs. The chronic inflammatory state arising from the ulcer may result in systemic amyloidosis.
Squamous cell carcinoma occasionally develops in a pressure ulcer and should always be considered in patients with a nonhealing wound.


Prevention
Pressure ulcer prevention is an ongoing task; regular follow-up is required to identify changes in clinical status, and daily skin inspections should be performed to detect early evidence of pressure-induced skin damage.
Pressure relief
Pressure relief is the most important factor in preventing pressure ulcers. This may be accomplished in two ways: proper patient positioning and appropriate use of pressure-reducing devices.
Patient positioning
Proper positioning of
bed-bound individuals begins with aregular turning schedule. A two-hour interval typically is recommended, although this varies depending upon patient risk and the type of mattress used. Skin erythema can occur in less than two hours on a standard mattress. Turning should be performed successively from the back, to the right side, and then to the left.
In addition to regular turning, the position of bed-bound patients is important. Patients should be placed at a 30 degree angle when lying on their side to avoid direct pressure over the greater trochanter. Pillows or foam wedges may need to be placed between the ankles and knees to avoid pressure at these sites.
The heels require particular attention; pillows may be placed under the lower legs to elevate the heels, or special heel protectors can be used.
Elevation of the head of the bed should be limited to minimize exposure to shear forces. Chair-bound patients may generate considerable pressures over the ischial tuberosities; they should probably be repositioned at least every hour. Patients who are cognitively intact and are able to use their upper extremities can be trained to shift weight even more frequently

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