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SOURCE

Source: Fish DN. Skin and soft-tissue infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071658. Accessed May 16, 2017.

CONDITION/DISORDER SYNONYMS

  • Decubitus ulcer.

  • Bed sore.

  • Pressure sore.

DEFINITION

  • Damage to underlying soft tissue from pressure and/or shear.

ETIOLOGY

  • Most pressure sores colonized by bacteria; bacteria frequently infect healthy tissue.

  • Cultures reveal polymicrobial growth:

    • Aerobic Gram-positive and Gram-negative bacteria.

    • Anaerobes.

PATHOPHYSIOLOGY

  • Factors that predispose to formation of pressure sores:

    • Paralysis.

    • Paresis.

    • Immobilization.

    • Malnutrition.

    • Anemia.

    • Infection.

    • Advanced age.

  • Factors critical to formation of pressure sores:

    • Pressure.

      • Areas of highest pressure generated over bony prominences.

      • Degree and length of time are important.

    • Shearing forces.

    • Friction.

    • Moisture from incontinence and perspiration.

      • When combined with other forces, it increases the risk of pressure sore formation 5-fold.

EPIDEMIOLOGY

  • Most common among:

    • Chronically debilitated.

    • Elderly.

    • Spinal cord injury.

PREVENTION

  • Prevention is single most important aspect in management of pressure sores.

    • Minimize friction and shearing forces by proper positioning.

    • Keep surface relatively free from moisture through skin care and prevention of soilage.

    • Most important factor: pressure relief, even for 5 min once every 2 hours.

RISK FACTORS

  • Immobilization in bed or wheelchair.

  • Altered mental status.

  • Incontinence.

  • Malnutrition.

CLINICAL PRESENTATION

SIGNS AND SYMPTOMS

  • Comorbid conditions may mask typical signs and symptoms of infection.

  • Clinical signs of infection in surrounding tissue:

    • Redness.

    • Heat.

    • Pain.

    • Swelling.

  • Signs of infection may be present.

    • Purulent discharge.

    • Foul odor.

    • Fever.

    • Leukocytosis.

TABLE 1.aPressure Sore Classification

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