The pressure ulcer (PU) is defined as any area of damage on the skin and underlying tissue caused by prolonged pressure on a hard surface with chronic diseases, especially in the elderly with limited mobility, with significant morbidity and high economic impact and social. Analyze how in Medicine is one of the most feared complications secondary to prolonged bed rest and / or situations of immobility. This is a problem but not exclusively geriatric, most often affects people over 75 years. Analyze effective treatment, etiology, and epidemiology, assessment of the patient and proper treatment of this PUs.
Are lesions of the skin that appear anywhere on the body because of a continuous pressure on a hard support surface. The surface may be occipital, scapula, vertebrae, elbows, iliac crests, sacrum, buttocks, knees and heels.
General population prevalence of 1.7% between 55 and 69 years and 33% between 20 and 75.
It is a common problem in the care of patients with chronic diseases, especially in the elderly with limited mobility, with a significant morbidity and high economic and social impact.
Pressure ulcers (PU) are one of the most feared complications and secondary to prolonged bed rest and immobility situations.
Pathogenesis of pressure ulcer (PU)
It is produced by an external pressure, prolonged and constant over a bony prominence and a hard surface which causes ischemia, vascular membrane, which causes vasodilatation of the zone, the liquid extravasations and cellular infiltration. If the pressure does not decrease, there is a strong local ischemia in the surrounding tissues, venous thrombosis and degenerative changes leading to necrosis and ulceration.
This process can continue and reach deeper levels with destruction of muscle, fascia, bones, blood vessels and nerves. Pressure ulcers (PU) (4) require the existence of microcirculatory disorders in support areas located on a hard surface. The hydrostatic pressure of the coetaneous capillaries between 16 and 32 mmHg. All these figures pressure exceeding decreased blood flow and ischemic damage may occur even in less than 2 hours.
Friction forces and shears forces decreases the pressure required to cause tissue damage.
Described a number of risks in the development of pressure ulcers (PU) independent of the patient's condition. Of these, immobility is the most important.
The incidence of injuries of ulcers is very difficult to know exactly. A large number of pressure ulcers being treated at the home of a patient left without any records. In addition, many of the sores that appear in patients hospitalized or in nursing homes are not given any importance and, therefore, are not like any disease, making it very difficult to make a reliable statistical average. Over 70% of ulcers occur in over 70 years.
Prevention of occurrence of new pressure ulcers:
Nutritional support: a good nutritional support promotes healing and may prevent the appearance of new lesions. The nutritional needs of a person with PU are increased and the diet should ensure at least the following: Calories: 30.35 kcal per kg body weight per day, protein: 1.25 to 1.5 g / kg of body weight per day. In cases of hypoproteinemia, you can get to take up to 2 g / kg. Minerals: zinc, iron and copper. Vitamins C, A, B.
Support water, 30 cc of water per day per kg of weight. If that is not covered with the usual diet, we must turn to supplements hyperproteic of eternal or oral nutrition to prevent deficiency states and put the patient in a positive nitrogen balance and quality.
Emotional support: there is a decrease in functional capacity that affects both the individual and the family. It should be counseling and education when developing the care plan to follow up.
The best way to treat a pressure ulcer (PU) is to prevent occurrence.