Master Pressure Ulcers with Picmonic for Nursing RN

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Pressure Ulcers

Pressure-cooker Ulcer-volcanoes
Picmonic
A pressure ulcer can develop when there is pressure on any part of the body for an extended period of time. Blood flow gets cut off to areas of the skin where pressure is present causing cell death. This results in the skin to breakdown, and if left untreated an ulcer can form. This puts the patient at risk for infections. Common areas for pressure ulcers to form over bony areas where pressure can be higher. Common areas are: tailbone, buttocks, elbows, heels, shoulders, and ears. Always assess the patient’s skin during every assessment.
8 KEY FACTS
TYPES
Stage 1 - Non-Blanchable Redness
Stage with (1) Wand and Nun-bleach

In this stage the skin is still intact. This is typically the first indication of skin breakdown, and frequent turns should be initiated while avoiding putting pressure on the reddened area. To determine if the reddened area is a stage one, push a finger into the reddened area. If the skin does not turn white, then it has entered into stage one.

Stage 2 - Partial Thickness
Stage with (2) Tutu and Partial-thickness skin loss

In stage two, the ulcer can be classified as partial thickness open or partial thickness closed. The ulcer will either develop a blister (closed) or become an open sore. Skin is not intact at this stage and at risk for becoming infected.

Stage 3 - Full Thickness Skin Loss
Stage with (3) Tree showing Full Thickness Skin Loss

In stage three the ulcer has cratered into the dermis and subcutaneous tissue. Fat could be visible with sloughing of the tissue. Nerve damage can also occur at this stage.

Stage 4 - Full Thickness Tissue Loss
Stage with (4) Fork showing Full Thickness Tissue Loss

Bone is exposed in stage four. Slough and eschar may be present. The wound could also have undermined or tunneled into the surrounding tissue.

Unstageable
Hidden-stage of Ulcer-volcano

Wounds are unstageable when the depth of the wound cannot be determined. This is typically due to dead tissue covering the ulcer like a scab. The dead tissue needs to be removed by the physician or a wound specialist before staging can occur.

Possible Deep Tissue Injury
Deep-diver causing Tissue Injury

This can occur when the skin looks like a deep bruise. This is not to be confused with Stage one pressure ulcers, as the skin is more purplish or maroon. These types of injuries should be reported to the doctor immediately for these injuries can quickly turn into a Stage three or four pressure ulcers.

CONSIDERATIONS
Skin Color Alterations
Skin-suit-man with Color Alterations

It is important to remember that blanching is not always apparent in patients with dark-pigmented skin. Assessing for an increase in warmth, pain, or skin firmness are other indicating of skin breakdown.

Remove Necrotic Tissue Before Staging
Removing Necrosis-crow with Tissues

Necrotic tissue needs to be removed before staging, because it can cover up the true depth of the wound. The physician or wound nurse specialist will recommend treatment in this case. It is also important to remember that once a wound is staged, the wound will always be classified as its highest stage type until fully healed.
Example: A wound became a stage three before it started healing. Even though the wound has healed to a stage one, it is still considered a stage three.

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