Review Question - QID 107054

This patient's clinical presentation is consistent with a pressure ulcer, which is best prevented by repositioning every 2 hours.

Pressure ulcers are common in immobile patients, and typically occur over bony prominences. The key parts of the staging system for pressure ulcers are as follows: (1) Intact skin with pressure-related changes, (2) partial-thickness skin breakdown, (3) full-thickness skin breakdown, (4) damage to bone, muscle, or supporting structures, or the presence of a sinus tract. Treatment may include debridement and repositioning without pressure on the area.

Bluestein and Javaheri discuss the management of pressure ulcers. They note that treatment includes removal of necrotic tissue, and maintenance of a moist environment for tissue healing. Debridement can be performed surgically or medically, however urgent, sharp debridement is recommended in cases of sepsis or tracking cellulitis.

Reddy et al. perform a meta-analysis to determine the ideal treatments for pressure ulcers. They find that there is no evidence supporting one technique of wound support or dressing. In addition, while several studies have looked at the use of vitamin supplements to treat pressure ulcers, the outcomes are not convincing.

Figure A shows a stage 4 left foot pressure ulcer in a long-term care facility resident. Illustration A shows the 4 stages of pressure ulcers.

Incorrect Answers:
Answer 1: Massaging of bony prominences increases the risk of pressure ulcer formation.
Answers 3-4: Repositioning should be performed every 2 hours in immobile patients in order to decrease the risk of pressure ulcers.
Answer 5: Warfarin therapy is not considered a risk factor for pressure ulcer formation.