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What are the most common locations in a supine patient? (2)
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1. sacrum
2. heel
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What are the most common locations in a seated patient? (3)
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1. ischial
2. trochanteric
3. sacral (if reclined)
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What are the four National Pressure Ulcer Advisory Panel stages? Stage I:
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Nonblanchable erythema present greater than 1 hour after pressure relief; skin intact
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Stage II:
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Partial-thickness skin loss
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Stage III:
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Full-thickness skin loss into subcutaneous tissue, but not through fascia
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Stage IV:
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Through fascia into muscle, bone, tendon or joint
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What are the primary etiologic factors? (4)
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1. pressure
2. shear
3. friction
4. moisture
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What is normal capillary pressure, above which ischemia results?
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12 to 32 mmHg
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What are the secondary etiologic factors? (6)
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1. malnutrition
2. sensory loss
3. wound infection
4. age
5. immobilization -> contractures
6. systemic issues (DM, smoking, etc)
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How frequently should supine patients be turned to relieve pressure ischemia?
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2 hours
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With what duration and frequency should sitting patients be lifted from their wheelchairs to relieve pressure ischemia?
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10 seconds every 10 minutes
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For patients at high risk, what additional measures should be considered?
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air mattress or specialized wheelchair cushions
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How can the secondary risk factors be modified? (5)
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1. monitor & optimize nutrition (albumin, transferrin, prealbumin, etc)
2. tight glucose control in diabetic patients
3. smoking cessation
4. treat infections
5. treat contractures with PT & muscle relaxants
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What is the treatment for partial thickness (Stage I and II) pressure sores?
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1. pressure relief
2. reduce other risk factors (primary and secondary as above)
3. wound dressings (DuoDerm, petroleum gauze, or silver sulfadiazine)
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How long does it take most Stage I and II pressure sores to heal?
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2-3 weeks
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How are full thickness (Stage III and IV) pressure sores treated?
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1. pressure relief
2. modify risk factors
3. debridement (possibly at bedside)
4. dressings (wet-to-moist, debriding dressings, antimicrobial dressings, or occlusive dressings)
5. treatment of soft tissue infection (debridement, drainage, antibiotics)
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What must you suspect if bone is exposed?
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osteomyelitis
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How is it diagnosed?
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bone biopsy (done at bedside with rongeur)
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How is it treated? (2)
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1. aggressive debridement of infected bone
2. IV antibiotics for at least 6 weeks
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