NUR 324 Lecture Notes - Lecture 8: Glycerol, Llers, Pressure Ulcer
Document Summary
Pressure ulcers - localized injury to skin and underlying tissue; result of pressure in combination w/ shear and/or friction: areas of greatest risk: occiput, trochanters, ischium. Decreased: indication of malnutrition; helps keep skin healthy & growing. Risk assessment: bradent scale w/ 6 sub-scales: sensory perception, moisture, activity, mobility, nutrition, friction/shear, score can range from 6-23, the lower the score, the higher the risk for developing pressure ulcer. Pressure ulcers - prolonged, intense pressure affects cellular metabolism by decreasing blood ow = tissue ischemia & ultimately tissue death. Pressure intensity- occluded vessel = tissue ischemia; pt. w/ decreased sensation won"t be able to respond to discomfort = tissue death. Pressure duration- low pressures over extended period of time, as well as high intensity pressure over short period of time = tissue damage. Tissue tolerance- integrity of tissue & supporting structures; nutrition, advanced age, and low bp can affect tissue"s tolerance to external pressure.