Monday, January 30, 2017

Management Of Pressure Ulcers

A 85-year-old debilitated nursing home resident was found to have pressure ulcers. He has no evidence of bacteremia or osteomyelitis. Which of the following is an acceptable treatment?
A) Application of povidone-iodine gauze two times per day
B) Application of hydrogen peroxide 3 times per day
C) Systemic antibiotics for 7 to 10 days
D) Keeping the area clean and dry until granulation tissue forms
E) Surgical debridement

The answer is
E. (Surgical debridement)

Discussion: When treating pressure ulcers, it is important to maintain a moist environment while keeping the surrounding skin dry. This can be accomplished by loosely packing the ulcer with saline-moistened gauze. Topical antimicrobials such as silver sulfadiazine cream may be helpful in ulcers that appear infected. Topical antiseptics such as povidone-iodine or hydrogen peroxide should not be
used in the treatment of pressure ulcers. Systemic antibiotics should be reserved for serious infections (e.g., bacteremia, osteomyelitis). A 2-week trial of topical antimicrobials may be considered for ulcers that do not appear infected but are not improving. Although most patients are successfully managed without surgery, procedures may be appropriate in patients whose quality of life would be markedly improved by rapid wound closure. Stage 3 and 4 ulcers with necrotic tissue should be debrided. Ulcers with minimal exudate that are not infected can be covered with an occlusive dressing to promote autolytic debridement. Ulcers with thick exudate, slough, or loose necrotic tissue should undergo mechanical debridement. Options include wet-to-dry dressings, hydrotherapy, wound
irrigation, and scrubbing the wound with gauze. Ulcers with evidence of cellulitis or deep infection should undergo sharp debridement with a scalpel or scissors. Ulcers with a thick eschar or extensive necrotic tissue should undergo sharp debridement as well. However, a thick, dry eschar covering a
heel ulcer should generally be left intact. Patients without access to surgical interventions (such as in a long-term care setting) or those who may not be acceptable surgery candidates can be treated with enzymatic debriding agents. Wound debridement should stop once necrotic tissue has been
removed and granulation tissue is present.

1 comment:

  1. Don't You Think It's High Time You Tried Herbal Remedy?

    In 2015, I was diagnosed of genital herpes.. I was 21 years old and I had no idea what that was. When my doctor explained to me what Genital Herpes was all about and what type I had...I was freaked out! if I had missed coming to the ER any sooner, I would have possibly died without having the slightest clue of what led to my death, as i have never heard of, or experienced the virus before! The rashes grew and i have been living with it ever since then. Most of the time, I feel dirty knowing i was living with herpes. Though the doctor already encouraged me to keep using my medications even though there is no permanent cure for the virus. So i continued with my medications, which only makes the rashes to disappear, and reappear after some days. Late last year, I started surfing the web, seeking for herbal treatment as alternative. So i was on YouTube one evening,i stumbled upon a comment about Dr. Ugo and how his herbal medications cured a woman's daughter of Herpes and I decided to reach out to him. He asked me some questions which i answered, after which He prepared some herbs and sent them to me. He then guided me on how to use them. i used the herbal medications for about ,21days. The rashes gradually dried up. So i went for a test and came back home Herpes free. So My experience with this virus made me to realize, people should find out more about themselves before it's too late. So that when tested positive, they will know how to go about it before it becomes late. If you are having any sickness or virus and needs deliverance contact Dr.Ugo (for your permanent healing) He is the right person to tell your health challenges to. You can contact the doctor via his email address :