A 77-year-old woman is transferred to a skilled nursing facility after a 2-week hospital stay for hip fracture repair. Her hospital course was complicated by a lower gastrointestinal hemorrhage and subsequent bacteremia from an intravenous line.
Vital signs are within normal limits. The patient is alert and oriented to person and date; she appears thin. She has a 4x5-cm pressure ulcer over her presacral area that extends through the skin, but no muscle or bone is exposed. The ulcer has little exudate and minimal surrounding erythema.
In addition to nutritional support, which of the following is indicated for this patient's pressure ulcer?

Question

A 77-year-old woman is transferred to a skilled nursing facility after a 2-week hospital stay for hip fracture repair.  Her hospital course was complicated by a lower gastrointestinal hemorrhage and subsequent bacteremia from an intravenous line.
Vital signs are within normal limits.  The patient is alert and oriented to person and date; she appears thin.  She has a 4x5-cm pressure ulcer over her presacral area that extends through the skin, but no muscle or bone is exposed.  The ulcer has little exudate and minimal surrounding erythema.
In addition to nutritional support, which of the following is indicated for this patient's pressure ulcer?

Quizplus · Accepted Answer

11ec193a_9776_dec8_853d_e33dda834f9e_MD0002_00 This patient has a stage 3 pressure ulcer. All patients with such ulcers require pressure relief measures, including scheduled patient turning, and optimized nutritional status. Wound fluids contain tissue growth factors that facilitate reepithelialization and wound healing, but excess fluid may cause wound maceration. Therefore, it is important to provide a balanced moist wound environment while keeping the surrounding skin dry. stage 3 pressure ulcer Absorbent dressings are appropriate for wounds with significant exudate as they can remove the excess exudate while maintaining a moist environment. This patient has a dry wound without exudate or evidence of infection and would benefit from a semipermeable dressing (eg, hydrocolloid, hydrogel) to promote a moist wound environment. Dressings should generally be changed every 1-2 days. (Choice B) Occlusive dressings (eg, DuoDerm) can be used on stage 2 ulcers, but they are not recommended for full-thickness (stage 3, 4, or unstageable) ulcers. These dressings can create an anaerobic environment that promotes infection, prevents inspection, and causes deep fistula formation. (Choice C) Wet-to-dry and wet-to-wet saline gauze dressings are frequently used to aid debridement of wounds with extensive exudate. However, gauze dressings are labor intensive and do not reliably maintain a moist wound environment. (Choice D) Systemic antibiotics should be used for pressure ulcers with evidence of cellulitis or osteomyelitis. Topical antibiotics (eg, silver sulfadiazine) can be used for ulcers with superficial infection or overgrowth. However, this patient has no specific signs of infection (eg, purulence, warmth, erythema, excessive bleeding, foul odor). (Choice E) Vacuum-assisted closure (VAC) devices continuously or intermittently apply negative pressure to the wound surface. This promotes tissue remodeling and increased blood flow and decreases tissue edema. VAC has been found effective for diabetic foot wounds but has uncertain benefit for pressure ulcers. Educational objective: Pressure ulcer management requires pressure relief and attention to nutrition. Dressings should be chosen to maintain a moist wound environment. Occlusive dressings should not be applied to full-thickness wounds. __________ References: Pressure ulcers: prevention, evaluation, and management. (http://www.ncbi.nlm.nih.gov/pubmed/19035067) Treatment of pressure ulcers: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/19066385) Wound care in the geriatric client. (http://www.ncbi.nlm.nih.gov/pubmed/19554098)

A 77-Year-Old Woman Is Transferred to a Skilled Nursing Facility