need advise to treat stage III pressure ulcer

skylark, BSN, RN · May 30, 2011

OK, first of all, are there any signs of infection?

Redness, odour, pyrexia, etc. Take a swab for microbiology.

Second map the size of the wound, including depth. You can use a sterile swab to probe the depth and check for any sinus cavities running under it.If you can trace it using one of those acetate sheets, thats great, and it helps the patient know there is improvement when you retrace later and can show them the difference.

Third, figure out how much exudate is likely to be leaking from it. It might take a day or two of dressing changes to figure that one.

Then look at the actual wound bed. Can you see healthy granulation or is it all covered in exudate.

Don't forget that cavity wounds need to heal upwards, (fill) before they can close. If you let them heal across without adequate granulation they just form a pocket which sooms breaks down again.

Necrotic tissue needs to be lifted off the wound, and this can be a slow process. If you can get under the tissue, applying a hydrocolloid gel can work wonders, it breakd it down from underneath so that after afew days it lifts off.

Larger areas might need more aggressive treatment, namely removal using a surgical blade. But please get someone experienced to do this, its not called 'surgical debridement' for nothing!!

OK, now what to dress it with,

Infected wound will need antibiotics, (as per swab results), and also antimicrobial dressings, probably silver or iodine based.

Wet wounds will need alginate and foam to absorb the exudate.

Stubborn slough/exudate will need gels and hydrocolloids to break them down.Healing will not take place until the slough layer is gone.

Sore and excoriated surrounding skin will need barrier films, or it will soon break down further from the wound leakage and the repeated changing or adhesive dressings.

Cavity wounds will need packing to stop them healing over before they fill. alginate ribbon is usually best for this, but it does depend on the indivudal wound characteristics.

All wounds will need a protective dressing, and maybe bandaging to secure, if its a heel, for example.

Maybe more than one of the above applies. There are combo dressings, alginate WITH silver, for example.

I'm working in the UK right now, so my dressing formulary will most likely be different to that used on the US.

But if you can give more details of the wounds, I can make suggestions as to what I would use.

And finally, figure out the cause of the ulcer.

Pressure, friction, excoriation - maybe all these and more.

Is there equipment you can use to prevent it happening again?

Review the choices of mattress and chair cushion, and check the moving and handling tehniques being used to move this patient.

Also look for the obvious - are they lying on catheter tubing by mistake, is one if the staff wearing jewelry that would scrape them, causing a wound that would deteriorate into an ulcer, etc.

A nutrition review never does any harm either!

Hope that helps.

ira1027 · May 30, 2011

Great! Thanks a lot!