ulcers

this is my question and choices:

who is at most risk for pressure ulcers?

a)22 year old comatose patient?

b)8 month old baby?

c)92 year old bedridden patient?

my colleagues say a...but I say c, because of the loss of skin elasticity change due to age.

Thanks in advance.

I say C. I really don't think that is a hard question, actually. Of course a 92 year old who is bedridden is going to be the most at risk.

this is my question and choices:

who is at most risk for pressure ulcers?

a)22 year old comatose patient?

b)8 month old baby?

c)92 year old bedridden patient?

my colleagues say a...but i say c, because of the loss of skin elasticity change due to age.

thanks in advance.

i would agree with c. choice a is correct, but c is the better answer.

i like your questions, it shows that you're thinking! some people may think it's an easy question, but if you're just starting out-- you'll have a lot of questions. don't ever feel silly for asking them.

:welcome:

I say C. I really don't think that is a hard question, actually. Of course a 92 year old who is bedridden is going to be the most at risk.

Okay, but isn't the comatosed patient bedridden too? Can a comatosed pt move, sit and have sensation? That's why I chose that answer.

i would agree with c. choice a is correct, but c is the better answer.

i like your questions, it shows that you're thinking! some people may think it's an easy question, but if you're just starting out-- you'll have a lot of questions. don't ever feel silly for asking them.

:welcome:

thanks for your help. and.................yes there are no silly questions if you don't know the answer. better safe than sorry, specially in our proffession.

Both are confined to the bed. One is elderly (higher risk) and one is young. That's where the difference arises.

c coz an old person has a higher risk than a younger one

by definition a pressure sore is "a sore caused by pressure from a splint or other appliance, or from the body itself when it has remained immobile in bed for extended periods of time. the likelihood of a patient developing a pressure sore is increased if urinary incontinence is present. . .the operative force is pressure, leading to inadequate blood supply of the area and, if continued, [leads] to a sore or ulcer." [page 1559, taber's cyclopedic medical dictionary, 18th edition, published in 1997 by f.a. davis company]

this question and the resulting answer choices is asking you to evalute two things in relation to the formation of pressure ulcers: age and mobility. the term "bedridden" merely means confined to bed. it doesn't necessarily mean that the patient is immobile. in coma, however, the patient is stuporous or totally withdrawn and often totally immobile or not making any purposeful movement at all leading to situations where pressure over areas of the body is depriving those areas of adequate blood supply.

i have seen stoke victims who passed out and were not found for hours or a day. when we admitted them we would find a bruise (from their fall) along with redness and occasionally a rhabdomyolitis (inflammation of the muscles) over the dependent areas of the body that were in contact with the floor where they had lain for hours or days. this redness is the preliminary step to pressure ulcer formation.

this also happens in young drug addicts who take huge doses of their drugs and pass out for long periods of time in one position from which they do not move. sometimes they awaken and find themselves with a skin blanching or redness over the dependent areas of their body that were against the furniture they passed out on. if they can get up and move around they won't go on to develop any pressure ulcers. but the key here is that they get eventually get up and move around--get mobile. if they were to continually pass out for long periods of time in the same position time after time, they would be at risk to develop pressure ulcers young as they are.

so, i think, in reading the stem of this question carefully, the issue at hand is knowing that immobility, not age, is what leads to pressure that deprives an area of it's blood supply and that this is the underlying cause of a pressure ulcer. i do not discount that the frailty and inelasticity of 92-year old skin would contribute to this, but actively mobile 92-year olds, even those who are bedridden but kept turned and repositioned properly, don't develop pressure ulcers. also, having been in practice for a long time, i've seen cases where young people in comas who haven't been diligently turned and repositioned have gotten pressure sores in some very odd areas (pinna of the ear, shoulder)--very sad.

thanks for a very helpful and interesting answer.

Yep - I think on further consideration, I am convinced. Go with A. Looking at the Braden Scale (used for pressure sore risk assessment) was helpful to me.

http://www.bradenscale.com/braden.PDF

Okay, but isn't the comatosed patient bedridden too? Can a comatosed pt move, sit and have sensation? That's why I chose that answer.

Both A and C are at risk. I guess that technically using the braden scale, A would be the most at risk. Using real world experience, though, I still stick with C. The skin of a elderly, bedridden patient is absolutely going to breakdown before the skin of a 22 year old, unless they've been in a coma for a long period of time.

Also (beware: total tangent, really isn't relevant to this question) in my experience a 22 year old in a coma is going to get better medical care than an elderly bedridden patient. Meaning, the 22 year old is going to get passive ROM and turned q1-2. Some nurses (NOT ME) tend to push aside turning and repositioning the elderly. I'm not sure why, perhaps for fear of causing a skin tear... or seeing it as just a natural way of life? Like, oh you're old, its about time for you to die anyway. Does that even make sense? Lol

This also happens in young drug addicts who take huge doses of their drugs and pass out for long periods of time in one position from which they do not move. Sometimes they awaken and find themselves with a skin blanching or redness over the dependent areas of their body that were against the furniture they passed out on. If they can get up and move around they won't go on to develop any pressure ulcers. But the key here is that they get eventually get up and move around--get mobile. If they were to continually pass out for long periods of time in the same position time after time, they would be at risk to develop pressure ulcers young as they are.

.

When doing my third semester clinicals I had a pt in the ICU who tried commiting suicide via overdose. He was unconscious for several days before some friends found him. He had pressure sores from his ear all the way down his arm. They were so bad that he actually had nerve damage. I have never seen any pressure sore/ulcer this bad and I worked in LTC for 9 years!

So, I agree, the answer would be 'a'. (for the same reasons Daytonite stated)

dang! you guys are the bomb-diggity.