Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 30

30

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Common findings in patients with pressure
ulcers are anemia with reduced serum iron,
transferrin, total iron-binding capacity, increased
ferritin, erythrocyte sedimentation rate, C-reactive
protein, white blood cells, and reduced
lymphocytes, total protein, albumin, and zinc
(Gurcay, E., et al., 2009). Animal studies have
shown the value of obtaining serum and urine
biomarkers of pressure-induced deep tissue injury.
Creatine kinase, myoglobin, heart-type fatty acid
binding protein, myosin, and troponin-I have been
found to show a rapid increase of concentration
upon compression, which may provide an
indication of deep tissue injury (Makhsous et al.,
2010). Further studies will be needed before
biomarkers for deep tissue injury should be used
for routine clinical practice.
Malnourished patients are at high risk for
pressure ulcer development and with the presence
of pressure ulcers are likely to experience delayed
healing. Serum measurements of visceral proteins
(albumin, total protein, and prealbumin) levels
estimate the adequacy of the individual's
nutritional intake.
Assessments of posture, positioning, and
equipment are important in determining the
causation of pressure ulcers; such assessments
are critical in developing effective prevention
and treatment strategies. It is important to
identify all seating surfaces a person might use
including shower/commode chairs, lounge
chairs, desk chairs, etc. An individual's posture
and level of pressure on the support surface
should be evaluated as well as an individual's
efficiency in transferring and performing
pressure redistribution. All support surfaces on
any seating device should be checked for
moisture at pressure points and for mechanical
integrity, deterioration, and fatigue.
Psychosocial supports (family, friends,
caregivers) and resources (financial, medical)
should be explored since they may be of critical
importance in sustaining the optimal treatment
plan. The individual's self-care capability and the
availability of appropriate personal care
assistance also should be determined. If the
adequacy of available treatment resources cannot
be assured, delivery of the prescribed treatment
plan will be in jeopardy.

Assessment and Reassessment
of the Pressure Ulcer
12. Describe and document in detail an existing
pressure ulcer and is treatment. Include the
following parameters:


Anatomical location and general
appearance



Category/Stage



Characteristics of the wound base
* Viable tissue (granulation,
epithelialization, muscle, bone,
or subcutaneous tissue)
* Nonviable tissue
(necrotic, slough, eschar)



Size of wound - length x width x depth



Exudate amount and type



Odor



Wound edges



Periwound skin



Wound pain



Documentation of current treatment
strategies and outcomes to date.

An objective and thorough description of
pressure ulcers enables the development of an
appropriate treatment plan, form the basis for
serial assessment to determine response to
treatment, and provides a reliable means of
communicating wound status among health-care
professionals. A description of location, size, and
severity of the ulcer is important in assessing
mechanism of injury and positional restrictions.
These restrictions should be incorporated into
the treatment plan.
(Scientific evidence-N/A; Grade of recommendation-N/A;
Strength of panel opinion-Strong)

13. Monitor, assess, document, and report any
observable/visible change in wound status.


Monitor the pressure ulcer with each
dressing change, or if there is no
dressing then routinely.



Conduct a comprehensive assessment
of the parameters listed in
Recommendation No. 12 at regular
intervals

(Scientific evidence-II, V; Grade of recommendation-B;
Strength of panel opinion-Strong)

Initial wound assessment and subsequent
reassessment provide the basis for pressure
ulcer management. Although randomized clinical
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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