Risk factors for pressure ulcers
However, there are a number of situations or risk factors that increase the likelihood of developing ulcers in the right situation.
The factors that contribute to the production of pressure ulcers can be grouped into five large groups:
Pathophysiological:
- Skin lesions: edema, dry skin, lack of elasticity, fragility; they increase the probability of producing wounds of any kind in the event of minor injuries.
- Oxygen transport disorder: peripheral vascular disorders, venous stasis, cardiopulmonary disorders.
- Nutritional deficiencies (by default or by excess): decrease in the subcutaneous fat layer, loss of lean or muscle mass, malnutrition, obesity, hypoproteinemia, dehydration.
- Immune disorders: cancer, generalized or localized infection.
- Altered state of consciousness: stupor, confusion, coma, disorders that decrease the mobility of the patient.
- Motor deficits: paresis, paralysis.
- Sensory deficiencies: loss of painful sensation, general due to stupor or localized by alterations of the nerve trunks (for example poly or mononeuropathies).
Derivatives of the treatment:
- Imposed immobility, the result of certain therapeutic alternatives. For example, in bone injuries (fracture of the femur or pelvis, the most frequently implicated in the development of ulcers in these cases.)
- Immunosuppressive treatments or drugs, especially corticosteroids, which decrease the general immune response and cause skin atrophy.
- Sedatives, since they cause a decrease in mobility and the response to pain and discomfort.
- Probes and vascular lines; many patients and relatives, for fear that these devices will move or come off, reduce mobility in bed or sitting.
Situational:
- Immobility: The immobility syndrome, secondary to different pathological situations (acute illnesses, bedridden or hospitalization) is one of the factors that are most involved in the development of ulcers, since it allows the action of pressure long enough for it to occur. skin lesion. 90% of patients with less than 20 spontaneous movements at night develop ulcers, which are also common in patients who cannot sit in a wheelchair or get out of bed on their own.
- Due to the friction of both clothing and other objects. Tangential forces produce shear between the layers of the skin and break it, causing injuries. This is very common to occur during an inadequate mobilization of the elderly person (by dragging) or by sliding the patient in bed or during sitting.
Derivatives of the environment:
- Lack of health education of caregivers of dependent patients, infrequent changes of position, diaper too wet, etc.
- Mattresses or seats that are too hard or with cushions that are too soft, easy to crush and become hard.
- Poor practice by healthcare teams.
(Updated at Apr 15 / 2024)