Orthopaedic Surgery/Decubitus Ulcers

Epidemiology

The overall prevalence of presure sores in the nursing home population is 11% ulcers

Sociology

Sorting out the influence of clinical factors and care factors is a poignant reminder of how the responsibility for the physical integrity of the nursing home resident falls to the staff of the nursing home. We can only hope and attempt to foster a quality standard akin to the care of a loving family which we hold as an optimal standard even though by definition the nursing home patient by virtue of clinical factors, the intensity and duration of care needed has exceeded the capacity of the extended family unit to provide for their needs. Thus this issue is a comment on modern industrial society and the breakdown of the family unit and the outsourcing of intergenerational responsibilities.

Pathophysiology

Wound Healing

Prevention

In the case of pressure ulcers prevention is the most cost effective approach, however in the population at risk medicare dollars are not available for preventative measures and in fact treatment is underfunded until complicated by infection. Like falls, pressure ulcers have been considered a nursing-sensitive outcome. pressure ulcers

Nutrition

Nutritional inadequacy and pressures sores go hand in hand. How to prevent the second by attending to the first is not so easy. How to overcome depression and altered awareness and diminished appetite, loss of taste, even the loss of a sufficient coordination to physically engage in eating make nutrition a more daunting problem than encouraging the nursing home patient to eat. Feeding tubes have there own problems including impeding mobility, diarrhea and fecal incontinence (with resultant risk of skin breakdown) nutrition

Treatment

Dressings

Debridement

Coverage