A pressure sore is a tissue breakdown and necrosis caused by long-term pressure on local tissues of the body, impaired blood circulation, continued local tissue ischemia and hypoxia, and lack of nutrition, resulting in loss of normal skin function.
1. Risk factors causing pressure sores
(1) Local factors: The traditional concept is that pressure sores occur mainly because the patient is bedridden for a long time and does not change position for a long time; the skin is often stimulated by moisture and friction. The new concept is that the three main physical forces that cause pressure sores are pressure, friction, and shear, usually due to the combined action of two to three forces.
(2) Systemic factors: Systemic factors that cause pressure sores include coma, paralysis, systemic malnutrition, old age, frailty, long-term fever, cachexia, edema, etc. In recent years, a large number of clinical practices have not only confirmed the role of the above-mentioned systemic factors in the occurrence of pressure sores, but also summarized some quantitative indicators for clinical reference.
2. Prevention and care of pressure sores
(1) Proper assessment: Currently, the common assessment methods include Norton’s score, which indicates that patients are prone to pressure ulcers when the score is ≤14, and Braden’s score, which indicates that the lower the score, the higher the risk of pressure ulcers. The implementation of focused prevention for high-risk patients after evaluation allows for the rational allocation and use of limited medical resources. The medical education network has shown that massage does not help prevent pressure sores because the reddening of soft tissues under pressure is a protective response of normal skin, which will generally recede automatically 30-40 min after pressure is lifted and no pressure sores will form; if the reddening continues, it indicates soft tissue damage, and massage will certainly increase the degree of damage.
(2) Intermittent release of local pressure is the primary measure to prevent decubitus ulcers. 30° lateral position change method can effectively relieve the pressure on the bony prominence and improve the effect of pressure ulcer prevention.
Semi-recumbent or sitting position time is shortened to within 30min each time; skin damage caused by friction can be reduced by using protective films (transparent dressings such as 3MTegaderm), protective dressings.
(3) Good skin care: The main thing is to keep the skin clean and dry, avoiding moisture, friction and excremental stimulation. The bed should be kept flat and clean, dry, and of appropriate thickness, and for those who are incontinent, vomiting and sweating, they should be scrubbed clean in time, not using a broken potty, and not pulling hard when using it. To moisturize dry skin where pressure sores occur, spray local skin twice a day with Sai Skin Run.
(4) Improve the patient’s general nutritional status: For those who are bedridden, cachectic or seriously ill, attention should be paid to strengthening nutrition and giving high-protein, high-vitamin meals according to their condition. Those who cannot eat should be given nasal feeding, and if necessary, rehydration, blood transfusion and intravenous infusion of high nutrients to enhance resistance and tissue repair ability.
(5) Tools used to prevent pressure sores: Pressure-reducing facilities include both dynamic pressure-reducing facilities and static pressure-reducing facilities. Dynamic pressure-reducing facilities such as air beds are ideal for preventing pressure sores, using electronic inflatable pumps to inflate or deflate at regular intervals, thereby changing the contact area between the body and the mattress and reducing local pressure.
(6) Treatment: The treatment of pressure sores is based on a combination of local treatment, supplemented by systemic treatment. It is currently believed that moistening under aseptic conditions is beneficial to the formation of traumatic epithelial cells and promotes the growth of granulation tissue and healing of traumatic surfaces, and keeping the traumatic surface of pressure sores moist is beneficial to the growth of granulation and epithelial migration and accelerates healing. Some studies have proved that the treatment of pressure sores with wet healing therapy is satisfactory and can reduce the number of drug changes and shorten the treatment time. According to the different stages of pressure sore wounds, choose suitable new dressings. The transparent patch, transparent sacral tail patch and enhanced decompression patch of Comyeel (comyeel) wound care series have hydrocolloid components, which can improve local blood supply and oxygen supply through the change of oxygen partial pressure of the skin, its surface is smooth and friction is small, reducing the shearing force of the pressurized area, while absorbing skin secretions and maintaining normal PH value and suitable skin It can also absorb skin secretions and maintain normal skin pH and temperature. It can prevent and care for stage I pressure sores. For pressure sores that are deep to the bone and poorly treated by conservative treatment, surgical treatment can be used to accelerate healing.
(7) Psychological care: Pressure sores mostly occur in the elderly who are bedridden for a long time or in those who cannot take care of themselves due to spinal cord injury or limb paralysis, who often suffer from prolonged illness and are prone to anxiety, pessimism, despair and other negative inferiority complexes, and lose confidence in the treatment of the disease.
(8) Carry out health education to prevent pressure sores by explaining the occurrence and development of pressure sores and knowledge of prevention and care to family members so that they also learn and master the skills to prevent pressure sores and actively participate in the prevention and care of pressure sores. At the same time, we strengthen management to raise the full awareness and attention of all medical and nursing staff to pressure sores, focusing on improving nurses’ judgment, observation, understanding, and work skills, familiarizing them with the preferred sites of pressure sores, assessing high-risk groups, and working to achieve a targeted approach.
A mobility training: It helps to restore the normal mobility of the ankle joint.
1. Dorsal extension of the ankle joint.
Method.
Sit with straight legs and keep the foot perpendicular to the support surface
Passively flex the ankle joint upward to the limit or until you feel slight pain, maintain for 10 seconds, then slowly return to the original position for 5 seconds
Start the exercise 3 days after the injury, 15 times a day
2.Plantarflexion of the ankle joint
Method.
Sit with straight legs and keep the foot perpendicular to the supporting surface
Passive flexion of the ankle joint downward to the limit or until you feel slight pain, maintain 10 seconds, then slowly return to the original position for 5 seconds
Start practicing 3 days after the injury, 15 times a day
Second flexibility training: helps to relax the leg muscles, reduce the tension of the Achilles tendon and the muscles around the ankle joint, improve their biomechanical properties, enhance the stability of the ankle joint, and thus prevent re-injury. The initial movements are started 3 days after the injury, and the higher movements need to be started at a time determined by your own recovery, in order not to cause pain or slight pain.
Method: Hold each exercise in the extended position for 20 to 30 seconds.
Frequency: practice 7 days a week every day each exercise repeated 10 times / group 3 groups.
1, gastrocnemius extension training.
Initial movements.
Sit with straight legs, fold the towel over the root of the thumb of the foot.
Slowly pull the towel dorsiflexion ankle, until the upper part of the gastrocnemius muscle extension (tense).
Advanced movements: Once you are able to stand, try stretching with your hands on the wall.
Place the injured foot behind the normal foot with the toes all facing forward.
Keep the heel off the ground and keep the injured leg straight at all times.
Slowly flex the knee joint of the normal leg until the gastrocnemius muscle of the injured leg is extended (tense).
2, the extension of the Achilles tendon training.
Initial movements.
Sit with knees slightly bent, fold the towel over the root of the bunion of the foot.
Slowly pull the towel until the lower part of the gastrocnemius and heel stretch (tense).
Advanced movements: Once you are able to stand, try the following movements.
Place the injured foot behind the normal foot with the toes facing forward.
Keep the heel off the ground.
Slowly flex the knee of the healthy leg until the heel of the affected foot is extended (tense).
Three muscle training:Strong leg muscles can assist the ligaments to work together to keep the ankle joint stable. Frequency: 20 reps of each exercise per day, 7 days per week. Initial movements can be started 1 day after the injury, higher movements need to be determined according to their own recovery to start time, to not cause pain or slight pain is appropriate.
1.Peroneal muscle strength training.
Primary action: push outward and upward
Foot flat on the floor, the outside leaning against the wall or bookcase
Foot force to push outward and upward, they feel the outer calf muscles in force, but did not produce foot activity
Hold for 10 seconds, relax for 5 seconds
Advanced movements: start after 3 weeks of injury
Tie the elastic band to the desk
Sitting position, keep the knee and foot of the injured leg in a straight line and place the elastic band over the middle of the injured foot
Pull the elastic band upward on the injured foot to the limit or until you feel mild pain, then slowly relax it
2.Ankle inversion muscle strength training
Primary action: inward turning
Foot flat on the floor, two feet leaning on each other, force to the inside push. They feel the inner calf muscles in force, but no foot activity
Hold for 10 seconds, relax for 5 seconds
Advanced movement: use elastic band
Tie the elastic band to the desk
Sitting position, keeping the knee and foot of the injured leg in the same line, put the elastic band on the medial side of the injured foot.
Pull the band medially
3.Tibialis anterior muscle strength training.
Primary action: push upward
Place the heel of the normal foot on the back of the injured foot.
Normal foot downward pressure while the injured foot cocked upward push (that is, the heel does not leave the ground). Feel the muscles on the front side of the calf exerting themselves, but no foot activity is generated
Hold for 10 seconds, relax for 5 seconds
Advanced movement: elastic band
Tie the band to the desk.
Sit with straight legs and place the band over the middle of the injured foot
Slowly pull the elastic band toward the trunk to the limit or until mild pain is felt, then slowly relax
Figure 8 Isotonic training of anterior tibialis muscle strength
Balance training: An ankle sprain reduces the balance of the injured foot, which can easily cause a re-sprain and even lead to the opposite ankle being affected. Therefore, once you no longer have pain when standing, you can try balance training.
Method: Stand upright with the injured side of the lower limb, the healthy side of the lower limb off the ground, maintain balance for 10 to 30 seconds, slowly put down, practice 20 times a day / group 3 groups
Standard: start from action 1, when the action can be held for 60 seconds, you can start practicing the next action.
Action 1: arms flat to the side of the body, eyes open, the injured side of the lower limbs straight;
Action 2: arms crossed in front of the chest, eyes open, lower limbs on the injured side straight;
Action 3: arms raised to the side of the body, eyes closed, lower limbs of the injured side straight;
Action 4: arms crossed in front of the chest, eyes closed, lower limbs of the injured side straight;
Action 5: the same as action 1, but with the injured side of the lower limb squat 45 °;
Action 6: the same as action 2, but with the injured side of the lower limb squat 45 °;
Action 7: the same as action 3, but with the injured side of the lower limb squat 45 °;
Action 8: the same as action 4, but with the injured side of the lower extremity squat 45 °.