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Pressure Sores also known as decubitus ulcers or bedsores have always been a problem for nurses caring for chronically ill immobile and elderly patients in the tertiary care setting This problem is exacerbated by modern medical interventions which have allowed us to extend the life expectancy of these patients well into old age As a result previous illnesses such as pneumonia which would have claimed the lives of these patients has become less of a problem However with increasing age immobility and frailty pressure sores are more likely to develop and many assessment tools have been developed to try to ascertain the risk and implement preventative measures to inhibit their development The cost of pressure sores has been estimated to cost 300 Million Waterlow1988 without considering the obvious pain and anxiety it causes to our patients We will look at these tools and the preventative measures later in the essay but first it is necessary to review the aetiology of pressure sores and their formation Aetiology of pressure sores The skin is an excellent defence against pathogens and the elements but was not designed to have a constant load of pressure on it This is particularly true in areas where the skin is in close proximity to bone such as in the knees sacrum pelvis elbows and heels See appendix Fig 1-3 It is in these areas that pressure sores are susceptible to form A pressure sore is an area of localised damage to the skin and may involve underlying structures Tissue damage can be restricted to superficial loss or extend to involve muscle and bone Banks 1992 PG 42 Pressure sores can be divided into several grades of increasing severity Table 1 as devised by Torrence 1983 Also found are CLOSED PRESSURE SORES where the surface remains intact but there is deep damage Risk Factors As mentioned in the introduction pressure sores are a particular problem in the
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