By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...
Skin breakdown is common in the frail elderly, often who are consistently putting pressure on a given skin area due to immobility and impaired skin integrity and ability to heal secondary to age and comorbidities. Once a "pressure ulcer" has been identified, it is important to perform an assessment, document findings, and devise an appropriate management plan. It is important to understand the patient's general medical history to identify reversible conditions and precipitating or aggravating factors, as well as to identify what supports are currently in place to assist the patient with wound management and activities of daily living. Physical examination and documentation are also important. UpToDate provides a simple diagram that summarizes a pressure wound staging score (National Pressure Ulcer Advisory Panel), and this is useful in terms of providing followup care to assess progress (or lack thereof) of healing, and to communicate wound severity with other health care providers.
It is also useful to document physical measurements of wound (location, length, width, depth, discharge, etc.) and capturing photos can also help.
Wound care follows some basic principles, and may include different strategies depending on individual patient circumstances. The UpToDate article, "Clinical staging and management of pressure-induced skin and soft tissue injury" (2018), from which the above staging diagram was also pulled, suggests the following as a general approach to caring for pressure wounds: