Wound care in the geriatric client

Abstract

With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.

Keywords: debridement; diabetic ulcers; elderly; pressure ulcers; vascular ulcers; wound care.

Figure 1

Pressure ulcer staging. Images are reused with permission from the National Pressure Advisory Panel. Copyright © 2009. http://ww.npuap.org/.

Figure 1

Pressure ulcer staging. Images are reused with permission from the National Pressure Advisory Panel. Copyright © 2009. http://ww.npuap.org/.

Figure 2

Anterior left lower leg, venous hypertension ulcer.

Figure 3

Posterior left lower leg, venous hypertension ulcer.

Figure 4

Left foot, medical hallux, Stage III; Medial first metatarsal head, Stage II; Medial mid-foot, Stage II; Medial malleolus, Stage IV.

Figure 5

Posterior right thigh, Stage III.

Figure 6

Coccyx, Stage IV.

Figure 7

Left hip, Stage IV; unstageable eschar covered.

Figure 8

Lateral left ankle, Stage IV; lateral mid-foot, unstageable.

Figure 9

Full body view, multiple ulcers.

Figure 10

Right posterior heel, Stage IV, with slough and eschar.

Figure 11

Right posterior heel with granulation tissue.

Figure 12

Right posterior heel almost healed.