Prawidłowa ocena rany jest kluczowym czynnikiem pozwalającym na wdrożenie skutecznego leczenia. Kolejną część naszego cyklu o zasadach oceny ran poświęcamy odleżynom. Jak rozpoznać ranę i prawidłowo ocenić ranę odleżynową?
Oceny rany należy dokonać podczas pierwszej wizyty pacjenta w gabinecie. Podstawowym narzędziem, które należy wykorzystać do tego celu, jest tzw. trójkąt rany.
Więcej informacji na temat oceny rany znajdziesz tutaj
Następnie ranę należy ocenić w skali, która odpowiada etiologii rany:
- skala NPUAP – odleżyny
- klasyfikacja Fontaine’a – owrzodzenia niedokrwienne
- skala CEAP – owrzodzenia żylne
- skala SINBAD – owrzodzenia w przebiegu zespołu stopy cukrzycowej (opieka domowa)
- skala PEDIS – owrzodzenia w przebiegu zespołu stopy cukrzycowej (opieka ambulatoryjna i lecznictwo zamknięte)
- skale NERDS i STONEES – rany zakażone
W sporządzeniu charakterystyki rany pomaga kolorowa skala oceny rany.
Poniżej pokazujemy, jak zastosować te narzędzia w praktyce na przykładzie odleżyn.
Przypadki kliniczne – odleżyny
Przypadek nr 1 - Odleżyna pośladka; rana zakażona
Okalające tkanki: napięte, obrzęknięte
Brzegi rany: uniesione, obrzęknięte
Łożysko: nierówne, krwawiące, z dużą ilością wydzieliny i rozpulchnioną ziarniną
Skala kolorowa: rana zielono-czerwona
Skala NPUAP: odleżyna 4
Przypadek nr 2 - Odleżyna kości ogonowo-krzyżowej
Okalające tkanki: niezmienione
Brzegi rany: odwarstwione od dna, lekko uniesione
Łożysko: blade, pokryte martwicą żółtą rozpływną – w niewielkiej ilości, widoczne ścięgna kręgosłupa, kieszeń na godz. 6-1
Skala kolorowa: rana zielono-żółta
Skala NPUAP: odleżyna 4
Przypadek nr 3 - Odleżyna pośladka i kości ogonowej
Okalające tkanki: na godzinie 7-11 z uszkodzonym naskórkiem, reszta niezmienione
Brzegi rany: płaskie, częściowo pokryte martwicą czarną rozpływową (na godz. 9-4)
Łożysko: na godz. 4-9 z czystą, grudkową ziarniną, która obejmuje również szparę pośladkową, na godz. 9-4 łożysko pokryte martwicą czarną rozpływową, odwarstwioną od brzegów na godz. 9, z dużą ilością wysięku
Skala kolorowa: rana zielono-żółto-czerwona
Skala NPUAP: odleżyna nieznanej głębokości/4
Przypadek nr 4 - Odleżyna kości krzyżowej
Okalające tkanki: zaczerwienienie na godzinie 10-12 i wokół rany, obrzęknięte
Brzegi rany: lekko pogrubione
Łożysko: zamknięte, pokryte martwicą czarną, suchą, wokół martwica żółta łączy się z brzegami rany, bez wysięku
Skala kolorowa: rana zielono-czarna
Skala NPUAP: odleżyna zamknięta
Przypadek nr 5 - Odleżyna krętarza biodrowego
Okalające tkanki: niezmienione
Brzegi rany: płaskie
Łożysko: nieuszkodzona skóra, zaczerwienienie i obrzęk
Skala NPUAP: odleżyna 1
Przypadek nr 6 - Odleżyna zamknięta goleni
Okalające tkanki: lekko zaczerwienione na godz. 12-2 i godz. 4-5, zasinione, suche
Brzegi rany: niewidoczne
Łożysko: pokryte pęcherzem z wydzieliną krwistą
Skala kolorowa: rana zielono-czarna
Skala NPUAP: odleżyna zamknięta
Przypadek nr 7 - Odleżyna kręgosłupa piersiowego
Okalające tkanki: niezmienione
Brzegi rany: lekko uniesione, na godz. 6-12 odwarstwione od dna
Łożysko: pokryte ziarniną z kieszenią na godz. 6-12 i widocznymi ścięgnami kręgosłupa z wysiękiem średniej ilości
Skala kolorowa: rana zielono-czerwona
Skala NPUAP: odleżyna 4
Przypadek nr 8 - Owrzodzenie pięty
Okalające tkanki: uszkodzony naskórek suchy, zgrubienie wokół rany, bez cech infekcji
Brzegi rany: zmacerowane, pozbawione naskórka, odwarstwione od dna na godz. 11-5
Łożysko: nierówne z luźnymi tkankami martwicy żółtej rozpływnej, bez cech infekcji
Skala kolorowa: rana zielono-żółta
Skala NPUAP: odleżyna zamknięta
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