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Ralph , is 5 months post congestive heart failure (CHF), he is confined to a wheel chair due to advanced peripheral neuropathy and foot drop. His care is managed at home by a family nurse practitioner (FNP) who visits once a week and as necessary. On one of her visits, the FNP notes that Ralph has developed a Grade 3 sacral decubitus ulcer, lower extremity edema, and dyspnea while sitting. He is also confused and not oriented to person, place or time.
Questions
What risk factors for tissue break down are present? Explain in detail, the cellular changes that led to the sacral decubitus, now with necrotic dermal tissue. (Hint: the etiology and pathogenesis of the ulcer from injury to cellular death)
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