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5 pressure ulcers are found mostly in bedridden patients with spinal injury etc pressure ulcers develop as a result of prolonged periods of immobility during unrelieved pressure which compresses tissues that overlie bony prominences. 6 once the pressure ulcer has developed, it tends to deteriorate owing to the patient's physical characteristics, such as extreme bony prominence, and poor condition in general. The nature of the excessive pressure is important in the development of pressure ulcers. The principal factor in pressure ulcer development is excessive tissue pressure that prevents the normal supply of blood to the affected area. The severity of skin and tissue damage will depend on how long the patient has been exposed to these excess pressures. 8 in the words of betsy myers, prevention is the best intervention for pressure ulcers.

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By being aware of the risk factors for pressure ulcer development, assessing for changes in risk factors on an ongoing basis, and addressing risk factors, the incidence of pressure ulcers can be markedly reduced. 9 several risk factors have been identified for the development of pressure ulcers and are classified into extrinsic and intrinsic factors. Extrinsic factors include interface pressure, shearing forces, friction and moisture. Intrinsic factors are the nutritional status of the patient, patient age, immobility, incontinence, circulatory factors, and neurological disease. Three main mechanical factors are thought to contribute in the development of pressure ulcers: pressure, friction and shear. 10 pressure ulcers are present in patients with intensive immobility and recovery is delayed for these patients due to many reasons including the accompanying medical complications like infections extending the hospitalization period for patients.

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11 a successful wound management should include assessment, planning, management, reassessment, admission, transfer, reporting and audit. As per epuap guidelines 2010 , all patients with wounds should be reassessed and documented at least weekly and the treatment methods and any alterations to be discussed with the patient. The first step in pressure ulcer prevention is to identify those patients at risk and a variety of risk assessment tools have been developed since the 1960s. It is important that an assessment tool is appropriate for the specific patient setting in which it is used. 12 a study conducted by ingela henoch 2003 gives the following details on risk assessment tools for pressure ulcers.

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