Bilonda bia pa bulalu (bilonda bia pression), njiwu ya disama dia sepsis, ne dilama dia lukasa dia muaba mukuabu¶

Padi muntu mukulakaje udi kayi wendakana, mu bulalu, anyi mu kakalu ka balema upeta tshilonda tshikole, tshidibu babikila misangu ya bungi ne: tshipupu tshia mu bulalu anyi tshipupu tshia pa mutu, tshilonda etshi tshidi tshitamba kuikala ne disama dia dikoba dia pa mutu. Dikuma dia tshiamu tshia munda tshidi tshimueneka pankatshi pa mifuba ya munda (bu mudi: tshiadi, tshiadi, tshitupa tshia mu nshingu, tshitupa tshia mubidi, anyi tshikasa) ne matela anyi tshilamba tshia kulala tshidi tshitshibula mishipa ya mashi mikese, tshienza bua dikoba, mafuta a muinshi mua dikoba ne mifuba ya munda mua oxygène ikale ne nzala too ne padi tshitupa tshia mubidi tshinyanguka (**nekrose). Dîba didi disama dia tshimpitshimpi dibuela mu dikoba ne dilua mafuta a bungi (Tshitupa 3) anyi dileja mifuba, mifuba, anyi mufuba (Tshitupa 4 anyi Eschar udi kayi mua kujika), bactérie idi ibuela lukasa mu tshitupa tshia mubidi tshidi tshifua, yenza njila mululame mu mashi ne mufuba udi mua kufikisha ku septesis **, muba ya lufu (steosis disama)**, an necrotising fasciitis mu meba makese.

Kupeta tshina tshidi ne mupuya mubi, tshidi tshipatuisha mâyi ku mukolo, ku tshiadi anyi ku tshikasa tshia muntu mukulumpe, nansha wewe ulama muledi kumbelu anyi ubandisha bilamba bia bulalu paudi uya ku lupitadi anyi ku nzubu wa baminganga bapiluke, ntshilumbu tshia lukasa tshia luondapu. Bantu ba bungi badi balama bena mu mêku batu bakolesha mputa ya pression mu mpukapuka padibu bayisukula ne peroxyde wa hydrogène cytotoxic anyi maluvu, bateka mubedi pa bipese bia "donut" bidi bipangisha mashi bua kuya, anyi bavuija mubedi mu muaba wa 90-degree udi utshibula mufuba wa tshiadi. Mukanda ewu udi umvuija mushindu wa kujingulula disama dia sepsis ne dia cellulite didi ditangalaka, mputa ya mu tshitupa tshia nzembu ku diambuluisha dia mikenji ya NPIAP (National Pressure Injury Advisory Panel), kuvuala ne kumbusha mputa mukole bimpe too ne padi baminganga badi batangila mputa bafika, kuenza 30-Degree Later Tilt ku diambuluisha dia ndongamu wa ku nzubu, ne kufila luapolo kulengulula padi nzubu kampanda ulekela bua disama dia Stage 3 anyi Stage 4 didi mua kuepuka dikola.

Enza nunku mpindieu¶

1. Bikila bena mudimu ba lukasa lukasa pikala muntu muleje bimanyinu bia sepsis anyi disama didi ditangalaka bikole. Shi muntu mukulakaje udi ne mputa wa pa bulalu udi upeta dipanga dia lungenyi dipiadipia anyi dibungama dia mu lupitadi, dipanga dia bukole, mashika adi ateketa, luya lua pa mutu pa 38.0 degre Celsius (100.4 degre Fahrenheit) NANSHA luya lua mubidi lua muinshi mua 36.0 degre Celsius (96.8 degre Fahrenheit), dipuekesha dia lukasa, dikuma dia mutshima, anyi dikuma dia mputa, dipatuka dia mputa nimero ya tshimpitshimpi ya muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) ku diambuluisha dia nomba ya tshimpitshimpi tshilaminu. Ambila muntu udi utuma bantu ne: "Ndi ne muntu mukulakaje udi ne disama dia pression udi uleja bimanyinu bia disama dia sepsis dikole."
2. Umbusha bujitu bua mubidi 100 pa lukama pa tshilonda diakamue ("Zero Pressure Offloading"). Kakuena manga a lufu anyi tshilamba pa buloba tshidi mua kuondopa tshilonda tshia bulalu padi mubedi utshidi mulale anyi musombe pa mutu patshi to. Ela bitekete bitekete ne ukuatshishe mubedi ku luseke luende ludi kaluyi lunyanguke ku diambuluisha dia matamba adibu basuike panyima pende ku 30-degree tilt, anyi wela tshikasa tshidi tshisama mu lupepele pa kuteka matamba mu bule muinshi mua dikasa dia kuinshi kumbukila ku dikasa too ne ku muonji wa Achille.
3. Kuena ne bua kuela peroxyde wa hydrogène, maluvu a kusukula nawu, povidone-iodine (Betadine), anyi sabuni mukole munda mua tshilonda tshia Stage 3 anyi Stage 4 to. Muinshi mua NPIAP / EPUAP ne Agency for Healthcare Research and Quality (AHRQ) mikenji ya luondapu, bintu bia antiseptique bu mudi peroxyde wa hydrogène ne hydrogène bidi **totoxique: ** kuosha ne kushipa selile mipiamipia ya granulation ne fibroblastes idi iteta bua kuibakulula muaba udi mputa. Sukula tshilonda tshidi tshiunzuluke bitekete bitekete ne anu mâyi a mukele adi kaayi ne disama (0,9% wa chloride de sodium) anyi mâyi mimpe a kunua adi ne luya lua mubidi, ne utshibuikile ne tshilamba tshia mâyi tshidi katshiyi ne disama anyi tshilamba tshia foam too ne padi munganga mua kutshikonkonona.
4. Kuena ne tshia kuenza mudimu ne "tshilamba tshia donut" anyi tshia dikoba dia mukoko nkayatshi bua kujikija mputa wa mu mukolo to. Tshilamba tshia tshilamba anyi tshia donut tshidi tshisangisha 100 pa lukama tshia bujitu bua mubidi wa muntu mu tshilamba tshikese tshidi tshinyunguluke mputa, tshienza bu tshintu tshidi tshikosa mashi adi apita munkatshi mua mputa ne adi avulangana.
5. Tangila tshitupa tshionso tshia mifuba kumbukila ku mutu too ne ku makasa mpindieu. Padiku tshilonda tshimue tshia bulalu, misangu yonso kudi tshikuabu tshisokome. Wenza mudimu ne muendu udi ukenka bua kutangila mufuba wa tshiadi, tshiadi tshia pambelu (trochanters minene), mifuba yonso ibidi ya kusombela (ischial tuberosities), bikono bionso bibidi, bikono bionso bibidi bia pambelu (malleoli), bikono bia pa makaya, bikono, kunyima kua tshifu, ne kunyima kua matshi (muaba udi oxygène wa mu mishiku ufina dikoba).
6. Wewe mupeta disama dia Stage 3, Stage 4, anyi Unstageable bedsore mu nzubu wa bakulakaje anyi mu lupitadi, udiangatshila foto ne tshipiminu ne ulombe munganga / udi ulama mputa diakamue. Mu nzubu wa dilama dia matuku a bungi, kuenza disama dia Stage 3 anyi Stage 4 didi mua kuepuka didi dishipa dia mikenji yetu (bulombodi buetu) dikengeshibua mu nzubu ya bakulakaje, dilengulula, ne diipata). Teka tshipiminu tshia metre tshikezuke anyi tshiamu tshia arjan ku luseke lua tshilonda (kuyi ulenga bulalu buunzulula) bua kufunda bule ne butshiama buatshi kumpala kua kulomba bua kuya diakamue ku lupitadi lua bantu badi ne masama a lufu pikalaku disama.

flowchart TD
    A["Tangila tshitoke, tshipupu, Eschar mufike, anyi tshina tshiunzulula pa Immobile Senior"] --> B{"Bimanyinu bia sepsis anyi ditangalaka dia masama bidiku anyi? (Dipanga dia lungenyi, luya > 38C anyi luya < 36C, tshipupu tshibi, tshitoke tshikunze, dipuyakana dia lukasa)"}
    B -->|"Eyowa - Disama dia sepsis dikole anyi disama dikole"| C["Bikila ku 911 / 112 / 999 diakamue bua kupeta manga a tshimpitshimpi ne dipanda dia mubidi"]
    B -->|"To - Stable Vitals"| D{"Disama dia tshisumi didi mu tshitupa kayi (tshitupa tshia NPIAP)?"}
    C --> E["Umbusha 100% ya bujitu pa mputa paudi muindile ambulanse"]
    D -->|"Tshitupa 1 (tshitoka tshidi katshiyi mua kutokeshibua) anyi tshitupa 2 (tshitupa tshikole/tshitupa tshia rose)"| F["Umbusha diakamue + Ulame ne Silicone Foam Dressing + Ubalulule kunyima kua mêba 2 onso"]
    D -->|"Tshitupa 3 (Tshitupa tshia mafuta), Tshitupa 4 (Mufuba/Mifuba mipatuke), anyi Unstageable (Black Eschar)"| G["Longolola tshikebelu tshia lukasa tshia dituku dimue/dituku didi dilonda kudi munganga anyi muena mudimu wa mputa (WOCN)"]
    G --> H["Sukula bitekete bitekete ne 0.9% ya saline sterile (kakuyi peroxide/alcool) + tshilamba tshia sterile"]
    F --> I["Enza 30-Degree Lateral Tilt Schedule + Floating Heels + Pressure-Redistributing Mattress"]
    H --> I

Mushindu wa kulongolola mputa: tshikandakanda tshia NPIAP / EPUAP¶

Baminganga ba pa buloba bujima batu balongolola mputa ya mputa ku diambuluisha dia Kasumbu ka difila dia mibelu ka mputa wa mputa wa mu ditunga (NPIAP) ne Kasumbu ka difila dia mibelu ka mputa wa ku mpukapuka ka mu Mputu (EPUAP). Kumanya tshitupa tshijalame kudi kukuambila ni udi ne tshimanyishilu tshia kumpala anyi ne bualu bua tshimpitshimpi bua dipanda.

"Diteta dia dilengeja dia munu" bua dimanya dia tshitupa tshia kumpala¶

Paudi umona tshitupa tshia dikoba tshikunze anyi tshifiike pa muaba udi ne mifuba (bu mudi mukila, tshiadi, anyi tshikasa), fina munu mukezuke udi ne tshilamba tshia bianza bitekete bitekete munkatshi mua tshitupa tshikunze munkatshi mua sekonde 3, pashishe uleke:

• Blanchable Erythema (Normal Reactive Hyperemia): Tshitupa etshi tshidi tshilua tshitoka (tshidi tshitoka) bua tshitupa tshîpi padibu batshifina ne pashishe tshidi tshilua tshia rose kabidi padi mashi apingana munda. Microcirculation itshidi anu mimpe; umbusha bujitu buonso pa muaba au diakamue ne tshitoke netshijike mu minite 30 anyi 60.
• Non-Blanchable Erythema (Stage 1 Pressure Injury): Paudi ubandisha munu webe, tshitupa atshi tshidi tshishala tshikunze tshitoke, tshikunze tshifiike anyi tshikunze ne katshiena tshilua tshitoke to. Pa dikoba difiike (muaba udi dikala dikunze kadiyi dimueneka patoke), keba tshitupa tshidi tshimueneka tshikunze, tshikunze, anyi tshifiike kupita dikoba didi dinyunguluke, tshidi tshiumvuika tshikole anyi tshikole kunyima kua tshianza tshiebe, anyi tshiumvuika tshikole/tshikole (tshikole) pa kumona tshitupa tshidi pabuipi. Etshi i Disama dia tshitupa tshia kumpala, mbuena kuamba ne: dinyanguka dia mishipa diakatuadija kale.

NPIAP Pressure Injury Staging and Emergency Action Table¶

Kumanya mputa ya mu bulalu idi ne disama ne disama dia sepsis didi mua kunyanga muoyo kudi bantu bakulumpe¶

Pabuipi ne mputa yonso idi kayiyi ijika idi mikoleshibue kudi bactérie ya pa mutu pa dikoba, kabiena biumvuija ne: mubedi udi mu tshipupu tshia septic to. Udi ne tshia kumanya mua kusunguluja mputa udi wenda ukola ne disama dia munda didi ditangalaka anyi sepsis.

1. Bimanyinu bia disama dia mputa mikole (Cellulitis, Abscès, ne Osteomyélite)¶

Tangila tshilonda ne tshitupa tshia 10 centimètres (4 inches) tshia kikoba tshidi tshinyunguluke mu butoke buimpe:

• Ditangalaka dia Erythema (Cellulitis Halo): Dikala dikunze, difu, dikola (dikolesha), ne luya lupita pa 2 centimètres (0.8 inches) pambelu pa muelelu wa tshilonda. Ingidija tshimanyishilu tshia dikoba tshidi mua kusukula anyi bipenyi bua kuzola mulongo wa tutoyi ku muelelu wa pambelu wa tshitoke ne kufunda dîba (2:00 PM); Shi tshintu tshikunze tshitangalake kupita mulongo weba wa encre mu meba makese, disama didi dienda dikola lukasa ne didi dilomba bua kuela manga a lufu mu mishipa.
• Purulent Drainage and Putrid Anaerobic Odor: Mupuya mukole wa jaune, wa vert, wa brown, anyi wa mabele udi mu tshina, anyi mupuya mubi, mubole, wa mubidi udi ubola udi utungunuka nansha wewe mumane kusukula tshilonda ne mâyi a mukele. (Dimanya: Bilamba bia hydrocolloid bidi bienza tshintu tshidi ne mupuya wa jaune padibi bikuata mâyi a mu mputa; misangu yonso ela mputa ne mâyi a mukele kumpala kua kumona mupuya).
• Fluctuance and Crepitus (Gas in the Tissues: Surgical Emergency): Wewe mufina bitekete bitekete ne munu udi ne tshianza pa dikoba didi dinyunguluke tshilonda anyi pa mutu pa tshilamba tshifiike tshia eschar ne mumvue tshibombi tshiuwule tente ne mâyi muinshi (dishintuluka), kudi tshilonda tshidi tshikuate. Shi udi umvua dibutuka anyi dibutuka muinshi mua kikoba bu mudi Rice Krispies anyi bubble wrap (subcutaneous crepitus), bactérie idi yenza kapepe (Clostridium anyi polymicrobial necrotizing fasciitis) idi inyanga tshitupa tshia munda tshia dikoba; bikila 911 / 112 / 999 diakamue bua dipanda dia lukasa dia kusungila muoyo.
• Mufuba udi mupatuke anyi mutoke (Osteomyelitis): Mu tshilonda tshia mu tshitupa tshia 4 muudi mua kumona mufuba mutoke anyi mutoke kuinshi kua tshina, anyi muaba udi tshilonda tshibenga kuondopa munkatshi mua mbingu nansha muditshi tshipatuka, bactérie idi mua kuikala mikuate mufuba nkayawu (osteomyelitis), bidi bikengela MRI anyi biopsie ya mifuba ne biopsie ya mbingu 66.

2. Bimanyinu bia mubidi bia Sepsis kudi bantu bakulumpe (Bua tshinyi bantu bakulumpe kabatu misangu ya bungi bapeta kapia kakole to)¶

Dilama dia mputa ya ku luseke lua bulalu ne dipuekesha dia bintu (Patudi bindile munganga)¶

Shi udi ulama muntu mukulakaje udi kayi wendakana kumbelu ne mupeta tshilonda tshia mu tshitupa tshia 2, tshia 3, anyi tshia 4 lelu (kakuyi disama dia sepsis didi mua kushipa muntu diakamue didi dilomba ambulanse), londa mikenji eyi menemene bua kujadika mputa too ne padi munganga anyi munganga wa mputa ulua:

Tshitupa 1: Ela bitekete bitekete pa bulalu bua mputa ne 0.9% ya saline ya sterile (anyi saline ya lukasa ya ku nzubu)¶

1. Sukula bianza biebe bimpa na nsabanga ne mayi munkatshi mua masekonde 20 ne uvuale bifulu bia nitrile bia tshianana.
2. Wenza mudimu ne tshiamu tshia 0.9% tshia sodium chloride (saline wa pa tshibidilu) tshia kuowa natshi mputa: Wewe kuyi ne tshibombi tshia tshiamu tshia sterile tshia saline tshia ku farmasi, udi mua kuenza saline wa isotonic wa lukasa kumbelu pa kulamba 1 litre (4 nkopo) ya mayi a mu pompi anyi a mu milondo misambakaja ne 2 grammes ya thé (9 poods) ya plaod non-plaod Mukele wa ku mesa mu minite itanu mu tshilongo tshibuikila, pashishe umulekele bua afike too ne ku luya lua mubidi (37°C / 98.6°F) kumpala kua kumuenza mudimu. (Kuena ne bua kuenza mudimu ne mayi mashika pa bulalu bua mputa to, bualu kuenza bua mputa ikale ne mashika muinshi mua 33°C kudi kuimanyika mudimu wa diondapangana dia globules blancs ne dia mitotic munkatshi mua mêba 4).
3. Teka tshilamba tshia kuowela muinshi mua tshiadi tshia mubedi anyi kuinshi kua mukolo bua kukuata mâyi adi apatuka, ne usukule tshilonda bitekete bitekete ne tshintu tshikezuke tshia 30 mL anyi mulondo wa kufinya udi mutantshi wa 5 anyi 10 centimètres (2 anyi 4 inches) kule. Kukoki nansha kakese munda mua tshilonda tshia bulalu ne tshilamba tshia kusukula natshi anyi gaze muume.

Tshitupa 2: Ela tshilamba tshia bukubi tshia tshitupa tshîpi tshia "Moist-to-Moist"¶

• Kuena ne bua kuenza tshilamba tshia kale tshia "Wet-to-Dry" (muaba udibu basuika tshilamba tshiume mu tshilonda, tshilekela bua tshiume tshilue tshitupa tshikole, ne tshipatuka tshiume), bualu kupatula tshilamba tshiume kudi kupatula tshitupa tshipiatshipia tshidi ne makanda a mubidi ne kuenza kanyinganyinga kakole.
• Bua tshilonda tshia mu tshitupa tshia 2 tshidi katshiyi tshikole: Ela dikoba didi diunyunguluke diume, ela tshitupa tshikese tshia zinc oxide barrier cream pambelu pikala dipanga dia tshiadi tshikole, ne ufuke bulalu bua rose budi kabuyi bukola ne wafer hydrocolloid anyi silicone-bordered foam dressing.
• Bua tshina tshikole tshia Stage 3 anyi Stage 4: Ela tshilamba tshia gaze tshidi katshiyi tshiluka (anyi tshingoma tshia calcium alginate) ne mâyi a mukele, tshikosa bua tshikale tshitoke (tshitoke, katshiyi tshitoka mâyi), tshilengeja bimpe, ne tshiteka bitekete bitekete mu tshina bua tshikuate pa mutu pa tshilonda kakuyi kutapa anyi kutapa tshitupa. Buikila pa mutu ne tshilamba tshiume tshia mu difu tshidi katshiyi ne disama (ABD pad) anyi tshilamba tshia foam ne kulamakaja miele pa dikoba dimpe ne dibeji dia bupole anyi tshilamba tshia silicone.

Tshitupa 3: Enza mudimu wa "30-Degree Lateral Tilt" (Ku meba 2 onso)¶

Bua tshinyi tudi tuenza mudimu ne 30-degree tilt pamutu pa kuela mubedi njila yonso ku luseke luabu ku 90 degre? Paudi ukudimuna muntu mukulakaje udi kayi ne makanda onso ku luseke luende mu angle wa 90-degree mutangile ku matela, 100 pa lukama wa bujitu bua mubidi wende udi wimana buludiludi pa tshitupa tshia mifuba tshia mu nshingu (tshitupa tshinene tshia trochanter) ne pa mufuba wa pambelu wa tshikasa, bienza tshitupa tshipiatshipia tshia mu tshitupa tshia 3 tshia mu nshingu mu bulalu bua mêba 24 paudi uteta bua kukosa mufuba wende kanyinganyinga.

flowchart TD
    A["2-Hour Bedbound Repositioning Cycle (Kupita 30-Degree Tilt)"] --> B["Mêba 0 too ne ku 2: 30-Degree Right Lateral Tilt (Makunji adi kuinshi kua mukolo wa ku dia bakaji/tshiadi; Sacrum ne mufuba wa tshiadi tshia dia balume bionso bibidi bidi bienda pa mâyi)"]
    B -->|"Enza mudimu ne dibeji dia dizola bua kubandisha - Kukoki dikoba nansha dimo"| C["Mêba 2 too ne ku 4: Kulala panshi (Kulala pa nyima ne mutu <= 30 Degrees & Bikasa bipueka pa matela pa matamba a muana wa ngombe)"]
    C -->|"Shi tshilonda tshia mu tshiadi/tshia tshia mu nshingu tshidiku: Kupueka panshi"| D["Mêba 4 too ne ku 6: 30-Degree Left Lateral Tilt (Bilamba bia muinshi mua mukolo/tshiadi tshia dia balume; Bilamba pankatshi pa binu ne bikono)"]
    D --> B

Mushindu kayi wa kuteka mubedi mu 30-Degree Lateral Tilt tshitupa ku tshitupa¶

1. Misangu yonso enza mudimu ne tshiamu tshia bantu babidi tshia "Draw Sheet Lift" (Kukoki mubedi pa tshilamba to): Dikokangana ne dikosa (padi dikoba dilamakaja ku tshilamba tshia bulalu tshia butoyi padi mufuba wenda upueka munda mua mubidi) bidi bipatula mishipa ya mashi idi muinshi mua dikoba. Teka dibeji dia tshilamba tshia butoke (anyi dibeji dia nylon dia low-friction) muinshi mua mubedi kumbukila ku makaya too ne ku bikono, ne ubandishe mubedi kakese pa matela kumpala kua kumushintulula.
2. Lama mutu wa bulalu (HOB) ku 30 degrés anyi kuinshi: Pa kumbusha padi mubedi udia, unua, anyi upeta biakudia bia mu tube (anyi ne disama dikole dia muoyo/COPD didi dilomba bua kupuyakana), kulekedi mutu wa bulalu bua lupitadi mubandishibue ku 45 too ne ku 60 degrés munkatshi mua mêba to. Padibu babandisha mutu wa bulalu pa mutu pa 30 degrés, bukole budi bukoka mubidi wa mubedi panshi mutangile ku makasa a bulalu, bukoka tshiadi ne mufuba wa mukila ne bukole bua bungi bua dikosa.
3. Tshilamba tshia nsongo kunyima kua nyima ne mataku mu angle wa 30-degree:
   • Ela mubedi bitekete bitekete kudi wewe, funda matamba abidi makole mu bule kunyima kua maboko ende ne kuinshi kua mukolo/mataku, ne umulekele apingane pa matamba bua tshifu tshienda tshiikisha mu 30-degree angle ku matela.
   • Enza "Dikonkonona dia tshianza": Ela tshianza tshiebe tshitekete muinshi mua mukolo wa mubedi ku dia balume pa mutu pa sacrum/tailbone ne pa mutu pa mufuba wa kuinshi kua tshiadi (trochanter). Mu ditenteka dia bushuwa dia 30-degree, tshianza tshiebe tshidi ne tshia kupitshila mu tshianza tshiebe (tshidi tshienda mu lupepele) NE bujitu bua mubedi budi buimana pa mushipa wa tshiadi pamutu pa kuikala buludiludi pa mutu pa mufuba wa tshiadi.
4. Teka tshilamba tshia kulala pankatshi pa maboko ne bikono, ne "Ela bikono":
   • Kulekedi dikasa dimue dia mifuba anyi tshikasa tshiimana buludiludi pa mutu pa dikasa dikuabu anyi tshikasa tshikuabu to; Teka tshilamba tshile pankatshi pa maulu kumbukila ku tshiadi too ne ku makasa.
   • Bua kubandisha bikasa: Teka tshilamba tshimue anyi bibidi mu bule muinshi mua bikono bionso bibidi bia kuinshi kumbukila kuinshi kua dikasa too ne ku tshianza tshia Achille, nunku bikasa bionso bibidi bilengeja bimpe mu lupepele pa mutu pa muelelu wa tshilamba tshia kulala kabiyi bikuata tshilamba tshia bulalu to.

Tshitupa 4: Lama luya lua dipanga dia tshiadi ne uvudije biakudia bidi ne proteyine ne kalori diakamue¶

1. Disama dia dikoba didi difumina ku dipanga dia kulama (IAD) ne dinyanguka dia bintu bia mu tshifu: Bintu bia mu tshisuku bidi ne enzymes ya digestion (proteases ne lipases) idi idisha dikoba dia muntu padiyi ipetangana, ne padi mashi asambakana ne bactérie ya mu tshifu, urease udi ukudimuna urea mu amoniaque caustic udi ubandisha pH wa dikoba ne wosha dikoba. Tangila bilamba bya pa bula kunyima kua meba 2 onso, usukule bitekete bitekete na pH-balanced no-rinse perineal cleanser (never harsh bar soap), wela zinc oxide anyi dimethicone moisture barrier paste pa dikoba didi kadiyi dinyanguke, ne webeja munganga ni udi ne **catheter wa pambelu wa tshitupa tshîpi (bu mudi Puck a wa pambelu) tshiamu tshia kukoka natshi anyi tshiamu tshia kuela natshi kondomu tshia balume) ntshikumbane padi tshilonda tshia mu tshiadi tshiondapa.
2. Emergency Nutritional Support (NPIAP Guidelines): Kuondopa tshilonda tshia mu tshitupa tshia 3 anyi tshia 4 kudi kulomba bukole bua bungi bua mubidi, bualu mubidi udi uteta bua kukola kabidi mifuba ne kikoba eku ujimija proteyine idi mu mputa. Muinshi mua NPIAP / EPUAP mikenji ya bidia, muntu mukulumpe udi ne disama dia tshiadi udi dijinga ne 30 too ne ku 35 kilocalories ku kilogramme wa bujitu bua mubidi ku dituku ne 1.25 too ne ku 1.5 grammes ya proteine ku kilograme wa bujitu bua mubidi ku dituku (pabuipi ne **85 too ne ku 105 **s ya proteine ku dituku bua k lb wa bantu bakulumpe, pa kumbusha padibi bipangisha kudi disama dia tshiadi tshia ku ndekelu kua dialyse), pamue ne bintu bia kudia bidi ne proteyine ya bungi bidi ne L-Arginine, Zinc, ne Vitamine C.

Kulomba bua kubenga kulengulula nzubu wa bakulakaje anyi lupitadi (Tshitupa 3 ne 4 "Kakuyi bualu")¶

Mu ditunga dia États-Unis, Centres for Medicare & Medicaid Services (CMS) udi uteka disama dia tshitupa tshia 3, anyi dia 4 didi dipeta panyima pa dibuela mu lupitadi anyi mu nzubu wa baminganga bapiluke bu **Disama didi difumina ku lupitadi (HAC) / Disama dikole didibu mua kumanyisha "Never Event Under the Federal Reursing Home N 44 Act" § 483.25(b)(1)), nzubu wa bakulakaje udi ne tshia kujadika ne: muntu udi ubuela mu nzubu kayi ne mputa ya pression kena ne disama edi to, anu padi nsombelu wa muntu au uleja ne: kavua mua kuepuka to, ne muntu udi ne mputa ya pression udi upeta luondapu ne midimu idi ikengedibua (mudi Group 2 Low-APressures anyi Group 3 Air-Fluidized Bed) bua kukolesha diondapangana ne kuepuka disama.

Wewe muye kutangila muntu uudi munange mu nzubu wa bakulakaje anyi mu lupitadi ne mupeta tshilonda tshikole tshidi ne mupuya mubi tshidi bena mudimu basokoke anyi bapepeja bu "tshipupu tshikese":

1. Dilomba dia kumona tshikebelu tshia lukoba tshia lumingu ne 2-Hour Turning Logs: Ebeja mulombodi wa mudimu wa bu-munganga (DON): "Ndîba kayi divuabu banji kumona tshipupu etshi mu tablo, ntshikondo kayi tshidibu bafunde, ntshikondo kayi tshivua munganga udi ulama mputa mutshikonkonone bua musangu wa ndekelu, ne bua tshinyi muledi wanyi utshidi anu mulale pa matela a tshiamu tshia nzembu matela a lupepele lukese lua bukole bua kushintuluka anyi?"
2. Lomba bua kuya ku lupitadi lukasa pikalaku bimanyinu bia disama anyi dia sepsis: Nzubu ya bakulakaje itu imue misangu ielakana bua kutuma muntu udi ne disama dia Stage 4 mu nzubu wa lupitadi bualu dibueja muntu mu lupitadi didi dijula ​​dikonkonona dia malu a bukola bua mubidi dia mbulamatadi. Vuluka ne: kuena dijinga ne dianyisha dia nzubu wa bakulakaje bua kubikila 911 ku telefone webe paudi muimane ku luseke lua bulalu bua baledi bebe bikalabu ne disama dia septique, dia fièvre anyi dia delirious.
3. Fula dilomba dia mbulamatadi kudi muena mudimu wa malu a dilama dia matuku a bungi ne kudi tshibambalu tshia dikonkonona dia malu a bukola bua mubidi: Bala bulombodi buetu bujima pa dikengeshibua mu nzubu ya bakulakaje, dilengulula, ne diipata bua mishindu milelela ya difila dia luapolo lua ditunga ne mishindu ya kulama bijadiki.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi munganga wakamba ne: mputa wa baledi banyi uvua "munene ne mukole" diakamue panyima pa lupitadi lua mputa mumane kumusukula?¶

Padi tshitupa tshia 3 anyi tshia Unstageable pressure ulcer tshibuikila kudi tshilamba tshia **eschar** tshifiike anyi tshia **slough** tshikole tshia jaune (tshitupa tshifue, tshidi tshifua), tshitupa tshifue tshidi tshienza bu tshintu tshidi tshisokoka bunene bulelela ne bulampe bua tshina tshidi muinshi muatshi, eku tshipangisha tshitupa tshimpe bua kukola ne kudia bactérie. Padi munganga wa mputa anyi munganga wa mputa udi muanyishibue wenza **dipanda dia mputa dia nsongo anyi dia enzyme** bua kumbusha tshitupa tshidi tshifue, bunene bulelela bua tshitupa tshidi muinshi mua mputa budi bumueneka. Kumona tshitupa tshikezuke, tshikunze tshia nyama, tshidi ne mabue makese (**tshitupa tshia granulation**) kuinshi kua tshibuelelu tshinene kunyima kua diumusha dia tshiamu tshia mitaku ke tshintu tshia kumpala tshidi tshikengela bua kuondopa kumbukila kuinshi too ne kuulu.

Misangu bungi kayi idi muntu mukulakaje udi kayi wendakana udi musombe mu nkuasa wa balema anyi mu nkuasa wa tshilala benyi ne bua kupingajibua?¶

Kusomba mululame mu kakalu ka balema anyi mu tshibasa tshia bantu bakulumpe kudi kufila **bukole bua bungi** pa mifuba ibidi mikese ya kusomba (**ischial tuberosities**) ne ku mukila kupita kulala panshi pa bulalu. Muinshi mua **mikenji ya NPIAP**, mubedi udi mu nkuasa wa balema anyi udi mu nkuasa udi kayi mua kushintulula bujitu buende udi ne tshia kuikala muteka muaba mukuabu **nansha dîba 1 dionso** (ne yeye mua kuenza mudimu ne maboko ende, badi ne bua kumulongesha bua kuenza mudimu mukese wa dishintulula bujitu kunyima kua **minite 15**). Shi muntu mukulakaje udi ne tshilonda tshia tshitupa tshia 3 anyi tshia 4 pa mufuba wende wa kusomba (ischium) anyi pa sacrum, **ikala anu musombe mu nkuasa** (anyi epuka bua kusomba pa tshilonda tshionso) ne uteka mukanda wa **tshiamu tshia luya anyi tshia gel/foam tshidi tshifila bukole (bu mudi tshilamba tshia kulala tshia pa tshibidilu) pa nkuasa tshilamba tshia kulala anyi tshia donut.

Ndi mua kuenza mudimu ne mafuta a antibiotique asatu (Neosporin) anyi buitshi mu tshitupa tshikole tshia tshitupa tshia 3 anyi tshia 4 anyi?¶

Kuela manyi a mafuta a petrole (Neosporin/Polysporin) mu tshina tshia tshitupa tshia 3 anyi tshia 4 tshia tshitupa tshia 3 anyi tshia 4; Mafuta a neomycin a OTC adi menza anu bua bilonda bikese bia pa mutu, adi akebesha misangu ya bungi disama dia allergie kudi bantu batue ku 10 pa lukama, kaena abuela mu tshina tshia muinshi mua buloba to, ne adi akuata mâyi adi kaayi ne kapepe mu bipese bia muinshi mua buloba. Nansha mudibu benza mudimu ne **buitshi bua buitshi bua munganga bua Manuka** (bu mudi Medihoney) budi kabuyi ne disama dia gamma-irradiated kudi baminganga ba mputa bua kujikija mputa, **kuela buitshi bua mu tshisalu tshia mu tshisalu mu mputa udi mubulula** to, bualu buitshi budi kabuyi buenza mudimu budi mua kuikala ne *Clostrium botinum spoulinum*.

Mmunyi mundi mua kupeta Medicare anyi Medicaid bua kufuta matela a kapepe ka pression alternatif bua muledi wanyi udi mu bulalu kumbelu?¶

Muinshi mua **Medicare Part B Durable Medical Equipment (DME) Local Coverage Determinations (LCD L33820: Pressure Reducing Support Surfaces)**, Medicare udi utangila **Group 1 Support Surface** (alternating-pressure pad, gel overlay, or high-density foam mattress) pikala mubedi kayi mua kuendakana to diendakana pamue ne tshitupa tshionso tshia disama dia pression pa mutshi/tshifu ne bualu bumue budi mua kufikisha ku njiwu (dipanga dia kulama makanda, dipanga dia biakudia bimpe, anyi dishintuluka dia lungenyi). Medicare udi utangila **powered Group 2 Alternating-Pressure / Low-Air-Loss Mattress System** padi mubedi ne **ulcères ya bungi ya Stage 2** idi kayiyi milengejibue kunyima kua matuku 30 pa tshitupa tshia Groupe 1, NANSHA udi ne **ulcère munene anyi umue wa Stage 3 anyi Stage 4 pa tshiadi anyi pa tshiadi anyi tshia mu tshiadi (**, trochiter, anyi trochanum). Lomba munganga wa kumpala wa baledi bebe anyi nzubu wa luondapu lua mputa bua kutuma **Dilomba dia mpala ne mpala dia DME dia tshisumbu tshia 2 tshia matela a kapepe kakese (HCPCS Code E0277)** kudi mufidi wa DME udi mufundisha ku Medicare lelu.

Miaba mifumina¶

• Kasumbu ka ditunga ka malu a mputa ya mputa (NPIAP), Kasumbu ka bafidi ba mibelu ka mputa ya mputa ya ku Mputu (EPUAP), ne tshisumbu tshia Pan Pacific Pressure Injury Alliance (PPPIA): Dikuba ne diondapa dia mputa ya mputa: Mikenji ya malu a luondapu, Tshibejibeji tshia pa buloba bujima (NPIAP, 30-30-30, Helt Delt Dipuekesha, ne 30 to ne 35 kcal/kg & 1.25 to 1.5 g/kg Protein Nutrition Standards) (International).
• Tshibambalu tshia makebulula ne bulenga bua malu a bukola bua mubidi (AHRQ): Dikuba dia mputa mu lupitadi ne mu dilama dia ku nzubu: Epuka manga adi anyanga mishipa (Hydrogen Peroxide / Povidone-Iodine) ne Ring/Donut Cushions (United States).
• Surviving Sepsis Campaign (SSC) & Infectious Diseases Society of America (IDSA): International Guidelines for Management of Sepsis and Septic Shock & Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (International / United States).
• Centres for Medicare & Medicaid Services (CMS): 42 CFR § 483.25(b)(1) (Quality of Care: Pressure Ulcers in Long-Term Care Facilities) & Medicare LCD L33820 (Pressure Reducing Support Surfaces: Group 1, 2, and Criteria DME (3)) (Ume).
• Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE): Mukenji wa malu a luondapu CG179: Disama dia mputa, dikuba ne dilama (Royaume-Uni).

Malu adi apetangana¶

• Dikengesha dia mu nzubu wa bakulakaje, dilengulula, ne diipata
• Dibungama dia mu lupitadi, dipanga dia lungenyi dia tshimpitshimpi, ne dikuba dia bantu bakulumpe
• Bakulumpe badi bakuluka padibu kabayi mua kuimana
• Dipanga dia mudimu dia tshimpitshimpi dia muena mudimu ne dipandisha dia muntu mukulumpe
• Mukanda wa nomba ya tshimpitshimpi