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Decubitus te lijf pp 116–150Cite as

5 Wondzorg bij patiënten met decubitus

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Samenvatting

Wondgenezing is al decennialang een belangrijk aandachtsgebied in de praktijk, het onderwijs en het wetenschappelijk onderzoek van behandelaars van wonden en zorgverleners die zich met wonden bezighouden. Er is veel bekend over het genezingsproces, met name over dat van acute wonden. De normale reactie van verwond weefsel is een in de tijd geordend reparatieproces dat uiteindelijk resulteert in blijvend herstel van de anatomie en functie van het aangedane weefsel. Dit proces is niet eenvoudig en rechtlijnig, maar is een complex en levendig samenspel tussen cellen onderling en tussen cellen en de matrix buiten de cellen, onder invloed van vele stoffen, zoals mineralen enzymen en vitamines.[1,2]

In dit proces kan iets misgaan, waardoor de genezing wordt vertraagd of helemaal stopt. Er ontstaat een chronische wond. Decubitus is zo’n wond. Er zijn vier theorieën over de gevolgen van (te) langdurige druk en/of wrijfkrachten in de weefsels:

  • lokale ischemie van de weefsels;

  • verstoring van het metabole evenwicht;

  • reperfusieschade;

  • onherstelbare vervorming van cellen.[3]

Decubitus is niet per definitie een chronische wond. Een belangrijk kenmerk van een chronische wond is dat deze zonder behandeling niet binnen twee tot vier weken geneest.[2] Een graad 2 decubitus, waarbij de huid ontveld is, kan nog langs de natuurlijke weg genezen door intensivering van preventieve maatregelen. Een graad 3 of 4 decubitus valt doorgaans onder de chronische wonden. Op basis van een goede probleemanalyse, aanvullend onderzoek, een behandelplan en regelmatige evaluatie kan de chronische decubituswond tot genezen worden gebracht.

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Notes

  1. 1.

    Het afnemen van een wondkweek heeft geen zin als de belangrijkste verschijnselen van een wondinfectie ontbreken, omdat elke wond gecontamineerd of gekoloniseerd is (zie par. 5.3.1).

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Authors and Affiliations

  1. UMC St Radboud, Nijmegen

    dr. H.E.W. de Laat (verpleegkundig specialist decubituszorg), prof. dr. P.H.M. Spauwen (hoogleraar plastische en reconstructieve chirurgie) & dr. C.J.M. van der Vleuten (dermatoloog)

Authors
  1. dr. H.E.W. de Laat
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  2. prof. dr. P.H.M. Spauwen
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  3. dr. C.J.M. van der Vleuten
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Editor information

Editors and Affiliations

  1. Landelijk Expertisecentrum Verpleging & Verzorging (LEVV), Utrecht

    Else Poot (adviseur), Joke Mintjes-de Groot (directeur), Jan Weststrate (adviseur, Research Fellow) & Liesbeth van der Eerden (adviseur) (adviseur),  (directeur),  (adviseur, Research Fellow) &  (adviseur)

  2. Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Nieuw Zeeland

    Jan Weststrate (adviseur, Research Fellow) (adviseur, Research Fellow)

  3. Faculteit Gezondheidszorg, afdeling Opleiding Verpleegkunde, Hogeschool van Arnhem en Nijmegen, Nijmegen

    Marian Adriaansen (directeur) (directeur)

Appendices

Bijlage 1 Decubitus Wond Score

figure 8figure 8

Bijlage 2 Pressure Ulcer Healing Scale (vertaling. E. de Laat 2007)

figure 9

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de Laat, H., Spauwen, P., van der Vleuten, C. (2008). 5 Wondzorg bij patiënten met decubitus. In: Poot, E., Mintjes-de Groot, J., Weststrate, J., van der Eerden, L., Adriaansen, M. (eds) Decubitus te lijf. Bohn Stafleu van Loghum, Houten. https://doi.org/10.1007/978-90-313-6284-4_6

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