A nurse is caring for a client who is at risk for pressure injury formation due to immobility

Key facts

Pressure ulcers develop when skin in a particular area is damaged due to constant pressure or friction.
They are also known as bed sores, pressure sores or decubitus ulcers.
Pressure ulcers can form when people are confined to a bed or chair and cannot move due to age, illness, disability or frailty.
Pressure ulcers are preventable, so it is important to check your skin twice daily for early signs and to treat them quickly.
Try to move or change position in your bed or chair regularly to prevent pressure sores from developing — ask your carer for help if you need it.

Pressure ulcers — also known as bed sores, pressure sores or decubitus ulcers — develop when the skin or tissue beneath the skin is damaged due to constant pressure or friction. Pressure ulcers often occur on bony areas, such as the heels and elbows. However, they can appear on any part of the body that is under pressure for a long time.

Inhaltsverzeichnis Show

How can I prevent pressure ulcers?
What increases the risk of developing pressure ulcers?
How can pressure ulcers be treated?
What are the 4 stages of pressure ulcers?
Resources and support
What is a common cause of pressure injuries?
What are the top 3 risk factors for pressure ulcer formation?
Which of the following is a condition that increases the risk of pressure injuries?
Which patients are at most risk for pressure injuries?

Índice

How can I prevent pressure ulcers?
What increases the risk of developing pressure ulcers?
How can pressure ulcers be treated?
What are the 4 stages of pressure ulcers?
Resources and support

Pressure ulcers can be painful and uncomfortable and can take a long time to heal. They can also create sleep and mood disturbances, get infected and affect rehabilitation, mobility and long-term quality of life.

You should try to prevent pressure ulcers from forming if you are immobile or if you care for someone who is confined to a bed or chair.

How can I prevent pressure ulcers?

Pressure ulcers can be avoided, but often you may need help. If you have difficulty moving, preventing pressure ulcers might require a team effort, involving your health team, carer or a family member.

To protect your skin and prevent pressure ulcers, the following will help:

Keep active and move as much as you can (for example, if you can't move your legs, try and move your upper body frequently).
Eat a variety of nutritious foods, including plenty of fruits and vegetables.
Drink plenty of fluids to make sure you are hydrated.
Avoid smoking because this reduces blood flow to your skin.
Avoid firm massage, especially over bony areas.
Keep your skin dry as far as possible.
If you feel any skin pain or a feeling of burning, tell your doctor.

There are several things that will help you care for your skin:

Instead of soap, use a mild cleanser and dry the skin gently afterwards.
Apply moisturisers if the skin is dry, flaky or seems to crack easily.
Use barrier cream in skin folds.
Use warm (not hot) water when having a bath or shower.

It is important to move around as often as you are able. Continuous pressure on the same areas can lead to a pressure ulcer developing very quickly. The following may help you avoid this:

Change positions in bed at least every 30 minutes and, if you can, stand up and walk around.
If you can’t stand, move as much as you are able — for example, lean forward or move side to side in your chair for 2 minutes to take the pressure off your bottom and hips.
Try to avoid slumping or sliding forward in your chair.

Your healthcare team may use a range of special equipment to help reduce pressure in specific areas. This may include dynamic mattresses, cushions and heel wedges.

Check your skin twice a day and look for early signs of a pressure ulcer, such as:

red areas that don’t fade
blistered or bruised-looking skin
shiny areas
warm or hard patches
broken or cracked skin

Look at your entire body, but pay particular attention to bony areas such as the heels, buttocks (tailbone), elbows and between skin folds, as well as under plasters, dressings, splints or tubes. You may need someone to help you with this, especially if you have reduced mobility.

The healthdirect Symptom Checker can help you decide what to do next.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What increases the risk of developing pressure ulcers?

People who are confined to a bed or chair — for example due to stroke, spinal injury or dementia are at greater risk of developing extensive pressure ulcers. Other risk factors include:

immobility — being confined to bed after an illness or surgery, or due to paralysis
decreased sensory perception — decreased sensitivity and ability to feel pain
malnutrition or obesity
older age
circulation problems — reduced blood flow to pressure points
smoking
incontinence
diabetes and other health conditions that can affect blood supply

How can pressure ulcers be treated?

It is important to watch out for early signs of pressure ulcers and to contact your doctor if you notice any changes to the skin. Ulcers are best managed early on, and your doctor will assess whether your pressure ulcer can be managed at home, if you need a referral to a wound specialist or if you require treatment at hospital.

Use healthdirect’s Service Finder tool to locate your nearest GP or nurse clinic.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Wound dressings can enhance healing. Your healthcare team will select the most appropriate treatment and dressing, depending on your specific pressure ulcer. There are 6 classes of dressings:

film dressings
hydroactive dressings
hydrocolloid dressings
hydrogel dressings
foam dressings
alginate absorbent fibre dressings

Depending on the type of pressure ulcer, a bandage may also be applied to keep the dressing in place or support the injured area.

To promote healing and recovery, it is important to eat a balanced diet that includes protein, carbohydrates, fats and sufficient fluids.

Other treatments may include antibiotics if the ulcer becomes infected, or debridement — a procedure used to clean the wound and remove any damaged tissue.

What are the 4 stages of pressure ulcers?

You might hear medical staff refer to pressure ulcers in stages. Stage 1 is less severe, while an ulcer can progressively increase in severity to stage 4.

The 4 stages of pressure ulcers are:

Stage 1	The skin is red, but not broken. When you press the skin, it does not turn white.
Stage 2	There is some damage to the outer layer of skin. The pressure ulcer looks like a shallow, open wound with a redish-pink centre. It can also look like a blister that may or may not have opened.
Stage 3	There is full loss or damage of the skin. The wound looks quite deep but is still limited to the skin layers.
Stage 4	There is full loss or damage of the skin — it is deep and goes all the way to the underlying bone, tendon or muscle.

Pressure ulcers can be painful and become infected, and infection may spread from the skin (cellulitis), to blood (sepsis), muscle or bone. Treatment may require antibiotics, usually at home but sometimes in hospital. In very rare cases, chronic pressure ulcers can cause skin cancer. It's important to recognise pressure ulcers early and to act quickly to prevent complications.

Resources and support

For more information and support, try these resources:

Printer-friendly version

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Pressure ulcer risk assessment is crucial to the prevention of pressure ulcers. There are many factors which put certain patients at higher risk of developing these painful injuries that increase health care costs and lead to prolonged hospitalization, and sometimes death.

Continue reading to see how many of the following risks factors you are already aware of and which you might not have considered.

Poor mobility/immobility: Patients who are unable to independently change position are at increased risk of developing a pressure ulcer, due to pressure exerted over bony prominences which results in reduced blood flow to the tissues and subsequent hypoxia.

Poor nutritional status: Although there are few studies to support this idea, it is widely accepted (based on anecdotal evidence) that patients who are compromised nutritionally are at higher risk for the development of pressure ulcers; for this reason, patients with poor nutritional status may benefit from a dietary consult.

Compromised blood flow: Whenever there is compromised blood flow to the tissues, there is increased risk of pressure ulcer development. What are some common reasons that blood flow might be compromised? Peripheral arterial disease (PAD), venous insufficiency and shock are common culprits.

Neuropathy/compromised sensation: Obviously, if you cannot feel pain or pressure, you are at higher risk of developing a pressure ulcer. Patients who fit into this category include patients with spinal cord damage, stroke, MS, neuropathy and other conditions that compromise one’s ability to perceive pain and/or pressure.

Skin color/changes: Patients with darker skin pigmentation may be at risk for pressure ulcers simply because health care professionals fail to recognize the early signs of pressure damage (i.e. blanching erythema). In addition, patients with conditions that change the normal appearance of the skin are at high risk (e.g. patients with bruising, dermatitis, eczema and other skin diseases).

Support surfaces: The surface upon with the patient lies or sits can profoundly influence pressure over bony prominences, as can lying or sitting in the same position for long periods of time. Support surfaces should be assessed frequently and adjusted accordingly.

Pain: Pain may prevent patients from moving, even when they are feeling the unpleasant effects of pressure. Too much pain medication may sedate patients to the point where they don’t change position as often as they should. Patients should be assessed for their ability to move while still maintaining an acceptable level of comfort.

Age: At the extremes of age, patients may be at higher risk for the development of pressure ulcers due to inability to move/change position independently. Very young infants are unable to change position by themselves; the elderly may be similarly unable to change position due to other health problems limiting movement.

Mental status: Patients suffering from dementia or other cognitive disorders may be unable to comprehend instruction given that could help prevent pressure injuries, or may fail to recognize discomfort as a signal to change position.

Incontinence: Incontinence may cause skin damage that can increase the risk of developing pressure ulcers. This skin damage may make it more difficult for health care professionals to recognize the early warning signs of pressure ulcers (i.e. reddened areas of skin that blanch when light pressure is applied).

How did you do? Were you aware of all of the above listed contributing factors to pressure injuries? Being able to assess your patient for risk factors for pressure ulcers is important in developing a treatment plan to prevent pressure ulcers in vulnerable patients.

Source:
Guy, H. (2012). Pressure ulcer risk assessment. Nursing Times. http://www.nursingtimes.net/pressure-ulcer-risk-assessment/5040368.article

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

What is a common cause of pressure injuries?

Pressure ulcers can be caused by: pressure from a hard surface – such as a bed or wheelchair. pressure that is placed on the skin through involuntary muscle movements – such as muscle spasms. moisture – which can break down the outer layer of the skin (epidermis)

What are the top 3 risk factors for pressure ulcer formation?

Three primary contributing factors for bedsores are:.

Pressure. Constant pressure on any part of your body can lessen the blood flow to tissues. ... .

Friction. Friction occurs when the skin rubs against clothing or bedding. ... .

Shear. Shear occurs when two surfaces move in the opposite direction..

Which of the following is a condition that increases the risk of pressure injuries?

In addition to immobility and recuperation from surgery, other factors which may increase the risk of developing pressure ulcers include: poor nutrition, dehydration, diabetes, peripheral vascular disease, low albumin levels/anemia and obesity.

Which patients are at most risk for pressure injuries?

In our study, it was found that increasing age had a significant effect on pressure injuries and more than 90% of pressure injuries were reported in patients over 60 years of age that the main reason for this issue is due to less mobility and activity of older people.