Skin Pressure Ulcers

Pressure Ulcers

A pressure ulcer, commonly known as a bedsore, is an area of skin that breaks down when you stay in one position for too long without shifting your position. It can also be caused by friction, which can cause pain, infection, loss of mobility and poor recovery. It most often develops on parts of the skin that cover bony areas of the body, like heels, ankles, hips and tailbone. Patients with a medical condition that limits their mobility and confines them to a wheelchair or bed for long periods of time are at the most risk for developing pressure ulcers.

  • Symptoms

    Pressure ulcers fall into four stages:
    Stage I:
    Stage one is the beginning stage in which the pressure ulcer has the following characteristics:
    • Skin is not broken
    • Skin appears red on lighter skin tones and doesn’t lighten when touched, and on darker skin it shows discoloration and change in color when touched
    • Site may be tender, painful, firm, soft, warm or cool compared with the skin surrounding

    Stage II:
    • Outer layer of skin and part of the underlying layer of skin is damaged or lost
    • Wound may be shallow and pink or red
    • Ulcer may look like a blister

    Stage III:
    At stage III the ulcer has progressed into being a deep wound.
    • Loss of skin exposes fat
    • Appears crater-like
    • Bottom of the wound may have yellowish dead tissue
    • Damage may extend beyond the primary wound below layers of healthy skin

    Stage IV:
    In this stage the ulcer shows large-scale loss of tissue.
    • Ulcer may expose muscle, bone or tendons
    • Bottom of the wound likely contains dead tissue that’s yellow or dark and crusty
    • Damage extends under healthy skin beyond the primary wound

    Unstageable:
    A pressure ulcer is unstageable if its surface is covered in yellow, brown, black or dead tissue. In this case it isn’t possible to see how deep the wound is.

    The most common places for pressure sores in patients confined to a wheelchair are the tailbone and buttocks, shoulder blades and spine and the backs of the arms and legs. For patients who are bedridden, the most common sites tend to be on the back or sides of the head, rim of the ears, shoulders or shoulder blades, hip and lower back or tailbone and the heels, ankles and skin behind the knees.

    If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure.

    People who are the most at risk for developing a pressure ulcer are patients who are unable to change positions with ease due to generally poor health or weakness, paralysis, injury or illness that requires bed rest, recovery after surgery, sedation and coma. Other factors that increase risk of pressure ulcers are:

    • Age – The skin of older adults is more fragile and thinner. Seniors also produce new skin cells more slowly making them more vulnerable to developing sores.
    • Lack of sensory perception – People with spinal cord injuries and other neurological disorders may lose sensation. This loss of ability to feel pain or discomfort can result in being unaware of a developing sore or the need to change position.
    • Weight loss – When a patient loses weight due to prolonged illness the loss of fat and muscle cushioning can cause a sore because its lessens padding between a patient and a wheelchair or bed.
    • Poor nutrition and hydration – People who don’t get enough fluids, calories, protein, vitamins and minerals in their diet are vulnerable to the breakdown of tissue.
    • Excess moisture or dryness – Skin that is moist from sweat or lack of bladder control is more vulnerable to sores. Both dry skin and moist skin causes friction between the skin and bedding and clothing.
    • Bowel incontinence – Bacteria from feces can cause infection.
    • Poor blood flow – Conditions like diabetes and vascular disease increase the risk of tissue damage.
    • Smoking – Smoking reduces the flow of oxygen in the blood, which can lead to more severe wounds that heal more slowly.
    • Muscle spasms – Patients with muscle spasms may be at increased risk of pressure sores due to frequent friction.

  • Treatment

    To evaluate a bedsore a healthcare provider will determine:
    • Size and depth of the ulcer
    • Check for bleeding, fluids or debris in the wound that could cause infection or indicate infection
    • Try to detect odors signifying infection or dead tissue
    • Check the area around the wound for signs of spreading infection
    • Check for other pressure sores on the body

    A provider may also order blood tests and take tissue cultures. To treat an ulcer a patient must be repositioned constantly (every 15 minutes to 2 hours). Cleaning the wound with mild soap and patting it dry and cleaning open sores with a saline solution every time a dressing is changed are necessary to treating a pressure ulcer. The dressings help healing by keeping a wound moist and creating a barrier against infection. Gauzes, gels, foams and treated coverings can all be used.

    To properly heal a provider may use the following treatments:
    • Cutting away dead tissue
    • Loosening and removing wound debris
    • Enhancing the body’s natural process to break down dead tissue
    • Applying chemical enzymes and dressing to break down dead tissue
    • Infected pressure sores that don’t respond to other treatments will be treated with oral or topical antibiotics
    • A healthy diet to promote healing and tissue repair
    • To reduce the risk of infection and more pressure ulcers, frequent diaper changes, assistance with urinating and catheters may be used with incontinent patients
    • Applying suction to a clean wound to help healing in some types of pressure ulcers
    • In extreme cases surgery may be needed

  • Prevention

    The best treatment is prevention. Pressure wounds are 100% preventable.

    Here are some ways you can protect yourself or a loved one from developing a sore:
    • Change position every two hours to relieve pressure
    • Regularly get your skin checked
    • Moisturize dry skin
    • Don’t rub or massage skin that is reddened, purple or sore
    • Tell your nurse if you have a problem leaking urine or stool
    • Make sure skin is clean after going to the bathroom
    • Use pillows to pad areas between the knees and ankles
    • Never lie directly on your hipbone
    • Use donut-shaped or ring-shaped pillows
    • Purchase a special mattress
    • Stay active
    • Quit smoking
    • Keep a healthy diet
    • Stay hydrated
    • Protect the skin with talcum powder
    • Adjust the elevation of the bed

Links:

Pressure Ulcer Links:

Note: The NICHE for Patient+Family Encyclopedia provides links to third party web sites, however, NICHE does not recommend and or endorse any products or any of the content on any third party websites.