Pressure ulcers

Pressure ulcers

Description, Causes and Risk Factors:

Abbreviation: PU.

Alternative Name: Bedsore, pressure sore, decubitus ulcers.

Any lesion caused by unrelieved pressure resulting in damage of underlying tissue. Pressure ulcer can occur anywhere on body, more specifically on sacrum (tail bone), ischium, and trochanter, malleolus, coccyx, heel, elbow, shoulder, back. Pressure ulcers are a common problem among older adults in all health care settings. Pressure ulcers were more common in males (13%) than in females (10%). There was no significant difference between white and nonwhite populations with respect to having pressure ulcers.

Causes and risk factors may include:

    Interrupt blood circulation.

  • Diminish blood circulation.

  • Weaken cell wall of individual skin cells.

  • Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow.

  • People who are bedridden.

  • People who are in wheelchair most or all time.

  • People who Unable to move certain parts of their body without assistance.

  • People with altered mental status.

  • People with incontinent of bowel and/or bladder.

  • People who are malnourished.

  • People who are obese.

  • People who smokes.


    Stage I ulcers consist of intact skin with nonblanchable erythema resulting from extravasation of blood from ischemic, leaky blood vessels. If erythema is blanchable, the process most likely involves congested vessels and so vanishes shortly after pressure relief. Stage I ulcers are cone-shaped, with the apex toward the skin, suggesting minimal involvement at the surface but providing no indication of the potentially more extensive involvement beneath the surface. These ulcers should not be taken lightly, because the tissues beneath them might have more significant necrosis that can easily progress to more advanced stages of ulceration. In this regard, it is important to remember that muscle is much more susceptible to ischemia than is fat or dermis, because of higher metabolic activity and relatively lesser blood supply.

  • Stage II ulcers are associated with discontinuity of the skin (e.g., an abrasion, a blister, or a shallow crater) and involve the epidermis and/or dermis.

  • Stage III ulcers extend deeper into the subcutaneous fascia.

  • Stage IV ulcers are associated with involvement of the muscle, bone, or supporting structures (e.g., tendons, ligaments, joint capsules).


Common symptoms may include:

    Skin tissue that feels firm or boggy.

  • Local redness, warmth, tenderness, or swelling.

  • Reddish or purplish skin discoloration, often over a bony area.

  • Pain or itching of the skin.

  • Blistering, sores, skin breakdown, or drainage.

Specific symptoms based on stages may include:

    Stage I: A reddened area on the skin that, when pressed, is "nonblanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.

  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.

  • Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.

  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.


Diagnosis may include:

    Doctors will usually order blood tests to check your nutritional status and overall health.

  • X-ray or bone scan -if bone infection is suspected.

  • If you have chronic sores, the tissue cultured need to be done for unusual bacteria or fungi.

Riskassessment can be performed using either the Bradenor the Norton scale. The Braden scale evaluates 6 factors—level of sensory perception, skin moisture, level ofactivity, mobility, nutrition, and friction/shear—with aleast favorable score of 1 and a more favorable score of3 or 4. The Norton scale assesses 5 factors—physicalcondition, mental status, level of activity, mobility, and aging.


Although it may take some time, most stage I and stage II sores will heal within weeks with conservative measures. But stage III and stage IV wounds, which are less likely to resolve.

Treatment options may include:

1. Prevention.

2. Correct the underlying problem.

3. Wounds must be cleaned/dead tissueremoved before healing can occur.

4. Keep wound moist. Permits cells toperform migration/mitosis.

Preventive measures may include:

    Reposition residents at least every two hours to relieve pressure.

  • Use items that can help reduce pressure such as pillows, sheepskin, foam padding.

  • Provide healthy, well-balanced meals.

  • Assist with daily range-of-motion exercises for limited mobility residents.

  • Limit moisture, residents who are incontinent should be kept clean and dry.

Residents who have any of the risk factors, should be checked for pressure sores every day. Look for reddened areas that when pressed, do not turn white, blisters and sores.

Wound dressing:

    Keep wound bed moist.

  • Keep surrounding tissue clean & dry.

  • Eliminate dead space.

  • Do not use antiseptic agents.

Types of dressings:


  • Transparent films.

  • Hydrocolloid.

  • Hydrogel.

  • Alginates.

  • Foam.

  • Composite.

Hydrotherapy: Whirlpool baths can aid healing by keeping skin clean and naturally removing dead or contaminated tissue.

Oral antibiotics: If your pressure sores appear infected, your doctor may prescribe oral antibiotics.

Healthy diet: Eating a nutritionally rich diet with adequate calories and protein and a full range of vitamins and minerals — especially vitamin C and zinc — may improve wound healing. Being well nourished also protects the integrity of your skin and guards against breakdown. If you are at risk of or recovering from a pressure sore, your doctor may prescribe vitamin C and zinc supplements.

Surgery may also needed in some cases.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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