Pressure Injuries

What is a pressure injury?

A pressure injury (also called a bedsore, pressure ulcer, pressure sore, or decubitus ulcer) is an area of injured skin. A pressure injury happens when force is applied on the surface of the skin. This force can be a constant pressure on an area of skin or a dragging (shearing) force between the skin and another surface. These injuries usually happen over bony parts of the body (hips, heels, tailbone, elbows, head and ankles). A pressure injury can become life-threatening if it advances to a deep wound or becomes infected.

What are the stages of a pressure injury?

There are four stages that describe the severity of the wound. These stages include:

  • Stage 1: This stage is discolored skin. The skin appears red in those with lighter skin tones and blue/purple in those with darker skin tones. The skin does not blanch (turn white) when pressed with a finger.
  • Stage 2: This stage involves superficial damage of the skin. The top layer of skin is lost. It may also look like a blister. At this stage, the top layer of skin can repair itself.
  • Stage 3: This stage is a deeper wound. The wound is open, extending to the fatty layer of the skin, though muscles and bone are not showing.
  • Stage 4: This stage is the most severe. The wound extends down to the bone. The muscles and bone are prone to infection, which can be life-threatening.

Who is at risk for developing pressure injuries?

  • People with a limited amount of mobility or a total inability to move. Those in wheelchairs or bedridden are at particular risk and need to be moved or turned regularly.
  • Those with prosthetic (artificial) limbs. If the device does not fit properly, the skin can be irritated and a pressure injury can develop.
  • People with a loss of sensation. They are at risk because they may not feel the pressure being applied to the skin. As a result, they may not move, which could worsen the damage.
  • Those with malnutrition. Wound healing is slowed when nutritional needs are not met.
  • The elderly. As people age, the skin naturally becomes thinner and more easily damaged.

What are the causes of pressure injuries?

Pressure injuries are caused when a force is applied to the skin, causing damage to the tissue. Several types of force include:

  • Pressure: Constant pressure on the skin results from remaining in the same position for a prolonged period of time.
  • Shear: Shear damage or a dragging force can occur when the head of the bed is raised and the body slides down. The skin sticks to the sheets, but internal structures are damaged.
  • Moisture: Fluids (sweat, urine, fecal matter) that remains on the skin can cause the skin to become overly wet, which increases the risk for pressure injury development.

What are the symptoms of pressure injuries?

The symptoms of pressure injuries can include:

  • Changes in skin color (non-blanchable redness in lighter skin tones and non-blanchable blue/purple skin in darker skin tones)
  • Skin swelling, pain or tenderness
  • Skin that feels cooler or warmer to the touch than other areas
  • Skin loss, exposing deeper layers of skin
  • Pus-like drainage from an open area of skin

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