Pressure Sores
 
June 30, 2003
 
The phrase, pressure sore/ulcer, is defined as "an area of skin and tissue that becomes injured or broken down". Also known as bed sores or decubitus, pressure ulcers occur in both the acute hospital settings, as well as in nursing homes and home care settings. Pressure ulcers are an unfortunate and almost always preventable condition too often seen in the medical profession.
 
Pressure ulcers occur in a variety of patients, but more commonly occur in those who are bedridden or wheelchair bound. Because of their inability to move or change position frequently, constant pressure on capillaries (tiny blood vessels) causes the capillaries to close. Without oxygen and nourishment supplied by the capillaries, the surrounding tissue (skin, fascia, muscle, etc.) begins to breakdown and necrose (die). Friction (rubbing of skin surface), shearing (dragging skin across a surface), and maceration (exposure to fluids for extended time causing the skin to break down, i.e., urine, stool, or drainage from wound) are also known causes of pressure ulcers.
 
There are four stages defining the severity of an ulcer. Stage I: The beginning of a pressure ulcer noted as "reddened area on intact skin that, when pressed, is non-blanchable (does not turn white) Stage II: Partial thickness skin loss is noted by blisters and/or forms an open sore/shallow crater. Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue (just underneath the skin) that may extend down to, but not through, underlying fascia (fibrous membrane covering, supporting, and separting muscles). Stage IV: Full thickness skin loss with full destruction, tissue necrosis, or damage to muscle, bone, or supporting structures, i.e. tendon or joint capsule.
 
Treatment will vary depending on the stage of the pressure ulcer. Key factors in treatment is providing tissue load management, which refers to the distribution of pressure, friction, and shear of tissue. Staying off the ulcer is essential. Frequent respositioning, no less than every 2 hours and may require the assistance of a low-air-loss/air fluidized mattress/bed for tissue load management. Proper nutritional support is likewise essential. Initial care of pressure ulcer involves debridement (the removal of damaged/dead tissue), wound cleansing, application of dressings, and possible adjunct therapy. Some case will require surgical repair. In all cases, specific wound care strategies should be consistent with overall patient goals. Contribution by Bonnie Rupke, RN, CLNC and US Department of Health and Human Services, Clinical Practice Guidelines.
 
Tuesday, September 26, 2017
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