Pressure Injuries

Pressure Injuries

(Pressure Sores; Pressure Ulcers; Bed Sores; Decubitus Ulcers)

Definition

A pressure injury is damage to the skin and the tissue below it. It is due to long term pressure or friction on the skin.

It often forms over bony areas such as:

  • Hips and buttocks
  • Ankles
  • Shoulder blades
  • Heels of the feet
  • Back of the head
  • Elbows
  • Ears

Untreated pressure injuries can get worse. They need treatment right away.

A Pressure Injury Can Penetrate to the Bone

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Causes

Prolonged pressure slows or blocks blood flow to the skin. This can cause damage to the skin. Some areas of skin will die and can cause serious illness.

Risk Factors

This condition is more common in older adults and those with:

  • Limited movement—using a wheelchair or being in bed for a long time
  • Problems feeling pain or discomfort
  • Low body weight
  • Swelling or water retention
  • Dry skin

Long term health conditions that increase the risk of pressure injuries include:

Symptoms

Symptoms of a pressure injury may include:

  • Warmth or swelling
  • Skin that looks red or purple
  • Pain or itching of the skin
  • Blistering, sores, skin breakdown, or drainage

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done.

Tests may include:

Treatment

The goal of treatment is to avoid further injury and heal the wound.Talk to your doctor about the best treatment plan for you.

Proper care will let the wound heal. Steps may include:

  • Relieving pressure to the area. This can include change in positions and support tools.
  • Special bandages to clean out and protect the wound. Regular cleaning of wound and area around it.
  • Medicine to prevent infection and help the tissue heal. May be applied to the area or taken as pills.

Surgery may be need for large wounds. The doctor can remove dead tissue to let the area heal faster. Skin can also be taken from another area of the body to help close large wounds.

Prevention

To ease pressure on the skin:

  • Change position every:
    • 2 hours - in bed
    • 1 hour - in a wheelchair
  • Talk to the doctor about raising the head of the bed.
  • Do not sit or lay squarely on the hip.
  • Put a pillow under the calves of the legs or between the knees.
  • Talk to the doctor about special mattresses and cushions.

Wounds are less likely to happen in healthy skin. Steps for healthy skin include:

  • Check the skin daily for problems.
  • Keep the skin clean and dry.
  • Use creams to protect and moisturize the skin.

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org
National Pressure Ulcer Advisory Panel
http://www.npuap.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Alderden, J, Rondinelli, J, Pepper, G, et al. Risk factors for pressure injuries among critical care patients: A systematic review. Int J Nurs Stud. 2017 Jun;71:97-114.
Pressure injury of the skin and soft tissue. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/pressure-injury-of-the-skin-and-soft-tissue#GUID-726E7C43-DD36-4E0E-A1A1-47E498C1C3D9. Accessed December 21, 2020.
Pressure injury stages. National Pressure Ulcer Advisory Panel website. Available at: https://npiap.com/page/PressureInjuryStages . Accessed December 21, 2020.
Taking care of pressure sores. University of Washington Medicine website. Available at: sci.washington.edu/info/pamphlets/pressure_sores.asp. Updated December 21, 2020.
Last reviewed February 2020 by EBSCO Medical Review Board Mary-Beth Seymour, RN
Last Updated: 12/21/2020

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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